Use of image guided radiation therapy techniques and imaging dose measurement at Indian hospitals: A survey

Abstract

A national survey was conducted to obtain information about the use of image-guided radiotherapy (IGRT) techniques and IGRT dose measurement methods being followed at Indian radiotherapy centers. A questionnaire containing parameters relevant to use of IGRT was prepared to collect the information pertaining to (i) availability and type of IGRT delivery system, (ii) frequency of image acquisition protocol and utilization of these images for different purpose, and (iii) imaging dose measurement. The questionnaire was circulated to 75 hospitals in the country having IGRT facility, and responses of 51 centers were received. Survey results showed that among surveyed hospitals, 86% centers have IGRT facility, 78% centers have kilo voltage three-dimensional volumetric imaging. 75% of hospitals in our study do not perform computed tomography dose index measurements and 89% of centers do not perform patient dose measurements. Moreover, only 29% physicists believe IGRT dose is additional radiation burden to patient. This study has brought into focus the need to design a national protocol for IGRT dose measurement and development of indigenous tools to perform IGRT dose measurements.

Impact of different image guidance schedules in head and neck irradiation: A retrospective analysis

“…It would be prudent to consider the IGRT frequency based on individual patients rather than adopting a rigid protocol. In a national survey carried out by Deshpande et al., 68% of the radiation therapy centers adopted a patient‐specific approach for IGRT frequency; whereas, 18% and 14% adopted a daily and weekly approach, respectively 27 . Furthermore, Nabavizadeh et al.…”

“…25,26 Although daily image guidance appears to be the best approach to mitigate errors, it might not be feasible for all patients, especially those in high-volume centers, as it increases the radiation therapy centers adopted a patient-specific approach for IGRT frequency; whereas, 18% and 14% adopted a daily and weekly approach, respectively. 27 Furthermore, Nabavizadeh et al reported that daily IGRT was practiced in almost all sites; however, no modi-fication of PTV margin was carried out based on frequency. 14 Even the American Society for Radiation Oncology (ASTRO) recommends a balance between the needs of the disease/technique, the imaging dose, and resource requirements without specifying a rigid protocol.…”

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“…One possibility of a more individual approach is the determination of positioning inaccuracy during the first three treatment fractions with subsequent adjustment of CBCT frequency (e.g., daily vs. weekly). Even though this approach is already standard procedure in many treatment centers [ 12 , 14 , 15 ], it lacks reliable evidence.…”

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“…The application of IGRT strategies in RT practice has grown exponentially in the past decade but internationally large variation has been reported in the availability and utilisation of IGRT in clinical practice [14][15][16]. Furthermore, IGRT modalities are both underused due to concerns regarding accumulated imaging dose [17] and potential time consuming nature of its execution [18].…”