This publication provides guidelines, and highlights the milestones to be achieved by radiotherapy departments in the safe and effective introduction of image guided radiotherapy. Recent advances in external beam radiotherapy include the technology to image the patient in the treatment position, in the treatment room at the time of treatment. Since this technology and associated image techniques, termed image guided radiotherapy, are perceived as the cutting-edge of development in the field of radiotherapy, this publication addresses the concerns of personnel in radiotherapy departments as to the preparatory conditions and resources involved in implementation. Information is also presented on the current status of the evidence supporting the use of image guided radiotherapy in terms of patient outcomes.