It is well established within the radiotherapy community that image-guided radiotherapy (IGRT) is in a perpetual state of evolution and requires a multi-professional approach to ensure early adoption of new equipment and IGRT techniques and that processes are implemented rapidly and successfully within radiotherapy departments. We aim to use the example of the development of IGRT over a 10-year period, in a single centre, to highlight the different aspects involved in planning IGRT delivery.