Gail Anastasi1, Jenny Bertholet2, Per Poulsen3, Toon Roggen4, Cristina Garibaldi5, Nina Tilly6, Jeremy T Booth7, Uwe Oelfke8, Ben Heijmen9, Marianne C Aznar10. 1. St. Luke's Cancer Centre, Royal Surrey Foundation Trust, Radiotherapy Physics, Guildford, United Kingdom. Electronic address: gail.distefano@nhs.net. 2. The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Joint Department of Physics, London, United Kingdom; Division of Medical Radiation Physics, Department of Radiation Oncology, Inselspital, Bern University Hospital, Switzerland. 3. Aarhus University Hospital, Department of Oncology and Danish Center for Particle Therapy, Aarhus, Denmark. 4. Varian Medical Systems Imaging Laboratory GmbH, Applied Research, Dättwil AG, Switzerland. 5. European Institute of Oncology IRCCS, IEO-Unit of Radiation Research, Milan, Italy. 6. Elekta Instruments AB, Stockholm, Sweden; Medical Radiation Physics, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden. 7. Royal North Shore Hospital, Northern Sydney Cancer Centre, Australia. 8. The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Joint Department of Physics, London, United Kingdom. 9. Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam, Netherlands. 10. Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom; Nuffield Department of Population Health, University of Oxford, United Kingdom.
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.
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.
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