Computed tomography guided management of interfractional patient variation.
Interfractional patient variation occurs regularly and considerably during the radiotherapy course. Consequently, a generic but large planning target margin has to be applied when patient treatment plan design based on a single pre-treatment computed tomography scan is used to guide multifraction radiation treatment, which creates a major limiting factor for radiotherapy improvement. Planning target margins can be significantly reduced using multiple (or 4-dimensional) image feedback management in the routine treatment process. The most effective method in multiple-image feedback management of radiotherapy is the adaptive control methodology. The adaptive radiotherapy technique aims to customize each patient's treatment plan to patient-specific variation by evaluating and characterizing the systematic and random variations through image feedback and including them in adaptive planning. Adaptive radiotherapy will become a new treatment standard, in which a predesigned adaptive treatment strategy, including the schedules of imaging and replanning, will eventually replace the predesigned treatment plan in the routine clinical practice.
Yan
Di
D
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA. dyan@beaumont.edu
Lockman
David
D
Martinez
Alvaro
A
Wong
John
J
Brabbins
Donald
D
Vicini
Frank
F
Liang
Jian
J
Kestin
Larry
L
D019583:Dose Fractionation, Radiation; D006801:Humans; D009068:Movement; D009369:Neoplasms / Q000532:radiotherapy*; D015641:Radiography, Interventional; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D011881:Radiotherapy, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed