IGRT Treatment in Raipur

Image-Guided Radiation Therapy (IGRT) uses imaging immediately before each treatment session to verify the patient's position and confirm the tumour is precisely where it was during planning before radiation is delivered. It addresses a fundamental challenge: patients shift between fractions, and organs and tumours move with breathing, bowel filling and bladder volume changes.

Without image guidance, large safety margins are required, exposing more normal tissue to high radiation doses than necessary. IGRT confirms position at the point of treatment, allowing tighter margins, more precise dose delivery and better protection of surrounding normal tissue.

At Ramkrishna CARE Hospitals, IGRT is implemented on the Elekta Versa HD using its integrated XVI (X-ray Volume Imaging) system, acquiring 2D and 3D volumetric images at the point of treatment for submillimeter position verification and correction.

Why Choose Ramkrishna CARE Hospitals for IGRT Treatment in Raipur?

Ramkrishna CARE Hospitals combines advanced image-guided technology with experienced oncology specialists to deliver accurate, personalised IGRT treatment:

• Elekta Versa HD with XVI imaging: The Versa HD's integrated XVI system acquires 2D and 3D cone-beam CT images immediately before each fraction, verifying tumour position, detecting deviations from the planned position and correcting them before radiation is delivered
• HexaPOD six-degree-of-freedom couch: Position corrections are executed by the HexaPOD robotic couch, adjusting the patient in all six degrees of freedom (translational and rotational) to submillimeter accuracy. Essential for stereotactic treatments where three-axis couches are insufficient
• 4D image guidance for moving targets: 4D CBCT images the tumour across the full respiratory cycle, revealing motion extent and direction. For lung, liver and abdominal tumours, this allows treatment across the full motion envelope with appropriate margins or respiratory gating to deliver radiation only during a specific respiratory phase
• Critical Structure Avoidance: Unique to the Versa HD platform, dual registration aligns both the tumour & critical structures simultaneously, protecting organs at risk even when anatomy has shifted. Only Elekta offers this capability
• PET CT target definition: The uMI 550 identifies metabolically active tumour volumes with 2.76mm resolution and Time-of-Flight precision, which is more accurate than CT-derived volumes alone for lung, head & neck and lymphoma. PET-defined boundaries imported into Monaco ensure IGRT is verifying position to the correct biological target

Conditions Treated with IGRT

Doctors use IGRT to treat several cancers. They are:

• Prostate cancer: Prostate position varies substantially with rectal and bladder filling between fractions. Daily CBCT confirms position before each fraction, enabling dose escalation while limiting rectal & bladder doses
• Lung cancer: Respiratory motion makes IGRT mandatory for lung radiation therapy like SBRT and IMRT
• Head and neck cancers: Anatomical changes during treatment (shrinkage, weight loss) make frequent imaging essential to detect when replanning is needed
• Liver & abdominal tumours: Daily IGRT confirms target position where respiratory motion and organ filling variation are significant and essential for SBRT
• Brain tumours and radiosurgery: Submillimeter position confirmation for each SRS and SBRT fraction where errors could affect eloquent cortex or critical neurovascular structures
• Spinal & paraspinal tumours: Cord position verified before each SBRT fraction is mandatory when cord dose approaches tolerance limit
• Breast cancer: Verification for breath-hold techniques that reduce cardiac dose in left-sided radiotherapy
• Rectal and gynaecological cancers: Pelvic organ filling variation requires IGRT verification to confirm target and critical structure positions.

Who Needs IGRT?

IGRT is the standard for precision radiation delivery at Ramkrishna CARE Hospitals, not an optional add-on. Patients who particularly benefit from the highest level include:

• SBRT and SRS patients: Large doses in few fractions where submillimeter accuracy is mandatory
• Prostate dose escalation: Daily position verification directly reduces rectal toxicity risk
• Lung tumours with significant respiratory motion: 4D CBCT or gating characterises and accounts for motion
• Patients with anticipated anatomical change: Particularly head and neck cancer patients losing weight rapidly during treatment
• Tumours adjacent to critical structures: Spinal cord, brainstem, optic chiasm, bowel where positional error would result in serious toxicity

Symptoms That May Require IGRT Treatment

IGRT is selected based on cancer type, location and precision requirements. Presentations commonly leading to IGRT-based treatment plans include:

• Prostate cancer confirmed on biopsy 
• Lung tumour confirmed on CT and PET CT 
• Brain tumour, metastasis, or benign intracranial lesion requiring radiosurgery - submillimeter IGRT is essential
• Head and neck cancer adjacent to the spinal cord, brainstem, or salivary glands and daily IGRT reduces the margin required for safe delivery
• A rectal, cervical, or other pelvic cancer where radiation is part of the definitive or adjuvant treatment and target-organ positional variation is expected between fractions.

