Image-guided methods for targeting radiation therapy (IGRT) are crucial in the treatment of localized prostate cancer. ASTRO has now issued the final version of a new white paper addressing “best practices” to improve the safety and effectiveness of these types of technology in clinical practice.
For those who are interested in this type of detail, the relevant media release can be found on the web site of the American Society for Radiation Oncology (ASTRO) and the executive summary of the recommendations is available on line on the web site of the journal Practical Radiation Oncology.
The full text of the recommendations will be published in a future issue of Practical Radiation Oncology, but that sort of detail is probably more that most of the readers of this site would be interested in.
Filed under: Management, Treatment | Tagged: guidance, IGRT, image, radiation |
THE "NEW" PROSTATE CANCER INFOLINK 
How do you ensure that your doctor reads and follows these latest and greatest guidelines? Would be nice to know before I have radiation treatment.
Thanks so much for reporting this guidance paper. Having just completed my 34th TomoTherapy session (of 39 scheduled) this morning, I read your article with added interest and took a look at the executive summary and the linked “Supplemental Material — Assuring Safety and Quality in Image Guided Delivery of Radiation Therapy.” That document included the statement: “Dedicated devices for fraction-by-fraction [meaning session-by-session] imaging and guidance within the treatment room have been developed and rapidly deployed within the past 5 years. This is broadly referred to as Image Guided Radiation Therapy (IGRT).”
Much of it is highly technical and of limited interest to patients, as you indicated, but the parts I looked at were quite understandable for the most part and easy to skim for high points.
A key point that struck me was the emphasis placed on maintaining adequate margins, which were considered very important in order to cover the small discrepancies from ideal planning that are bound to occur. In other words, overconfidence in the theoretical technical capabilities of the image guidance systems needs to be guarded against. Another key point was the emphasis on communication between all team members. Another was regular, disciplined reviews for quality assurance.
An overall key point, especially for those of us who like to view research from a historical perspective, is the “dramatic” increase in IGRT use in the past 10 years. For instance, the cone-beam CT technology that is being used for me was initially deployed only 5 years ago but is now used by 32.6% of centers in a 2010 survey. (I’m wondering if I understood that correctly as it would mean initial roll-out about 2008 but adoption by one third of centers just 2 years later — incredibly fast adoption, especially in view of the profound investment decisions required. Maybe the radiation community is more used to handling rapid technological change than other medical communities. I suspect that is generally true, but I’m puzzled. Also, my impression is that TomoTherapy, which uses that technology, is not so widespread among radiation facilities, certainly not to the one third level by 2010 in my own region, unless you are perhaps counting only major centers.) Also, 70% of centers as of 2010 had volumetric x-ray guidance, which was almost non-existent in 2003, according to the paper.
I am pleased that the center doing my treatment seems to my layman’s eyes to be complying very well with the recommendations for which I can observe evidence. I’ve been most impressed by the high level of teamwork.
That’s easy … Take him a copy!