Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I: Intra-fraction breathing motion management

Gail Anastasi, Jenny Bertholet, Per Poulsen, Toon Roggen, Cristina Garibaldi, Nina Tilly, Jeremy T. Booth, Uwe Oelfke, Ben Heijmen, Marianne C. Aznar

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)79-87
Number of pages9
JournalRadiotherapy and Oncology
Volume153
DOIs
Publication statusPublished - Dec 2020

Keywords

  • Breath hold
  • Gating
  • Intra-fractional motion
  • Real-time respiratory motion management
  • Tumour tracking

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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