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Furthermore, tissue density differences at the lung-tumor interface contribute to disagreements between the administered and planned doses.

Thus, lung IMRT is especially challenging due to breathing motion. The National Cancer Institute (NCI) Guidelines for the Use of IMRT state that there is potential for significant dosimetric consequences if the target volume moves while treatment is being administered. While many benefits of IMRT exist, significant challenges are involved when unpredictable intrafraction movement is combined with the highly optimized nature of IMRT. Intensity Modulated Radiation Therapy (IMRT) has been used in lung cancer treatment to deliver dose distributions with steep gradients and exquisite target volume conformality.