IGRT in breast is a rapidly changing field and presently there is wide variation how it is adopted across the UK. Portal imaging is considered adequate for standard, tangential two field whole breast radiotherapy. However, increasing use of IMRT/ VMAT/ Partial breast and accelerated treatment demands more accurate methods of treatment verification. Volumetric imaging with Cone Beam CT is the gold standard but it is resource and time intensive. Planar imaging such as kV stereoscopic pair or MV -kV pair and surface guided modalities are more user friendly and may be adequately informative. All of these imaging modalities allow correction in all three planes and therefore make it possible to decrease margins and tolerances. To a large extent, technique used is dependent on the planning system, treatment technique, resource availability and experience within the department.
Successful implementation of IGRT requires clarity of technique to be used, frequency of imaging and correction strategies. There is a balance to be achieved between clinical and cost effectiveness. Treatment verification is only one part of a chain of factors in successful treatment delivery. Adequate immobilisation, good imaging technologies, use of fiducial makers helping delineate tumour bed, contouring guidelines and comprehensive quality assurance processes are all important in the optimal delivery of breast radiotherapy. This talk will draw on the challenges experienced in developing IGRT at a large centre in Leeds to explore these issues.

Educational aim:
• To gain an understanding of the different imaging modalities available for breast IGRT, recognising the advantages and disadvantages of each in different situations
Reference:
• The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine. On target: ensuring geometric accuracy in radiotherapy. London: The Royal College of Radiologists, 2008
Further reading:
• American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guidelines for Image-Guided Radiation Therapy (IGRT) International Journal of Radiation Oncology*Biology*Physics Volume 76, Issue 21 February 2010.Louis Potters et al.

0.5 CPD credit.
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