Implementation of an image‐guided radiation therapy program: Lessons learnt and future challenges

Abstract

The aim of this paper is to detail the experience obtained in implementing an image-guided radiation therapy program at the Northern Sydney Cancer Centre. This required retrofitting a Varian Clinac 21EX with an on-board imager. The commissioning and quality assurance procedures, organisation of a multidisciplinary image guided radiation therapy group, and the development of clinical protocols for orthogonal kV and cone beam computed tomography implementation are described. Reassessment of the image-guided radiation therapy program has continued as new equipment and software versions were made available in the department.

Image guided radiation therapy: it is only the beginning

“…Many departments have created multidisciplinary IGRT groups that consist of radiation therapists, medical physicists and radiation oncologists to coordinate the clinical implementation of IGRT. 12 Given the importance of the daily decision making at the treatment unit under time pressure and the potentially unfamiliar imaging systems such as Calypso, ultrasound or MRI, there is a great need for training and education. Journals such as The Radiographer have a role to play as they bring together imaging and therapy professionals.…”

Radiation therapist perspectives on cone-beam computed tomography practices and response to information

“…3,7,8 A number of studies have recognised the need to ensure radiation therapists possess the knowledge and skills necessary to manage new clinical information presented during the course of treatment delivery. 7,11,13 More recently, however, there has been increased focus on the evolving uses of CBCT images made possible through harnessing this additional soft-tissue information, such as adaptive planning, without considering the consequences for radiation therapists or the interprofessional team in which they work. Some have also discussed a shift in responsibility for assessment of positioning accuracy and approaches to achieve this.…”

“…Studies to date have focused primarily on acquisition of skills relating to cross-sectional anatomy and soft-tissue visualisation, 12 to better ensure the reproducibility of the patient's positioning for treatment. Some have also discussed a shift in responsibility for assessment of positioning accuracy and approaches to achieve this 7 , 11 , 13 . More recently, however, there has been increased focus on the evolving uses of CBCT images made possible through harnessing this additional soft-tissue information, such as adaptive planning, without considering the consequences for radiation therapists or the interprofessional team in which they work 14 , 15 …”

“…Some have also discussed a shift in responsibility for assessment of positioning accuracy and approaches to achieve this. 7,11,13 More recently, however, there has been increased focus on the evolving uses of CBCT images made possible through harnessing this additional soft-tissue information, such as adaptive planning, without considering the consequences for radiation therapists or the interprofessional team in which they work. 14,15 It is important to ensure that practice keeps pace with technology, and that considerations are made for how to handle clinical information that was not previously available.…”

Numerical deconvolution to enhance sharpness and contrast of portal images for radiotherapy patient positioning verification

“…These so-called electronic portal imaging devices (EP-ID), which are integrated into the treatment machines, either use direct imaging by the treatment beam [22,23,24,26,40] or use a dedicated x-ray source offset from the treatment beam at right angles [1,2,3,31]. Besides acquiring two-dimensional (2D) portal images, these devices are capable of performing cone-beam computed tomography (CBCT) by rotating the gantry during image acquisition [1,2,3,23,24,40]. This feature of modern EPID succeeds the earlier attempts of three-dimensional (3D) positioning verification based on dedicated CTs installed in the treatment room [21,26].…”