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Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I: intra-fraction breathing motion management
Anastasi, G Bertholet, J Poulsen, P Roggen, T Garibaldi, C Tilly, N Booth, JT Oelfke, U Heijmen, B Aznar, Marianne Camille
Anastasi, G
Bertholet, J
Poulsen, P
Roggen, T
Garibaldi, C
Tilly, N
Booth, JT
Oelfke, U
Heijmen, B
Aznar, Marianne Camille
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Abstract
Purpose: The POP-ART RT study aims to determine to what extent and how intra-fractional real-time respiratory motion management (RRMM) and plan adaptation for inter-fractional anatomical changes (ART), are used in clinical practice and to understand barriers to implementation. Here we report on part I: RRMM.
Material and methods: A questionnaire was distributed worldwide to assess current clinical practice, wishes for expansion or new implementation and barriers to implementation. RRMM was defined as inspiration/expiration gating in free-breathing or breath-hold, or tracking where the target and the beam are continuously realigned.
Results: The questionnaire was completed by 200 centres from 41 countries. RRMM was used by 68% of respondents ('users') for a median (range) of 2 (1-6) tumour sites. Eighty-one percent of users applied inspiration breath-hold in at least one tumour site (breast: 96%). External marker was used to guide RRMM by 61% of users. KV/MV imaging was frequently used for liver and pancreas (with fiducials) and for lung (with or without fiducials). Tracking was mainly performed on robotic linacs with hybrid internal-external monitoring. For breast and lung, approximately 75% of respondents used or wished to implement RRMM, which was lower for liver (44%) and pancreas (27%). Seventy-one percent of respondents wished to implement RRMM for a new tumour site. Main barriers were human/financial resources and capacity on the machine.
Conclusion: Sixty-eight percent of respondents used RRMM and 71% wished to implement RRMM for a new tumour site. The main barriers to implementation were human/financial resources and capacity on treatment machines.
Keywords: Breath hold; Gating; Intra-fractional motion; Real-time respiratory motion management; Tumour tracking.
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Date
2020
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Article
Citation
Anastasi G, Bertholet J, Poulsen P, Roggen T, Garibaldi C, Tilly N, et al. Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I: Intra-fraction breathing motion management. Radiother Oncol. 2020.