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Recently, the advantages in high-precision radiotherapy enable focusing of higher radiation energy (dose) to the tumor region while minimizing unwanted radiation exposure to surrounding normal tissue to avoid radiation injury. Intensity-modulated radiation therapy (IMRT) varies the intensities and profiles of beams from various directions to fit the tumor size and shape. This technique greatly improves dose concentration on target region and normal tissue sparing. Image-guided radiation therapy (IGRT) uses advanced imaging technology such as on-board imaging system to achieve precise and accurate dose delivery.

7. Changes in spherical shape factors in radiotherapy. (A) 120% 100% 80% 60% 40% 20% 120% 100% 80% 60% 40% 20% 0% 0% 0 10 20 30 40 Treatment days 0 10 20 30 40 50 Treatment days (C) 140% Average tumor radius (B) 140% Average tumor radius Average tumor radius 140% 120% 100% 80% 60% 40% 20% 0% 0 10 20 30 40 50 Treatment days Fig. 8. Changes of average tumor radius during the treatment in tumor A, B, and C. Vertical lines represent ranges from minimum to maximum. 2 Surface geometry map This study also proposed representation and evaluation method for changes in 3D tumor geometry using 2D surface geometry map.

0 Gy fractions delivered five times a week. Pre-treatment CT images (CT0) were taken for the treatment planning. The slice thickness of the pre-treatment CT images was 2 mm. After the start of treatment, follow-up CT images were taken at weekly intervals (CT1, CT2, CT3, etc). The slice thickness of the follow-up CT images was 5 mm. All patients were immobilized by thermoplastic masks during the CT scanning and treatment. Additionally, in the head and neck IMRT treatments in our hospital, A mouthpiece with three fiducial markers (2 mm diameter gold pellets) was used for the fluoroscopic verification of the patient set-up by means of real-time tumor-tracking radiotherapy (RTRT) system.

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