Abstract
Organ motion is a substantial concern in the treatment of thoracic tumours using radiotherapy. A number of technologies have evolved in order to address this concern in both the fields of CT imaging and radiation delivery. This review paper investigates the technologies which have been developed for the delivery of radiotherapy as well as the accuracy and workload implications of their use. Treatment techniques investigated include: breath hold, breath gating, robotic compensation and MLC manipulation. Each technique has its own advantages and drawbacks in regards to accuracy, treatment time, linac alterations and workload. Further, some treatment techniques have specific requirements for what kind of CT scans needs to be used in the planning process. This, along with the aforementioned considerations, could influence the decision as to implement some of these treatment techniques in the clinic.
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References
Keall PJ et al (2006) The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys 33(10):3874–3900
ICRU (1993) ICRU report 50: prescribing, recording, and reporting photon beam therapy. International Commission on Radiation Units and Measurements, Bethesda, Marylands
ICRU (1999) ICRU report 62: prescribing, recording and reporting photon beam therapy. International Commission on Radiation Units and Measurements, Bethesda, Marylands
ICRU (2004) ICRU report 71: prescribing, recording, and reporting electron beam therapy. International Commission on Radiation Units and Measurements, Bethesda, Marylands
ICRU (2007) ICRU report 78: prescribing, recording, and reporting proton-beam therapy. International Commission on Radiation Units and Measurements, Bethesda, Marylands
ICRU (2010) ICRU report 83: prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT). International Commission on Radiation Units and Measurements, Bethesda, Marylands
Hanley J et al (1999) Deep inspiration breath-hold technique for lung tumors: the potential value of target immobilization and reduced lung density in dose escalation. Int J Radiat Oncol Biol Phys 45(3):603–611
Moorrees J, Bezak E (2012) Four dimensional CT imaging: a review of current technologies and modalities. Aust Phys Eng Sci Med 35(1):9–23
Wong JW et al (1999) The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phy 44(4):911–919
Mah D et al (2000) Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer. Int J Radiat Oncol Biol Phys 48(4):1175–1185
Kim DJW et al (2001) Held-breath self-gating technique for radiotherapy of non-small-cell lung cancer: a feasibility study. Int J Radiat Oncol Biol Phys 49(1):43–49
Rosenzweig KE et al (2000) The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 48(1):81–87
Remouchamps VM et al (2003) Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. Int J Radiat Oncol Biol Phys 56(3):704–715
Cervino L et al (2009) Using surface imaging and visual coaching to improve the reproducibility and stability of deep-inspiration breath hold for left-breast-cancer radiotherapy. Phys Med Biol 54:6853–6865
Barnes EA et al (2001) Dosimetric evaluation of lung tumor immobilization using breath hold at deep inspiration. Int J Radiat Oncol Biol Phys 50(4):1091–1098
Ohara K et al (1989) Irradiation synchronized with respiration gate. Int J Radiat Oncol Biol Phys 17(4):853–857
Minohara S et al (2000) Respiratory gated irradiation system for heavy-ion radiotherapy. Int J Radiat Oncol Biol Phys 47(4):1097–1103
Vedam SS et al (2001) Determining parameters for respiration-gated radiotherapy. Med Phys 28(10):2139–2146
Shen S et al (2003) Validation of target volume and position in respiratory gated CT planning and treatment. Med Phys 30(12):3196–3205
Cui Y et al (2007) Robust fluoroscopic respiratory gating for lung cancer radiotherapy without implanted fiducial markers. Phys Med Biol 52:741–755
Cho B et al (2008) A monoscopic method for real-time tumour tracking using combined occasional X-ray imaging and continuous respiratory monitoring. Phys Med Biol 53:2837–2855
Seppenwoolde Y et al (2007) Accuracy of tumor motion compensation algorithm from a robotic respiratory tracking system: a simulation study. Med Phys 34(7):2774–2784
D’Souza W, Naqvi S, Yu C (2005) Real-time intra-fraction-motion tracking using the treatment couch: a feasibility study. Phys Med Biol 50:4021–4030
Keall P et al (2001) Motion adaptive X-ray therapy: a feasibility study. Phys Med Biol 46:1–10
Sawant A et al (2008) Management of three-dimensional intrafraction motion through real-time DMLC tracking. Med Phys 35(5):2050–2061
Cho B et al (2009) First demonstration of combined kV/MV image-guided real-time dynamic multileaf-collimator target tracking. Int J Radiat Oncol Biol Phys 74(3):859–867
Keall PJ et al (2004) On the use of EPID-based implanted marker tracking for 4D radiotherapy. Med Phys 31(12):3492–3499
Keall PJ et al (2006) Geometric accuracy of a real-time target tracking system with dynamic multileaf collimator tracking system. Int J Radiat Oncol Biol Phys 65(5):1579–1584
Yi BY et al (2008) Real-time tumor tracking with preprogrammed dynamic multileaf-collimator motion and adaptive dose-rate regulation. Med Phys 35(9):3955–3962
McQuaid D, Webb S (2008) Target-tracking deliveries using conventional multileaf collimators planned with 4D direct-aperture optimization. Phys Med Biol 53:4013–4029
Ozhasoglu C, Murphy MJ (2002) Issues in respiratory motion compensation during external-beam radiotherapy. Int J Radiat Oncol Biol Phys 52(5):1389–1399
Gui M et al (2010) Four-dimensional intensity-modulated radiation therapy planning for dynamic tracking using a direct aperture deformation (DAD) method. Med Phys 37(5):1966–1975
Suh Y et al (2009) Four-dimensional IMRT treatment planning using a DMLC motion-tracking algorithm. Phys Med Biol 54:3821–3835
Suh Y et al (2008) A deliverable four-dimensional intensity-modulated radiation therapy-planning method for dynamic multileaf collimator tumor tracking delivery. Int J Radiat Oncol Biol Phys 71(5):1526–1536
Krauss A et al (2011) Electromagnetic real-time tumor position monitoring and dynamic multileaf collimator tracking using a Siemens 160 MLC: geometric and dosimetric accuracy of an integrated system. Int J Radiat Oncol Biol Phys 79(2):579–587
Poulsen PR et al (2010) Dynamic multileaf collimator tracking of respiratory target motion based on a single kilovoltage imager during arc radiotherapy. Int J Radiat Oncol Biol Phys 77(2):600–607
Poulsen PR et al (2010) Detailed analysis of latencies in image-based dynamic MLC tracking. Med Phys 37(9):4998–5005
Ren Q et al (2007) Adaptive prediction of respiratory motion for motion compensation radiotherapy. Phys Med Biol 52:6651–6661
Smith RL et al (2009) Integration of real-time internal electromagnetic position monitoring coupled with dynamic multileaf collimator tracking: an intensity-modulated radiation therapy feasibility study. Int J Radiat Oncol Biol Phys 74(3):868–875
Sharp GC et al (2004) Prediction of respiratory tumour motion for real-time image-guided radiotherapy. Phys Med Biol 49(3):425
Tewatia D et al (2006) Clinical implementation of target tracking by breathing synchronized delivery. Med Phys 33(11):4330–4336
Neicu T et al (2003) Synchronized moving aperture radiation therapy (SMART): average tumour trajectory for lung patients. Phys Med Biol 48:587–598
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Moorrees, J., Bezak, E. Four dimensional radiotherapy: a review of current technologies and modalities. Australas Phys Eng Sci Med 35, 399–406 (2012). https://doi.org/10.1007/s13246-012-0178-5
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DOI: https://doi.org/10.1007/s13246-012-0178-5