Image guided radiotherapy (IGRT) in pediatrics provides a means for reduction of treatment volumes by permitting for the use of highly conformal plans with smaller treatment margins. IGRT may additionally allow for dose escalation and adaptive radiotherapy strategies. Current practice patterns and clinical protocols support the use of weekly or daily IGRT as standard practice in pediatric brain-directed IGRT. However, the benefits of IGRT must be weighed against its costs including potentially significant additional radiation dose, supporting the need to study lower dose IGRT protocols in this population. This chapter reviews common modalities of IGRT and the literature regarding its use specific to pediatric brain radiotherapy.
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