Benchmarking doses to inform optimisation of radiological protection for verification imaging in radiotherapy
- Author(s)
- Martin, CJ; Gros, S; Kron, T; Wood, T; Vassileva, J; Fourie, H; Djukelic, M; Small, W;
- Journal Title
- International Journal of Radiation Oncology, Biology, Physics
- Publication Type
- Online publication before print
- Abstract
- Realisation of the full potential of external beam radiation therapy requires accurate targeting, which in turn depends on frequent imaging of patients immediately prior to or during treatment. These verification images may expose normal tissues surrounding the tumour to additional radiation. Although imaging doses are substantially lower than therapeutic doses, irradiated volumes are larger and repeated exposure carries a non-negligible risk of inducing second primary cancers in adjacent tissues and other late effects, particularly in younger patients with longer life expectancies. Cone beam computed tomography (CBCT) with kilovoltage systems mounted on linear accelerators is the modality used most widely for verification in image guided radiotherapy (IGRT). In contrast to diagnostic radiology, where imaging parameters are adjusted routinely to optimise radiological protection for individual patients, radiotherapy departments often use vendors' supplied default protocols with limited optimisation. As imaging is often performed at every fraction, there is considerable scope for further optimisation of radiological protection. However, information about doses from CBCT imaging, which is a prerequisite, is frequently not available. In diagnostic radiology, imaging dose management is supported by routine surveys of standardized dose indices and the use of diagnostic reference levels (DRLs) for benchmarking practice. This paper reviews the methods used in diagnostic radiology and considers how a similar approach might be applied to patient imaging doses in radiotherapy. It identifies appropriate dose quantities such as the Cone Beam Dose Index (CBDI) and wide beam Computed Tomography Dose Index (CTDI(w)) that might be used for surveying and benchmarking imaging dose levels. It sets out actions that will be needed to initiate optimisation to balance image quality requirements against patient doses and discusses the next phase of setting up radiotherapy specific dose reference levels. Establishing such reference levels can raise awareness, support systematic imaging dose reduction, and improve the safety and effectiveness of IGRT.
- Department(s)
- Physical Sciences
- Publisher's Version
- https://doi.org/10.1016/j.ijrobp.2026.05.059
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2026-06-30 03:12:31
Last Modified: 2026-06-30 03:12:41