Sci-Fri PM: Delivery - 11: Accuracy considerations in modern radiation oncology: An update.
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The most recent reviews of accuracy requirements in radiation oncology were published in the 1990s, primarily in an era that was transitioning from 2-D to 3-D conformal radiation therapy (CRT). Since then, the technology associated with radiation oncology has changed dramatically. The combination of various forms of imaging for radiation therapy planning, treatment planning software, dose delivery technology including 4-D considerations as well as in-room daily image guidance has resulted in new perspectives on accuracy considerations. The underlying hypothesis for the use of these advanced technologies is that loco-regional control of cancer remains a significant barrier to cancer cure for many common cancers and that better dose distributions will translate into better outcomes. However, further clinical gain using these new technologies may be limited by single or compounded uncertainties associated with the entire treatment process. Thus, it is important to understand what factors should be considered in determining accuracy requirements as well as the realistic expectations of uncertainties that exist within the total treatment process. The need for accuracy is based on clinical requirements such as the steepness of dose-response curves, inherent heterogeneity in patient response to treatment, and the level of accuracy that is practically achievable. Statements on accuracy are dependent on the technology used and the reality of what is practically achievable and necessary. This review highlights some of the major differences between accuracy requirements as determined in the 2-D RT and 3-D CRT era versus the modern era of intensity modulated, image-guided, 4-D radiation therapy.