Some limitations in the practical delivery of intensity modulated radiation therapy.

The resolution characteristics of intensity modulated beam (IMB) profiles produced by milled compensators and by multileaf collimators (MLCs) are independently investigated with respect to the primary fluence. It is shown that both methods have different characteristics in the longitudinal and lateral direction and, as a consequence, the resolutions of the longitudinal and lateral delivered IMB profiles differ. For both methods, the restrictions are identified. For compensators, the maximum slopes in the machining process, which should not be exceeded, are quantified. For MLCs, emphasis is given to the direction perpendicular to leaf movement. A number of test modulations were created and the effect of different size MLCs on the intensity profile revealed that unacceptable errors can be introduced if the profiles are heavily modulated. The production of intensity modulated radiation therapy (IMRT) beams by both machined compensators or by MLCs is limited by physical constraints. Having identified these constraints, some steps should now be taken to accommodate them either in the objective function for the calculation of the beam profiles or in the delivery system.