Image-guided radiation therapy (IGRT) is the process of frequent imaging, during a course of radiation treatment, used to direct the treatment, position the patient, and compare to the pre-therapy imaging from the treatment plan. Immediately prior to, or during, a treatment fraction, the patient is localized in the treatment room in the same position as planned from the reference imaging dataset. An example of IGRT would include comparison of a cone beam computed tomography (CBCT) dataset, acquired on the treatment machine, with the computed tomography (CT) dataset from planning. IGRT would also include matching planar kilovoltage (kV) radiographs or megavoltage (MV) images with digital reconstructed radiographs (DRRs) from the planning CT.

This process is distinct from the use of imaging to delineate targets and organs in the planning process of radiation therapy. However, there is a connection between the imaging processes as IGRT relies directly on the imaging modalities from planning as the reference coordinates for localizing the patient. The variety of medical imaging technologies used in planning includes x-ray computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) among others.

IGRT can help to reduce errors in set-up and positioning, allow the margins around target tissue when planning to be reduced, and enable treatment to be adapted during its course, with the aim of overall improving outcomes.

The goal of the IGRT process is to improve the accuracy of the radiation field placement, and to reduce the exposure of healthy tissue during radiation treatments. In years past, larger planning target volume (PTV) margins were used to compensate for localization errors during treatment. This resulted in healthy human tissues receiving unnecessary doses of radiation during treatment. PTV margins are the most widely used method to account for geometric uncertainties. By improving accuracy through IGRT, radiation is decreased to surrounding healthy tissues, allowing for increased radiation to the tumour for control.

Currently, certain radiation therapy techniques employ the process of intensity-modulated radiotherapy (IMRT). This form of radiation treatment uses computers and linear accelerators to sculpt a three-dimensional radiation dose map, specific to the target's location, shape and motion characteristics. Because of the level of precision required for IMRT, detailed data must be gathered about tumour locations. The single most important area of innovation in clinical practice is the reduction of the planning target volume margins around the location. The ability to avoid more normal tissue (and thus potentially employ dose escalation strategies) is a direct by-product of the ability to execute therapy with the most accuracy.

Modern, advanced radiotherapy techniques such as proton and charged particle radiotherapy enable superior precision in the dose delivery and spatial distribution of the effective dose. Today, those possibilities add new challenges to IGRT, concerning required accuracy and reliability. Suitable approaches are therefore a matter of intense research.

IGRT increases the amount of data collected throughout the course of therapy. Over the course of time, whether for an individual or a population of patients, this information will allow for the continued assessment and further refinement of treatment techniques. The clinical benefit for the patient is the ability to monitor and adapt to changes that may occur during the course of radiation treatment. Such changes can include tumor shrinkage or expansion, or changes in shape of the tumor and surrounding anatomy.

The precision of IGRT is significantly improved when technologies that were originally developed for image-guided surgery, such as the N-localizer and Sturm-Pastyr localizer, are used in conjunction with these medical imaging technologies. SRT provides a Non-Surgical Alternative for Non-Melanoma Skin Cancer & an Effective Solution for Keloids.