Optimal Control of Motion in Stereotactic Body Radiation Therapy

Managing motion in stereotactic body radiation therapy presents intricate challenges, playing a crucial role in the successful implementation and delivery of stereotactic radiation treatment. This chapter delves into the origins of motion and explores different techniques to address these challenges. The focus includes an in-depth discussion of motion induced by respiration, encompassing various technologies and strategies that have been devised. This chapter covers motion management concepts from the planning phase to the execution of treatment, examining both established and emerging technologies. Considerations such as complexity, efficacy, and suitability to clinical treatment sites are explored. Technical details are provided for monitoring and measuring motion in stereotactic body radiation therapy, encompassing both X-ray radiation and non-X-ray radiation-based systems. Scope: Motion during the treatment process can stem from deliberate patient movement and involuntary movement. The latter may include respiration, cardiac function, peristaltic movements, and organ filling and emptying. Neglecting respiratory motion can result in imaging anomalies and uncertainties during simulation and treatment, impacting the overall accuracy of stereotactic body radiotherapy (SBRT) across imaging, planning, and treatment phases. Managing uncertainties in targeting specific areas is crucial at every stage of planning and treatment. This chapter focus on addressing respiratory motion to ensure the precise delivery of SBRT treatment, emphasizing its significance. In this context, the discussion encompasses identifying motion sources, outlining motion management concepts, and detailing systems used for monitoring and measuring motion. Although there is some overlap, the focus is on photon-based systems rather than proton-based ones. This chapter explores various possibilities related to gantry-mounted linear accelerator systems, their associated subsystems, and integrated dedicated systems.