Christopher Nutting and colleagues recently reported the results of a randomised trial comparing dysphagia-optimised intensity-modulated radiotherapy (DO-IMRT) with standard IMRT in patients undergoing radiation treatment for head and neck cancer.1 Some forms of DO-IMRT, which involve actively reducing the radiation dose received by the pharyngeal constrictor muscles, have been considered standard in many institutions and collaborative trials groups for some time now, and the authors should be congratulated on providing level 1 evidence for this practice.