Figure 1

Radiotherapy for cancer. (a) Treatment plan for a cervix tumor from 1990 with radiation delivered as two fields from the front and back - parallel opposed pair - with the gantry of the linear accelerator moving to deliver high energy X-rays from different directions. A large rectangular volume, including the central uterus containing the tumor, parts of the bowel (top) and the base of the spine (bottom), received the maximum planned dose. (b) Treatment plan for a cervix tumor from 2011 with radiation delivered as four fields (front, back, both sides) and multileaf collimators (metal leaves that move independently to block the path of the beam) to shape (conform) the maximum radiation dose not only around the large tumor but also to follow the lymph node chains where the disease had spread, while sparing as much normal tissue as possible. (c) Treatment plan from 2011 to treat pelvic sidewall disease following surgical resection for a cervix tumor. The intensity modulated radiotherapy was given as eight fields, with radiation intensity modulated along the beams using multileaf collimators to deliver the maximum dose to the tumor and to spare normal tissue. (d) Intensity modulated radiotherapy for a breast tumor. Examples of uneven radiation dose distribution using standard two-dimensional radiotherapy (left). The orange color depicts regions of unwanted high dose, superiorly and inferiorly. There is also an unwanted low-dose region depicted in green. Changing to intensity-modulated radiotherapy evens the dose distribution across the breast, as shown by the more homogeneous yellow color (right).