Week 3 discussion: IGRT QA

The CT-based in-room image-guided radiation therapy (IGRT) system is a newly

developed technique to improve safety and accuracy of radiation therapy by on-board image
guidance for precise daily patient positioning, target localization, motion monitoring, and
external beam alignment in radiation therapy.1,2 There are many commercial IGRT systems. In
my clinical, we use Varian on-board imager for LINAC linear accelerators following AAPM TG142 guidelines. The imaging guidance system used in the department includes kilovoltage (kV)
planar imaging, megavoltage (MV) planar imaging, and cone-beam CT (CBCT). The physicist
team takes major responsibility for the daily, monthly, and annual IGRT quality assurance (QA)
activities along with radiation therapists and the designated personals from radiation safety.
The morning warm-up radiation therapist performs daily kV, MV, and CBCT IGRT QA
along with other daily QA activities. The imager housing and collision interlocks are inspected
routinely. During the machine warm-up, the therapist verifies the operation, the coordinate
coincidence and image quality by imaging a phantom from all four cardinal angles for kV, MV
and CBCT. The kV and MV imaging QA are acquired though dual ceiling camera based portable
imagers shown in figure1 while CBCT QA uses 1 MU accelerators treatment beam and its portal

imaging system as seen in figure 2.2

Figure 1: kV and MV IGRT portable imaging with dual ceiling cameras.

Figure 2: CBCT QA imaging through OBI portable imaging system

Figure 3: The principle of CBCT imaging.

The IGRT monthly QA are performed by physicists to check the image quality as well as
the detailed safety and mechanical integrities. The physicist follows the institutional IGRT
monthly QA log to check and record the QA procedures such as imaging and treatment
coordinate coincidence, spatial resolution, contrast and quality of images, uniformity and noise
by imaging a phantom.
The designated personals from radiation safety perform the annual IGRT QA through a
special device to measure the imaging dose of CBCT, planar kV and MV imaging.
Current AAPM TG-142 provides reliable safe guidelines for institutional daily, monthly,
and annual QA of medical linear accelerators including IGRT imaging system. The manager
from my clinical site told me the guidelines have been worked well with regard to safety,
accuracy, and feasibility.
References:
1. Herma MG, Balter DA, McGee KP, et al. Clinical use of electronic portal imaging:
Report of AAPM radiation therapy committee Task Group 58. Med. Phys.
2001;28(5):712-727. http://dx.doi.org/10.1118/1.1368128.
2. Murphy MJ. Managing the imaging dose during image-guided radiation therapy.
http://www.aapm.org/meetings/amos2/pdf/41-10105-17589-928.pdf. Accessed October
12, 2016.