- •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.
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.
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Accepted: October 25, 2018
Received in revised form: October 18, 2018
Received: June 5, 2017
© 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.