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Real-time intrafraction motion monitoring in external beam radiotherapy

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DOI

  • Jenny Bertholet
  • Antje Knopf, Univ Groningen, University of Groningen, Univ Med Ctr Groningen, Dept Radiat Oncol
  • ,
  • Bjorn Eiben, UCL, University of London, University College London, Dept Med Phys & Biomed Engn, Ctr Med Image Comp
  • ,
  • Jamie McClelland, UCL, University of London, University College London, Dept Med Phys & Biomed Engn, Ctr Med Image Comp
  • ,
  • Alexander Grimwood, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England.
  • ,
  • Emma Harris, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England.
  • ,
  • Martin Menten, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England.
  • ,
  • Per Poulsen
  • Doan Trang Nguyen, Univ Technol Sydney, University of Technology Sydney, Sch Biomed Engn, University of Sydney, Australia
  • ,
  • Paul Keall, University of Sydney, Australia
  • ,
  • Uwe Oelfke, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, England.

Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to 'see what we treat, as we treat' and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs.

In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation.

Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT.

OriginalsprogEngelsk
Artikelnummer15TR01
TidsskriftPhysics in Medicine and Biology
Vol/bind64
Nummer15
ISSN0031-9155
DOI
StatusUdgivet - aug. 2019

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