Recent developments of image guided radiation therapy (IGRT), especially the On Board Imaging (OBI) system and the cone beam CT (CBCT), enable the radiation treatment more accurate and reliable. IGRT is widely used in the radiation therapy as a standard of care. Use of IGRT is even expected to increase in the near future. IGRT is only beneficial to patients when it is used with proper considerations of safety and appropriateness of the techniques. Institutional procedure should be developed based on the clinical need and the deep understanding of the system before applying the new technique to the clinic. Comprehensive QA program should be established before to the clinic and imaging dose should be considered when preparing the departmental practice guidelines for IGRT.

KeywordsIGRT, QA, Institutional procedure