NOMOS Peacock IMRT utilizing the Beak post collimation device.

Intensity-modulated radiation therapy (IMRT), an exciting recent development in the field of radiation therapy, is widely anticipated by many to make possible significant improvements in the quality of radiation treatments delivered to patients. The NOMOS Peacock method of delivery, often referred to as serial tomotherapy because of its "slice-wise" treatment of a tumor, has been used since 1994 to treat some 8000+ patients worldwide. This slice-wise method of treatment is known to produce extremely conformal dose distributions due to its ability to specifically match the dose distribution on each slice to the shape of the target volume on that same slice. Based on the belief of this institution, and the NOMOS Corporation, that an increase in the number of treatment slices into which the target is segmented would lead directly to an improvement in three-dimensional (3D) dose conformality, a joint effort was undertaken to develop a new MIMIC collimator treatment mode. Inherent to the original design of the NOMOS MIMIC binary multileaf collimator were 2 treatment modes: a 2-cm mode with a slice thickness of approximately 1.7 cm and a 1-cm mode with a slice thickness of approximately 0.85 cm. As a result of this collaborative effort, a new MIMIC treatment mode has been developed. The method employs a slit collimator, post-collimation device known as the BEAK, enabling the treatment mode referred to as Beak Mode. The device imposes a distal redefinition of the slice thickness, or length, by effectively blocking the full retraction of the MIMIC vanes. The end result is a newly available slice thickness of approximately 4 mm, which is shown in this work to yield significant improvements in dose conformality for 2 representative patients. The comparative analysis of these 2 patient plans includes, in addition to a comparison of isodose distributions, an evaluation of dose-volume histogram (DVH) information, and a comparison of indices of conformality (CI) and homogeneity (HI).