Quality, Technology and Outcomes: Evolution and Evaluation of New Treatments and/or New Technology

Anatomic descriptions of the prostate with and without CT. (A) Before CT and (B) contours on an axial CT scan.

(A) Four-field box plan for the prostate, 2-D planning. (B) Nonaxial 4-field prostate plan, 3-D planning. (C) Seven-field IMRT treatment of head/neck cancer, with beam intensities shown for the individual beam directions.

Isocomplication curve 1 is used for initial treatments. If technology improves conformality of high dose (ie, less normal tissue volume) for a given patient, the prescription dose moves in the direction of arrow A toward higher dose. If toxicity on curve 1 is low enough, then escalate to curve 2 (as shown by arrow B), which allows a higher treatment dose for the same volume irradiated. Technology improvement again allows motion on the isocomplication curve toward higher tumor doses.