The more IGRT systems, the merrier?

• Published in: Journal of applied clinical medical physics 2017-07, Vol.18 (4), p.7-11
• Main Authors: Sun, Baozhou, Chang, Jenghwa, Rong, Yi
• Format: Article
• Language: English
• Subjects: Accuracy; Assurance services; Clinical outcomes; Clinics; Drug dosages; Hospitals; NMR; Nuclear magnetic resonance; Oncology; Physics; Quality control; Radiation therapy; Radiotherapy, Image-Guided; Radiotherapy, Intensity-Modulated
• ISSN: 1526-9914; 1526-9914
• DOI: 10.1002/acm2.12126

Recently, one of vendors’ favorite marketing points for radiotherapy treatment machines is the “IGRT integration” with all possible imaging modalities on board, such as kV/MV 2D projection imaging, kV/MV 3D volumetric imaging, surface‐based imaging, electromagnetic imaging, ultrasound. [...]MRI‐based IGRT systems combined with the Cobalt or linac treatment unit are on the horizon and promised to elevate the IGRT complexity to a whole new level. In reality, with more (including IGRT) technologies introduced into the field, it has become increasingly more difficult to maintain adequate education/training for the staff. [...]it is more challenging to interpret the results from a combination of various IGRT modalities (e.g., optical surface imaging combined with CBCT, or electromagnetic imaging combined CBCT) than from individual modality. [...]RTOG 0631 compares the treatment outcomes of 16 Gy or 18 Gy single‐fraction SRS of spine metastasis under high‐precision (better than 2 mm) image guidance with 8 Gy single‐fraction 2D or 3D external beam treatment with generous (1–2 cm) PTV margin. [...]successful implementation of multiple IGRT systems in a few large academic centers may not be directly translated to stand‐alone clinics or community hospitals that constitute the majority of oncology practices in the United States. [...]technology is the most significant contributing factor to the growth in healthcare spending, and it is essential to attain good value for money spent in technology development.