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Motion management in Lung cancer
5/9/2024 1
Dr Kanhu Charan Patro
MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC
Clinical Director, HOD (Radiation Oncology)
ISRo- Institute of Stereotactic Radiation oncology
Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam
drkcpatro@gmail.com /M- +91-9160470564/ www.drkanhupatro.com
What is SBRT- THE TRIO?
• Ultrahigh dose radiotherapy
• Strict immobilization
• Motion management
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5/9/2024
4
Organs effected by respiration
• Lung
• Mediastinum
• Heart
• Breast
• Pancreas
• Liver
• Kidney
• Biliary
5/9/2024 5
Motion direction
• Superior inferior
• Mediolateral
• Anteroposterior
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Is lung moves?
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• Yes
• As you go from apex to Lower movement increases
• As you go from medial to lateral movement increases
MANAGEMENT OF DIFFUSE GLIOMAS
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Errors
Steps
SBRT WORKFLOW
Simulation Planning
TX
Deliver
y
Motion Verification Localization
Motion Management
Delivery
MANAGEMENT OF DIFFUSE GLIOMAS
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SBRT – Immobilization
ORGANS DO NOT FOLLOW STATUE GAME
Motion Management
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RADIATION ONCOLOGIST-THE ARJUN
Free breathing VS Motion managed
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Is motion being straight forward?
• No
• Hysterical motion
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GROSSLY
• ITV generation
• Abdominal compression
• Breath holding
• Gating
• Tracking
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What are available menu?
• ELEKTA – ABC - BREATHHOLD
• VARIAN - RPM
• CYBERKNIFE – SYNCHRONY
• CYBERKNIFE- FUDICAIL
• OTHER
– COMPRESSION- ABDOMINAL COMPRESSION
– ITV GENERATION
– VOLUNTARY BREATH HOLD
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ITV GENERATION
ITV GENERATION
• Fluoroscopy mode
• 4D CT
• SLOW CT
• MULTIPHASE CT
4D CT
1. 4D CT uses a new technology that captures the location
and movement of your tumor and the movement of your
body's organs over time.
2. This is valuable for accurately treating tumors located on or
near organs that move, such as those in the chest and
abdomen.
3. 4D CT describes various techniques for obtaining CT data
correlated with patient respiratory phase information so that the
changes associated with respiration (or other motion) are
displayed.
4. Phasing the respirtory cycle
Elekta symmetry Rspiratory phase acquisition
MULTI PHASE SCAN
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INSPIRATION EXPIRATION FREE BREATH
Artefact in
motion mx
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Slice
thickness
Pitch
Phase of
respiration
SLOW CT
Computed tomography scan operated slowly and/or
multiple slices taken are averaged, i.e. multiple phases of
respiration are recorded by slice
Generally available on most computed tomography
scanners.
Loss of resolution, which may lead to tumour blurring and
subsequent increase in observer error in tumour and OAR
delineation
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Abdominal compression
Abdominal compression
Breath holding
5/9/2024 40
HOLDING
Assists breath-hold by use of a valved spirometer. Often at
moderate or deep breath-hold.
Can reduce motion artefacts. Improvements in dose to
organs at risk. Potential for dose escalation compared
with free-breathing technique
Patient selection important; non-compliance of patients
with poor respiratory function. Increase in quality
assurance procedures
ELEKTA ABC
• Active breath coordinator
• Based on breath hold
• During breath hold treatment
• Works like spirometry
• Needs good lung function
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Nose and mouth peiece
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Green is the beam on
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Elekta ABC
VOLUNTARY BREATH HOLD USING WIRELESS DOOR BELL
GATING
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Particular
phase
ITV
GATING
1. Delivery of radiation within a specified part of the
patient’s breathing cycle termed ‘the gate’.
2. Phase or amplitude based.
3. Uses external respiration signal e.g. infrared,
spirometry, thermistors or internal fiducials. internal
fiducials.
4. Imaging and treatment synchronised with patient’s breathing
cycle
PHASE BASED TREATMENT-
CHOOSING PART OF DUTY CYCLE
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Varian RPM gating synchronization
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PRESSURE SENSOR GATING
Camera based gating
5/9/2024 58
Vision RT- SGRT - GATE RT
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Tracking
5/9/2024 61
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Synchrony
IN SUMMARY
• External signal – Gating
– Amplitude based
– Phase based
• Internal signal - Tracking
• Breath hold is also a type of amplitude based
gating
5/9/2024 74
5/9/2024
Various Motion management systems
5/9/2024 76
5/9/2024
MOTION MANGEMENT VIDEO
WHICH MOTION MANAGEMENT
SYSTEM IS BETTER?
GOSSIP- WHOSE SPOUSE IS BETTER?
ANSWER- WHAT MANAGEMENT ACQUIRES
Managing the Management
Stereotaxy
class
Target delineation class
Radiology class
Neurooncology Class
SRS/SBRT
Scan through Google lens
Go to free materials
5/9/2024 90
Kanhu
5/9/2024 91

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