Many facilities treat patients with Intensity Modulated Radiation Therapy (IMRT).

These facilities most commonly utilize a multileaf collimator (MLC) to deliver static angle IMRT. However, Compensator Based Intensity Modulated Radiation Therapy (CB IMRT) is a type of IMRT that does not use a MLC. The strategy to achieve an intensity modulated beam with a static angle is to utilize a compensator block.1 These blocks can be made from a variety of material, most commonly brass. Cerrobend, Plexiglas and a tungsten powder composite can also be used. Advantages of using CB IMRT include a faster treatment time (because there are no moving parts on the machine, each field is delivered more quickly) and more ideal dose patterns (because they will not be limited by leaf size, speed or leakage). Disadvantages include long fabrication times compared to MLC patterns (some facilities make their own compensators while others have to contract another company to obtain them) and the large size and weight of the compensators to achieve low dose regions. Therapists on the machine must change the compensator for each field. A video taken from .decimal (a company which fabricates compensators for the use of photon and proton therapies) explains how they make the compensators and how the devices are utilized in a clinical setting. The video can be found on their website with the link: http://www.dotdecimal.com/media/decimalpromo.2 It does a great job covering how the devices are created from beginning to end.

As the radiation beam travels from the linear accelerator toward the target, the compensator modulates the intensity of the beam. Compensator

Figure 1: An example of how a compensator works when treating tissue. 2

Figure 2: An example of a brass compensator.2

References 1. Keyes R. 365 Days of Medical Physics. http://medphys365.blogspot.com/2012/05/compensator-based-imrt.html. May 13, 2012. Accessed February 20, 2014. 2. .decimal. .decimal products compensator-based IMRT. http://www.dotdecimal.com/products/IMRT. 2012. Accessed February 20, 2014.