Quality assurance of image-guidance technologies

The introduction of image-guided radiotherapy systems (IGS) allows improved management of geometric variations in patient setup and internal organ motion. Commercially available technologies, based on ultrasound, projection radiography, or cone-beam CT, have been widely adopted in radiation therapy. All rely on the comparison of daily images with reference images of the patient anatomy to ensure coincidence of the treatment and planned isocenters. This article reviews how IGS hardware and software are commissioned for clinical release and what quality control checks are required to ensure consistent and reproducible geometric accuracy. As image guidance significantly modifies conventional radiotherapy processes, recommendations and potential issues are discussed to facilitate the introduction of image guidance into the clinical environment.