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BACKGROUND: Image-guided radiation therapy (IGRT) is a novel array of in-room imaging modalities that are usedfor tumor localization and patient setup in radiation oncology. The prevalence of IGRT use among US radiation oncologists is unknown. METHODS: A random sample of 1600 radiation oncologists was surveyed by Internet, e-mail and fax regarding the frequency of IGRT use, clinical applications, and future plans for use. The definition ofIGRT included imaging technologies that are used for setup verification or tumor localization during treatment.RESULTS: Of 1089 evaluable respondents, 393 responses (36.1%) were received. The proportion of radiation oncologists using IGRT was 93.5%. When the use of megavoltage (MV) portal imaging was excluded from the definition ofIGRT, the proportion using IGRT was 82.3%. The majority used IGRT rarely (in <25% of their patients; 28.9%) or infrequently (in 25%-50% of their patients; 33.1%). The percentages using ultrasound, video, MV-planar, kilovoltage (kV)-planar, and volumetric technologies were 22.3%, 3.2%, 62.7%, 57.7%, and 58.8%, respectively. Among IGRT users, themost common disease sites treated were genitourinary (91.1%), head and neck (74.2%), central nervous system(71.9%), and lung (66.9%). Overall, 59.1% of IGRT users planned to increase use, and 71.4% of nonusers planned toadopt IGRT in the future. CONCLUSIONS: IGRT is widely used among radiation oncologists. On the basis of prospective plans of responders, its use is expected to increase. Further research will be required to determine the safety,cost efficacy, and optimal applications of these technologies. [ABSTRACT FROM AUTHOR]