Real-time intrafraction motion monitoring in external beam radiotherapy
File(s)Bertholet_2019_Phys._Med._Biol._64_15TR01.pdf (3.36 MB)
Published version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2019-08-07
Date Acceptance
2019-06-21
Citation
Physics in Medicine and Biology, 2019, 64 (15), pp.15TR01-15TR01
ISSN
0031-9155
Publisher
IOP Publishing
Start Page
15TR01
End Page
15TR01
Journal / Book Title
Physics in Medicine and Biology
Volume
64
Issue
15
Copyright Statement
© 2019 Institute of Physics and Engineering in Medicine. Original content from this work may be used under the terms of the Creative Commons Attribution 3.0 licence.Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31226704
Subjects
0299 Other Physical Sciences
0903 Biomedical Engineering
Nuclear Medicine & Medical Imaging
Publication Status
Published
Coverage Spatial
England