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The management of imaging dose during image-guided radiotherapy: Report of
the AAPM Task Group 75
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image guidance has emerged as the new paradigm for patient positioning,
target localization, and external beam alignment in radiotherapy. Although widely
varied in modality and method, all radiographic guidance techniques have one thing in common—they can give
a significant radiation
dose to the
patient. As with all medical uses of ionizing radiation, the general view is that this
exposure should be carefully managed. The philosophy for dose management adopted by the
diagnostic imaging community is summarized by the acronym ALARA, i.e., as low as
reasonably achievable. But unlike the general situation with diagnostic imaging
and image-guided surgery, image-guided
(IGRT) adds the
dose to an already
high level of therapeutic radiation. There is furthermore an interplay between increased
imaging and improved therapeutic dose conformity that suggests
the possibility of optimizing rather than simply minimizing the imaging
dose. For this
reason, the management of imaging
a different problem than its management during routine diagnostic or image-guided surgical procedures. The imaging
dose received as
part of a radiotherapy treatment has long been regarded as negligible and thus
has been quantified in a fairly loose manner. On the other hand, radiation oncologists
examine the therapy dose distribution in minute detail. The introduction of more intensive
imaging procedures for IGRT now obligates the clinician to evaluate therapeutic
doses in a more
balanced manner. This task group is charged with addressing the issue of radiation
dose delivered via
image guidance techniques during radiotherapy. The group has
developed this charge into three objectives: (1) Compile an overview of image-guidance techniques and their associated radiation
dose levels, to
provide the clinician using a particular set of image guidance techniques with enough
data to estimate the total diagnostic dose for a specific treatment scenario, (2) identify ways
to reduce the total imaging
sacrificing essential imaging information, and (3) recommend
optimization strategies to trade off imaging
improvements in therapeutic dose delivery. The end goal is to enable the design of image
guidance regimens that are as effective and efficient as possible.
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