Updated guidance for image-guided radiotherapy

Radiotherapy Board publishes On Target 2

Published: 02 September 2021 Radiotherapy

The Radiotherapy Board has published new guidance to support the continued application of image-guided radiotherapy (IGRT) and enable the future implementation of four-dimensional adaptive radiotherapy (ART).

On Target 2: Updated Guidance for Image-Guided Radiotherapy supersedes 
the 2008 report On Target: Ensuring Geometric Accuracy in Radiotherapy and a later report produced in 2012 by the National Radiotherapy Implementation Group, entitled IGRT: Guidance for Implementation and Use.

Image guidance (including ART) is an essential component of radiotherapy, ensuring treatment delivery uncertainties are minimised. However, there are remaining uncertainties that should be assessed to ensure the clinical target volume receives the intended dose.

On Target 2 recommends the best evidence-based practices for IGRT and.  provides guidelines on how individual centres can implement and/or optimise image-guidance processes locally.

Key recommendations:

  • When establishing an IGRT service development strategy, 
  • the entire patient pathway should be considered from the time of radiotherapy consent
to radiotherapy planning, continuing throughout treatment, for every patient receiving IGRT. Frequency, imaging dose and complexity of the IGRT process should reflect the treatment intent, anatomical site and fractionation. 
  • Effective immobilisation is critical. Achieving reproducibility during radiotherapy planning and treatment involves reducing both patient bony anatomy motion and internal organ motion. This may complement or even reduce the need for intensive IGRT techniques.
  • Each radiotherapy centre should have in place site-specific IGRT protocols tailored to the needs of that site and take into account the factors affecting the accuracy of set-up.
  • Routine prospective IGRT data collection for the individual patient, individual treatment protocol and anatomical sites is essential to calculate systematic and random errors and inform local margins. Data collection and analysis is one of the most critical aspects of IGRT to ensure and maintain safe implementation and use. Once the accuracy of dose delivered to a target volume is established, IGRT – through research studies or prospective audit – may enable margin reduction and/or facilitate dose escalation to further improve outcomes.

The report states: ‘Only by including these principles in routine clinical practice can we ensure that patients receive high-quality and effective radiotherapy treatments.’

On Target 2 was produced by a multi-professional team led by Dr Kevin Franks, Dr Helen McNair and Professor Marcel van Herk. Dr McNair, lead research radiographer at the Royal Marsden NHS Foundation Trust, who co-chaired the group, said: ‘It is great to see On Target 2 in print. It has been a very collaborative piece of work and many people have contributed. Thank you to all who have done so. We very much hope the document is helpful to radiotherapy departments now and in the future’.

To download On Target 2, visit the SCoR's policy documents and guidance section.