The more IGRT systems, the merrier?

The field of radiotherapy (RT) has benefited substantially from advancements in Image-Guided Radiotherapy (IGRT) in the past 15 years. IGRT now constitutes the integration of a wide range of imaging technology with modern RT delivery systems that include 3D anatomical and functional-based imaging for tumor volume identification, 3D target volume localization, and motion management information for precise patient setup and monitoring. To streamline this complex process, system integration of planning and delivery with multimodality IGRT technologies is now a primary selling point for vendors. This integration becomes more complex with the increased number of image-guided patient positioning and motion management options. Current IGRT technologies include not only various x-ray based imaging systems but also other modalities, such as video/infrared (IR) cameras, ultrasound (US), and electromagnetic field systems. The capital purchase decision makers at hospitals welcome tools that allow for improved image guidance when it is consistent with their strategies for return on investment. But this may raise multiple issues that need to be addressed by medical physicists, including safe and practical implementation and commissioning, personnel qualification and training of staff, updates and servicing to ensure integration between systems, and of course reimbursement constraints. This brings us to our debate topic: Will more IGRT systems implemented in the clinic lead to better outcomes for RT treatments? Arguing for the proposition is Dr. Baozhou Sun. Dr. Sun is an assistant professor and chief of quality assurance services of radiation oncology at Washington University in St. Louis. He earned his Ph.D. in applied science from the College of William and Mary in 2005. Dr. Sun finished his medical physics residency training at Washington University in St. Louis in 2012 and became a faculty member at the same institution. He is certified in Therapeutic Radiological Physics by the American Board of Radiology. His research interests include quality assurance, proton therapy, imagingguided radiation therapy, and medical informatics. Arguing against the proposition is Dr. Jenghwa Chang. Dr. Jenghwa Chang received his Ph.D. in electrical engineering from Polytechnic University and is an ABR-certified medical physicist. He is currently an Associate Professor at Radiation Medicine of Northwell Health supervising the training/education of medical/physics residents and overseeing the quality assurance program for physics. Previously Dr. Chang held positions with Weill Cornell Medical College, NYU Langone Medical Center, and Memorial Sloan-Kettering Cancer Center. He is also a physicist surveyor for ACR Radiation Oncology Practice Accreditation (ROPA) program. His research interest includes optical diffusion tomography, Electronic Portal Imaging Device (EPID) dosimetry, MV/kV cone beam CT (CBCT), magnetic resonance imaging (MRI)-guided treatment planning, panoramic CBCT, and setup uncertainty of single isocenter for multiple targets technique.