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A pilot study evaluating the effectiveness of dual-registration image-guided radiotherapy in patients with oropharyngeal cancer

Goldsworthy, Simon; Dakers, Marcus; Higgins, Steven; Barnes, Terri; Jankowska, Petra; Dogramadzi, Sanja; Latour, Jos M


Simon Goldsworthy

Marcus Dakers

Steven Higgins

Terri Barnes

Petra Jankowska

Jos M Latour


© 2017 Canadian Association of Medical Radiation Technologists Purpose The purpose of the article was to determine the impact of Dual Registration (DR) image-guided radiotherapy (IGRT) on clinical judgement and treatment delivery for patients with oropharyngeal cancer before implementation. Methods Ninety cone beam computed tomography images from 10 retrospective patients were matched using standard clipbox registration (SCR) and DR. Three IGRT specialist radiographers performed all registrations and evaluated by intraclass correlation to determine inter-rater agreement, Bland-Altman with 95% limits of agreement to determine differences between SCR and DR procedures, changes in clinical judgment, time taken to perform registrations, and radiographer satisfaction. Results Inter-rater agreement between radiographers using both SCR and DR was high (0.867 and 0.917, P ≤.0001). The 95% limits of agreement between SCR and DR procedures in the mediolateral, cranial–caudal, and ventrodorsal translational directions were −6.40 to +4.91, −7.49 to +6.05, and −7.00 to +5.44 mm, respectively. The mediolateral direction demonstrated significant proportional bias (P ≤.001) suggesting non-agreement between SCR and DR. Eighty percent of DR matches resulted in a change in clinical judgement to ensure maximum target coverage. Mean registration times for SCR and DR were 94 and 115 seconds, respectively, and radiographers found DR feasible and satisfactory. Conclusion The standard method using SCR in patients with oropharyngeal cancer underestimates the deviation in the lower neck. In these patients, DR is an effective IGRT tool to ensure target coverage of the inferior neck nodes and has demonstrated acceptability to radiotherapy clinical practice.


Goldsworthy, S., Dakers, M., Higgins, S., Barnes, T., Jankowska, P., Dogramadzi, S., & Latour, J. M. (2017). A pilot study evaluating the effectiveness of dual-registration image-guided radiotherapy in patients with oropharyngeal cancer. Journal of Medical Imaging and Radiation Sciences, 48(4), 377-384.

Journal Article Type Article
Acceptance Date May 26, 2017
Online Publication Date Oct 21, 2017
Publication Date Dec 1, 2017
Journal Journal of Medical Imaging and Radiation Sciences
Print ISSN 1939-8654
Electronic ISSN 1876-7982
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 48
Issue 4
Pages 377-384
Public URL
Publisher URL