Precision radiotherapy: A guide to commissioning IMRT and IGRT

Abstract Commissioning radiotherapy is becoming increasingly challenging. Technical developments may result in better clinical outcomes but come at a cost. Radiotherapy services in the UK are often operating at or near capacity with no slack in the system. A balance between technical perfection and reasonable cost of service provision has to be struck. Eighty per cent of UK radiotherapy departments are now equipped to deliver precision treatments which conform precisely to the shape of the tumour in the individual patient. The benefits are an increase in the cure rate and a reduction in long-term side effects due to the unnecessary irradiation of normal tissues. The delivery of intensity-modulated radiotherapy (IMRT) with image guidance (IGRT) takes more staff time and is therefore more costly than conventional radiotherapy. Such precision is normal practice in Europe and North America but has only been partially implemented in the UK. This paper provides commissioners with a guide to the technology and its implementation together with an appreciation of its likely benefit.