On-board kV imaging
Modern linear accelerators have on-board kV imaging equipment. This enables image guided radiation therapy (IGRT), using either kV or CBCT. Implanted fiducial markers makes it easy and safe for the medical staff to determine the need for patient repositioning prior to each fraction (interfraction motion management).
Matching kV to DRR
The fastest and easiest method is to capture two orthogonal kV images and compare them to Digitally Reconstructed Radiographs (DRRs). The two sets of images are blended over each other and moved so that the markers in the kV image overlap with the corresponding structure in the DRR. Images courtesy of Dr Marcio Fagundes.
Matching CBCT to CT
It is sometimes beneficial to also visualize soft tissue using cone beam computed tomography (CBCT). The CBCT is then compared to CT. The two image sets then have to be compared in all three dimensions. Images courtesy of Dr Marcio Fagundes.