General Technical Considerations

Over the past decade, dramatic technological advances have revolutionized radiation planning and delivery. Three-dimensional CT scan simulation and treatment planning have allowed physicians to better target areas at risk while sparing healthy tissues. Further advancements, including proton beam, radiosurgery, intraoperative radiation therapy (IORT), and intensity-modulated radiation therapy (IMRT), have given physicians multiple options for highly conformal therapy (Swift 2002). Magnetic resonance imaging (MRI) and posi-

Figure 11.5.1

Example of a radiotherapy portal for an adrenal primary tumor following chemotherapy and gross total resection. The field encompasses the tumor bed and para-aortic lymph nodes. The treatment field is outlined in red and the kidneys are in green. It is necessary to spare at least one-third of each kidney (preferably more) to maintain renal function. Each patient's field is individualized based on three-dimensional outlines of the target on a planning CT scan.

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