Diagnosis Before IGRT Treatment

Doctors suggest several tests before IGRT treatment. They are:

• Histological diagnosis: Tissue biopsy confirming cancer type and subtype, which determines dose, fractionation and clinical target volume margins
• CT and MRI staging: Tailored to the tumour site, like MRI preferred for prostate, brain, and rectal cancer; CT for lung and head and neck staging and planning
• PET CT: Metabolic staging provides more accurate biological tumour volumes than CT alone, particularly for head and neck, lung and lymphoma. PET-defined volumes imported into Monaco form the target against which IGRT verifies position at each fraction
• CT simulation with immobilisation: A planning CT in the treatment immobilisation device establishes the reproducible position that IGRT will verify and correct at each fraction
• 4D CT for respiratory motion: For lung, liver, and upper abdominal tumours, it captures tumour motion across the respiratory cycle, essential for defining the internal target volume and for 4D IGRT on the Versa HD.

IGRT Treatment Procedure

Treatment procedure steps are:

• Pre-treatment imaging: The Versa HD XVI system acquires 2D orthogonal images or full 3D volumetric CBCT immediately before radiation delivery, typically taking one to two minutes
• Image registration: Acquired images are registered to the planning CT; translational and rotational deviations are quantified & compared against pre-defined action thresholds
• HexaPOD position correction: Deviations exceeding action thresholds are corrected by the HexaPOD in all six degrees of freedom, and a verification image confirms accuracy before treatment proceeds
• Radiation delivery: Once the position is verified, the Versa HD delivers treatment as VMAT at two to four minutes per arc. Actual radiation delivery is brief relative to the total appointment time.

Benefits of IGRT

Key advantages are:

• Precise tumour targeting: Daily imaging confirms position and reduces geographic miss risk.
• Reduced safety margins: Smaller planning target volumes mean less normal tissue receives high doses (reducing acute and late toxicity).
• Dose escalation: IGRT enables higher doses to tumours adjacent to critical structures that would be unsafe without real time position confidence.
• Adaptive radiotherapy: IGRT images track anatomical changes over the course, and significant changes trigger replanning to maintain accuracy throughout
• Improved local control: Accurate delivery and dose escalation increase local control rates for prostate, lung and head and neck cancers
• Detection of significant anatomical change: Unexpected findings such as tumour progression or contour change may be identified and prompt replanning.

Risks and Possible Complications of IGRT

IGRT risks are those of radiation therapy in general, with the key distinction that IGRT's purpose is to reduce normal tissue toxicity by improving targeting accuracy:

• Radiation side effects at the treatment site: Acute skin reactions, mucositis, fatigue and site specific toxicity are inherent to radiation therapy and managed with supportive care
• Late effects: Possible fibrosis and long term organ-specific toxicity, substantially reduced by IGRT's tighter margins
• Cone beam CT dose: CBCT adds a small additional radiation dose per fraction, clinically negligible and accepted given the benefit of improved treatment accuracy
• Residual intrafraction uncertainty: IGRT reduces but does not entirely eliminate positional uncertainty. Movement during delivery itself is not captured by pre fraction CBCT, though rapid VMAT delivery on the Versa HD minimises this window.

Side Effects of IGRT

IGRT-guided side effects are site-specific and generally less severe than treatments without image guidance, due to improved normal tissue protection from tighter margins:

• Prostate IGRT: Urinary frequency, urgency and bowel urgency during treatment. Late effects, including incontinence, rectal bleeding and erectile dysfunction, are significantly reduced compared with non-image-guided prostate radiotherapy
• Lung IGRT / SBRT: Fatigue, cough and rarely radiation pneumonitis reduced by IGRT's tighter margins limiting normal lung volumes receiving high doses
• Head and neck IGRT: Mucositis, xerostomia, dysphagia and skin reaction. Adaptive replanning maintains salivary gland sparing and reduces geographic miss risk as anatomy changes
• Brain SRS / IGRT: Headache, fatigue and temporary hair loss in the treatment field. However, radiation necrosis risk is minimised by IGRT's submillimeter accuracy confining high-dose radiation to the target
• Pelvic IGRT: Urinary frequency and bowel changes during treatment; late bladder and bowel dysfunction reduced by IGRT-verified positioning limiting incidental high-dose exposure.

Conclusion

IGRT is the clinical standard for precision radiation delivery, solving the fundamental problem of positional uncertainty through imaging at the point of treatment. At Ramkrishna CARE Hospitals, Raipur IGRT is implemented on the Elekta Versa HD using XVI cone-beam CT, HexaPOD six-degree-of-freedom correction, and 4D imaging for moving targets.

Every IGRT treatment is underpinned by uMI 550 PET CT target definition, Monaco Monte Carlo planning and AQUA automated quality assurance. For patients across Chhattisgarh, this precision radiation infrastructure is available here in Raipur.