It doesn't have to be either/or. But...As Don Rumsfeld said, "You go to war with the army you have, not the army you want." Some practices, and they are rare admittedly (think: a site with only a Tomotherapy machine) can't really do "port films" per se and they're wont to do daily IGRT/CBCT. If "MRI...

We were using plain MV films (1. modality), every 5 fractions (2. frequency), aligned to bony anatomy (3. alignment criteria), with instructions for iso shifts if discrepancies were greater than 1 cm (4. threshold for shifts). The same principles apply with volumetric imaging (see previous discussio...

We have not been doing daily imaging for tangential beam RT unless set up and reproducibility is a challenge or pt treated with DIBH ( we do daily MV imaging for these pts) 

This is a great conversation and points to a much bigger issue:  just because we have the technology, does it mean we have to use it on every patient (eg:  2-field breast), even if there is no documented clinical benefit (and potentially increases a patient's radiation exposure)?  Hea...

A survey of IGRT practice patterns by Nabavizadeh et al., revealed that for breast treatments, the majority of respondents used port films, with the assumption that the vast majority of respondents were using tangents (67.4% used portal imaging, and only 10.4% using CBCT or MVCT). In terms of freque...

~EPILOGUEThis month in the Red Journal an article from Royce et al appears detailing medical malpractice outcomes in regards to radiation oncology. A very good article and enlightening. One point among many it highlights is that wrong-site treatment is a significant medical malpractice issue in radi...

@Linda D. Grossheim raises an excellent point regarding long term risk from daily CBCT for breast radiotherapy, i.e., risk from excessive imaging dose. Consider: breast cancer patients often survive for decades, many are young, the opposite breast, lungs, heart will receive daily CT levels of d...