Document Type

Conference Proceeding

Publication Date


Publication Title

Int J Radiat Oncol Biol Phys


Purpose/Objective(s): We quantify the increase in use of pre-treatment imaging and verification imaging in radiation oncology over the past decade. We also quantify the trend towards hypofractionation, which has partially led to increased imaging.

Materials/Methods: The pre-treatment and verification imaging data used are from a single, tertiary, university-affiliated cancer center. Pre-treatment imaging was defined as magnetic resonance imaging (MRI), positron emission tomography (PET) and four-dimensional computed tomography (4DCT). Verification imaging was defined as cone-beam computed tomography (CBCT). All treatment approved plans were included from 2012 to 2021. Data extraction was performed using custom scripts interfacing with the treatment planning system (TPS) and patient information system. All registered image-sets of planning CT images with either advanced pre-treatment advanced imaging or verification images in the TPS were included. Hypofractionation sub-analysis was performed according to plans above and below 4 Gy per fraction that received a combination of pre-treatment and verification imaging.

Results: Between 2012 and 2021, a total of 42,214 plans were included. In 2021, MRI, PET, and 4DCT pre-treatment imaging modalities were used for 14%, 5%, and 3% of patients, respectively, which was an increase from 5%, 2%, and 0%, in 2012. In 2021, 55% of patients received CBCT for verification imaging compared to only 2% of patients in 2012. In the sub-analysis, cohort receiving greater than or equal to 4 Gy per fraction from 2012 to 2021, the percent of patients receiving one of MRI or PET for pre-treatment imaging and CBCT guidance for verification imaging increased from 1% to 22%. For the cohort receiving less than 4 Gy per fraction, there was an increase from 2012 to 2021 of 0% to 14% of patients receiving at least one of MRI or PET pretreatment imaging and CBCT for verification imaging. Table 1: Annual use of advanced pre-treatment, verification imaging, hypofractionation, and associated combination imaging shown. Entries indicate the percent (%) of patients per year with the imaging modality used in their treatment.

Conclusion: An increase in the adoption of advanced medical imaging was observed in standard of care treatments over the past 10 years. Imaging utilization continues to increase as clinical trial evidence matures. Further analysis could focus on the gap between desired standard of care for patients and the current offerings as well as the increase in capital and human resource requirement for implementation of these advancements.





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