Respiratory motion management (4D-CT, gating, breath-hold, tracking)
Ways of dealing with tumours that move as the patient breathes: image the motion, treat only in part of the breathing cycle, hold the breath, or chase the tumour with the beam.
Overview
Lung, liver, pancreas and breast targets move by a centimetre or more with breathing. Four-dimensional CT captures the motion so the target volume can include it or be defined at one phase; respiratory gating switches the beam on only during that phase; deep-inspiration breath-hold freezes the anatomy and, in left breast treatment, moves the heart away from the beam; and real-time tracking with fiducial markers or MRI moves the beam or couch with the tumour. Motion management is what makes stereotactic body radiotherapy safe for small mobile targets.
How it works
Measure or constrain respiratory motion so the planned dose lands on the target rather than on the tissue it moves through.
- Smaller margins and less normal tissue dose
- Enables stereotactic treatment of moving targets
- Reduces heart dose in breast radiotherapy
- Longer sessions
- Some patients cannot hold their breath
- Fiducial placement is invasive
Latest papers
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