Radiotherapy in Practice – Imaging HoskinP GohV ISBN: 978-0-199-23132-4

Abstract

A recent “point/counterpoint” article in Medical Physics (May 2010) discussed the adequacy of training programs in reflecting the heightened importance of medical imaging. The article discussed this in relation to medical physics training, but it highlighted this need within all professional disciplines owing to our increasing dependence on imaging within the field of radiotherapy; both pre-treatment and during treatment through newly available image guidance technologies. This book, one in a series examining practical aspects of radiotherapy, helps to fill the gap in training in a detailed and highly illustrative way. As with the other books in the series edited by Peter Hoskin, it is a multi-author work examining the role of imaging in each major clinical site. There are good general introductory chapters on the role of imaging and the basic principles for plain radiographs, CT, ultrasound, MR, radionuclide and PET imaging. The clinical chapters have a consistent format that discuss clinical background, diagnosis, TNM staging, radiotherapy imaging and target volume definition, therapeutic assessment, follow-up and including a bullet-point summary for all clinical sites. Each chapter can stand alone, which allows the reader to dive straight into their own clinical specialty, and there is excellent use of illustrations throughout all chapters, some in colour. The sections on TNM staging are clearly laid out and particularly comprehensive and informative for the reader. There is a welcome chapter on the concomitant doses involved with imaging at all stages in the patient pathway, and the importance of understanding and recording these as part of the clinical protocol, particularly with respect to the IR(ME)R. Like other chapters it is extremely informative and discusses typical doses and risk factors in the clinical setting. If there are any complaints, they are minor ones. It would have been useful, particularly now that on-treatment volumetric imaging is now (technically) widely available, to discuss how this is beginning to help adapt radiotherapy in vivo, both geometrically and dosimetrically. Similarly, aspects of four dimensional imaging (both pre-treatment and on-treatment) could have been expanded upon more; particularly as it tremendously enhances our ability to define and treat more accurately our clinical target volumes for lung tumours. It may also have been useful to tabulate the good information on target volume definition (in particular margins used and their derivation) in the same style as the excellent TNM staging discussions. However, the authors cannot be expected to write about every development – or the work would never get submitted for publication! This does not detract from what is an extremely comprehensive work for which the authors and editors should be commended. The book is stated as being primarily for clinical oncologists and radiologists, but it has a place within training programs for both physicists and radiographers too, particularly those specialising in virtual simulation and computerised treatment planning. Overall, it is a welcome addition to radiotherapy and oncology teaching, an excellent work and highly recommended.