The physical basis of IMRT and inverse planning

Intensity-modulated radiation therapy (IMRT) can sculpt the high-dose volume around the site of disease with hitherto unachievable precision. Conformal avoidance of normal tissues goes hand in hand with this. Inhomogeneous dose painting is possible. The technique has become a clinical reality and is likely to be the dominant approach this decade for improving the clinical practice of photon therapy. This Series will explore all aspects of the IMRT chain. Only 15 years ago just a handful of physicists were working on this subject. IMRT has developed so rapidly that its recent past is also its ancient history. This article will review the history of IMRT with just a glance at precursors. The physical basis of IMRT is then described including an attempt to introduce the concepts of convex and concave dose distributions, ill-conditioning, inverse-problem degeneracy, cost functions and complex solutions all with a minimum of technical jargon or mathematics. The many techniques for inverse planning are described and the review concludes with a look forward to the future of image-guided IMRT (IG-IMRT).