Highlights
- •Summary of image guidance to localize the target in real-time for intra-fraction motion.
- •Discussion of state-of-the art respiratory motion management.
- •Approaches to real-time tracking.
- •Real-time tracking technologies in clinical trial and clinical use.
- •Clinical application of real-time MRI soft-tissue imaging for real-time adaptive treatments.
Abstract
The technology of treating SBRT targets that move with respiration has undergone profound
changes over the last 20 years. This review article summarizes modern image guidance
to localize the target in real-time to account for intra-fraction motion. The state-of-the
art respiratory motion compensation techniques will be discussed, including the determination
and application of appropriate margins. This includes compression, gating and breath-hold,
including the use of audiovisual feedback to manage motion. Approaches to real-time
tracking include the use of hybrid external-internal imaging to build a skin-to-tumor
correlation, which can then be tracked with a mobile robot (CyberKnife Synchrony,
clinical since 2003) as well as the use of non-ionizing electromagnetic tumor surrogate
localization followed by real-time tracking with a moving MLC (in clinical trials
in Europe and Australia). Lastly, the clinical application of real-time MRI soft-tissue
imaging to deliver adaptive, iso-toxic treatments will be presented.
Keywords
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Article info
Publication history
Accepted:
October 25,
2018
Received in revised form:
October 18,
2018
Received:
June 5,
2017
Identification
Copyright
© 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
