I have posted this here before when IMRT hit the mainstream, and this "further development" of IMRT is interesting. But the truth of it all is that for the first time radiation oncologists have to know anatomy as well as a surgeon. Mapping the shape, intensity, and duration of many, many beams around vital structures, salivary glands, neurovascular bundles, and more - like known routes of metastasis is not as easy as radiation oncology used to be 5 years ago. More than ever, it is the knowledge and skill of the practitioner that makes the new technology useful or not. There is going to be a learning curve, and IMRT is still in one in many ways in the H&N world, and this extension of IMRT is no different. Just because Hoag, or LB has the equipment, I wouldn't necessarily correlate that to also having the experienced staff that has seen the volumes of patients and eventually their long term results that you would get at MDACC or MSKCC.... the fact is they just don't have the patient volume, and the "best of the best" are frequently attracted to the major centers for obvious reasons. It is always part science and part art. Medicine in not exact, and an improved piece of technology does not an improved outcome yield without the physician knowledge and experience component.