Image-guided Radiation Therapy (IGRT)
What is Image-Guided Radiation Therapy and how is it used?
Image-guided radiation therapy (IGRT) is the use of frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery of treatment.
In IGRT, machines that deliver radiation, such as a linear accelerator (for x-ray or photon) or cyclotron/synchrotron (for proton), are equipped with imaging technology so that the physician can image the tumor immediately before or even during the time radiation is delivered, while the patient is positioned on the treatment table. Using specialized computer software, these images are then compared to the images taken during simulation. Any necessary adjustments are then made to the patient's position and/or radiation beams in order to more precisely target radiation at the tumor and avoid healthy surrounding tissue.
Computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), ultrasound (US) and x-ray imaging may be used for IGRT. Newer methods for IGRT use a non-radiation light-emitting diode (LED) light on the patient's body surface or implanted magnetic transponder inside the patient's body.
IGRT is used to treat tumors in areas of the body that are prone to movement, such as the lungs (affected by breathing), liver, and prostate gland, as well tumors located close to critical organs and tissues. It is often used in conjunction with intensity-modulated radiation therapy (IMRT), proton beam therapy, stereotactic radiosurgery, or stereotactic body radiotherapy (SBRT), which are advanced modes of high-precision radiotherapy that utilize computer-controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. See the IMRT page (www.RadiologyInfo.org/en/info.cfm?pg=imrt), Proton Beam Therapy page (www.RadiologyInfo.org//en/info.cfm?pg=protonthera) or SBRT page (www.RadiologyInfo.org//en/info.cfm?pg=stereotactic) for more information.
Who will be involved in this procedure?
Delivery of radiation therapy requires a treatment team, including a radiation oncologist, therapeutic medical physicist, dosimetrist and radiation therapists. The radiation oncologist is a physician who evaluates the patient and determines the appropriate therapy or combination of therapies. The physician determines what area to treat and what dose to deliver. Together with the therapeutic medical physicist and the dosimetrist, the radiation oncologist determines what techniques to use to deliver the prescribed dose. The physicist and the dosimetrist then make detailed treatment calculations. Radiation therapists are specially trained technologists who acquire images and deliver the daily treatments. The radiation oncology nurse assesses the patient and provides the patient with additional information about the treatment and possible adverse reactions. The radiation oncology nurse also helps manage any reactions or side effects from treatment that may occur, in collaboration with the physician.
What equipment is used?
In IGRT, imaging equipment is mounted on or built into the machine that delivers radiation, such as a linear accelerator. Imaging equipment may also be mounted in the treatment room. Imaging technologies used in IGRT include x-rays, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and ultrasound (US). Sometimes, IGRT is performed by a special camera in the room that emits LED light and tracks the patient's body surface. For selected areas affected by breathing, a special small device is placed on the patient's chest or abdomen that emits light. This gives feedback regarding the respiratory stage.
Who operates the equipment?
The equipment is operated by a radiation therapist, a highly trained technologist. The overall treatment plan is created and supervised by the radiation oncologist, a highly trained physician specializing in treating cancer with radiotherapy.
Is there any special preparation needed for the procedure?
Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding their baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy, breastfeeding and imaging. Patients with pacemakers or loose metal in their bodies should inform the treatment team if MRI is used for simulation or IGRT.
For some IGRT procedures, a fiducial marker/s may be placed inside the body near or in the tumor to help the treatment team identify the area. These radiodense markers are made from materials that cannot be penetrated by x-rays, such as gold, and they appear white on images. They are usually placed at least one week prior to the first radiation therapy treatment. The patient's skin also may be marked or tattooed with colored ink to help align and target the radiation equipment.
Otherwise, there is no specific preparation for IGRT, other than the preparation for routine radiation therapy, which could be either 3-D conformal radiation therapy, intensity modulated radiation therapy, proton beam therapy, or stereotactic body radiotherapy (SBRT). See the IMRT page (www.RadiologyInfo.org/en/info.cfm?pg=imrt), Proton Beam Therapy page (www.RadiologyInfo.org/en/info.cfm?pg=protonthera) or SBRT page (www.RadiologyInfo.org//en/info.cfm?pg=stereotactic) for more information.
How is the procedure performed?
At the beginning of each radiation therapy session, the patient is carefully positioned guided by the marks on the skin defining the treatment area. Devices may be used to help the patient maintain the proper position. Images are then taken using imaging equipment that is built into the radiation delivery machine or mounted in the treatment room.
The physician then reviews the images and compares them to the images taken during simulation. The patient may be repositioned and additional imaging may be performed. After any necessary adjustments are made to the treatment plan and patient positioning, radiation therapy is then delivered.
The image-guidance process may add up to five minutes to each radiation therapy session.
What will I feel during and after this procedure?
Imaging performed prior to or during radiation therapy sessions is painless.
During the radiation therapy session, you may see or hear equipment moving around you during the imaging procedure. Patients may sometimes smell an odd smell during treatment that is caused by the ozone produced by the linear accelerator. Some patients may also see a colored light when they receive their treatment; this event is especially true for patients having their brain treated.
Side effects of radiation treatment include problems that occur as a result of the treatment itself as well as from radiation damage to healthy cells in the treatment area.
The number and severity of side effects you experience will depend on the type of radiation and dosage you receive and the part of your body being treated. You should talk to your doctor and nurse about any side effects you experience so they can help you manage them.
Radiation therapy can cause early and late side effects. Early side effects occur during or immediately after treatment and are typically gone within a few weeks. Common early side effects of radiation therapy include tiredness or fatigue and skin problems. Skin in the treatment area may become more sensitive, red, irritated, or swollen. Other skin changes include dryness, itching, peeling and blistering.
Depending on the area being treated, other early side effects may include:
- hair loss in the treatment area
- mouth problems and difficulty swallowing
- eating and digestion problems
- nausea and vomiting
- soreness and swelling in the treatment area
- urinary and bladder changes
Late side effects, which are rare, occur months or years following treatment and are often permanent. They include:
- brain changes
- spinal cord changes
- lung changes
- kidney changes
- colon and rectal changes
- joint changes
- mouth changes
- secondary cancer
There is a slight risk of developing cancer from radiation therapy. Following radiation treatment for cancer, you should be checked on a regular basis by your radiation oncologist for recurring and new cancers.
Using techniques such as IGRT, imaging specialists are maximizing the cancer-destroying capabilities of radiation treatment while minimizing its effect on healthy tissues and organs and the side effects of the treatment itself.
Locate an ACR-accredited provider: To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database.
Exam costs: The costs for specific medical imaging tests and treatments vary widely across geographic regions. Many—but not all—imaging procedures are covered by insurance. Discuss the fees associated with your medical imaging procedure with your doctor and/or the medical facility staff to get a better understanding of the portions covered by insurance and the possible charges that you will incur.
Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise in several radiologic areas.
Outside links: For the convenience of our users, RadiologyInfo.org provides links to relevant websites. RadiologyInfo.org, ACR and RSNA are not responsible for the content contained on the web pages found at these links.
This page was reviewed on March 07, 2013