Prog Med Phys.  2024 Jun;35(2):21-35. 10.14316/pmp.2024.35.2.21.

Motion Management and Image-Guided Technique in Photon Radiation Therapy: A Review of an Advanced Technology

• Jegal J
• Park H
• Kang S
• Choi CH
• Kim Ji

• KMID: 2557156
• DOI: http://doi.org/10.14316/pmp.2024.35.2.21

Abstract

Herein, we provide a concise review of the critical role of motion management in radiation therapy, with a focus on photon radiation therapy, real-time control of respiratory motion, and image-guided radiation therapy (IGRT) in lung stereotactic body radiation therapy (SBRT). The dynamic nature of human anatomy, particularly in regions prone to movement such as the thoracic and abdominal areas, poses significant challenges in accurately targeting tumors during radiation therapy. This review explores the implications of organ and tumor motion, emphasizing the necessity for precise treatment delivery. We assess the advancements in four-dimensional (4D) imaging techniques such as 4D computed tomography, which provide time-resolved images for enhanced treatment planning. The review highlights various motion management strategies, including motionencompassing methods, respiratory-gating, breath-hold techniques, and real-time tumor tracking, discussing their implementation and impact on treatment efficacy. The role of IGRT in lung SBRT is particularly emphasized, showcasing how real-time imaging and advanced targeting techniques enhance the precision of high-dose radiation delivery while minimizing exposure to surrounding healthy tissues. This comprehensive review aims to underscore the significance of integrating motion management in radiation therapy, highlighting its pivotal role in improving treatment accuracy, reducing toxicity, and ultimately enhancing patient outcomes in cancer care.

Keyword

Image-guided radiation therapy; Respiratory motion management; Patient respiratory training; Real-time tumor tracking; Motion-encompassing strategies

Figure

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  Fig. 1 The changes of geometric relationships between the planning target volume (PTV) and organs at risk (OARs) (esophagus, heart and spinal cord) in difference respiratory phases. (a) Phase-wise PTVs in a coronal computed tomography (CT) image, (b) phase-wise expanded PTVs and OARs in an axial CT image, and (c) example of overlap volume historgram curves for esophagus. Reused from the article of Kang et al. (Oncotarget. 2017;9:205-216) [9].

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  Fig. 2 Dose-volumetric histograms of the gross tumor volume from various respiratory phases as well as the four-dimensional (4D) cumulative dose DVH (average). Reused from the article of Huang et al. (Radiat Oncol. 2010;5:45) [23].

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  Fig. 3 Axial CBCT section of phantom with simulated respiratory motion (a) with phase-based motion correction and (b) with principal component analysis-model-based correction. Display window settings are the same for all images. Reused from the article of Zhang et al. (Med Phys. 2010;37:2901-2909) [25].

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  Fig. 4 A patient using the active breathing coordinators (ABC) deep inspiration breath hold. Reused from the article of Parasuramar et al. (Int J Gynecol Clin Pract. 2017;4:133) [56].

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  Fig. 5 Gating apparatus. The real-time position management (RPM) system (Varian Medical Systems). Reused from the article of Pépin et al. (Nucl Med Commun. 2014;35:113-122) [49].

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  Fig. 6 The exeperimental setup of visual biofeedback (BFB) (a) and screenshot of BFB provided to the volunteers.

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  Fig. 7 Planning target volume (PTV) and internal target volume (ITV) volume in free breathing and deep inspiration breath-hold (DIBH). FB, free breathing. Reused from the article of Mani et al. (Polish J Med Phys Eng. 2018;24:15-24) [60].

• 

  Fig. 8 Example of waveforms for closed limits to interrupt beam if treatment amplitude is greater than simulation amplitude. Horizontal lines represent the upper (blue) and lower (orange) limits. The black curve is an example of a respiratory waveform during treatment greater than the original, and the green curve is the waveform from computed tomography (CT) simulation. The yellow shaded area indicates that the beam is on. Reused from the article of Cetnar et al. (J Appl Clin Med Phys. 2016;17:283-292) [72].

• 

  Fig. 9 Isodose distribution in free breathing (FB) and deep inspiration breath-hold (DIBH) plans for the same patient. (a) Axial scan and (b) oblique reconstruction with visualization of tangential irradiation fields including the adaptations of the multileaf collimators “beam’s eye view,” in FB; (c) axial scan and (d) oblique reconstruction with visualization of tangential irradiation fields including the adapted of the multileaf collimators “beam’s eye view,” in DIBH. Reused from the article of Wolf et al. (Strahlenther Onkol. 2023;199:379-388) [52].

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  Fig. 10 Photographs of a patient in the simulation procedure with the abdominal compression device equipment. Reused from the article of Huang et al. (PLoS One. 2014;9:e98033) [73].

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  Fig. 11 Image-guidance motion management devices for pretreatment image-guided radiation therapy (IGRT) (AlignRT). Note that, these devices are also available for the IGRT during treatment in combination with real-time tracking technologies. Reused from the article of Nguyen et al. (Phys Med. 2023;108:102567) [85]

Reference

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