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Motion Management in SBRT: Principles, Advances and Clinical Implementations

Y Rong1*, L Ren2*, P Keall3*, (1) University of California-Davis, Sacramento, CA, (2) Duke University Medical Center, Durham, NC, (3) University of Sydney, Camperdown, NSW


(Thursday, 8/2/2018) 10:00 AM - 11:00 AM

Room: Karl Dean Ballroom A2

SBRT has become an effective paradigm to treat tumors in lung and abdominal regions. Due to the effects of respiratory motions in these regions, it is critical to develop robust and efficient motion management strategies to ensure the precision of SBRT from simulation, planning to localization and delivery. Various motion management techniques have been developed and implemented in practice in recent years. This education course aims to review the basic principles of motion management, introduce recent technology advances and provide instructions on the clinical implementations of the techniques.

The course will first discuss the sources and the effects of motion in SBRT treatments. Approaches to assess and account for motion in the SBRT workflow will be illustrated, including 4D imaging for motion assessment during simulation, incorporating motion information in the planning process, and monitoring motion during the treatment using various on-board imaging techniques. Then several strategies for minimizing and managing the respiratory motion will be introduced, including breath-hold, respiratory gating, automatic breathing control, abdominal compression, and coaching. The principles, technical details, and clinical implications of each strategy will be discussed. Finally, recent advances will be reviewed for active tumor tracking using marker or markerless based approaches on different types of radiotherapy units. Overall, the course aims to help attendees understand the sources and effects of motion, learn current practice and recent advances in motion management, and develop effective strategies to implement motion management for SBRT based on their clinical settings.

Learning Objectives:
1. Understand the sources and effects of motion on SBRT and the process for incorporating and monitoring motion in the clinical workflow
2. Understand the strategies to minimize and manage respiratory motion in SBRT. Learn the advantages and limitations of each strategy, and the clinical workflow to implement the techniques.
3. Learn the recent advances in motion tracking, and understand their potential clinical impact and future directions.

Funding Support, Disclosures, and Conflict of Interest: Dr. Ren is supported by NIH R01-CA184173. Dr. Keall has ~30 awarded patents and pending applications, holds licenses to Leo, Opus, Standard Imaging, Varian, and has ownership in Cancer Research Innovations (Partner), Leo (Founder), Opus (Founder), SeeTreat (Founder). He is also supported by grants from IBA, Philips, Siemens, and Varian.



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