© International Commission on Radiation Units and Measurements 2007
7 MOTION MANAGEMENT
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7.1 MOTION OF, AND WITHIN, THE PATIENT
The patient is not an inanimate object, but a living, breathing, and moving individual. The delivery of radiation to the target volume must involve first, an effort to minimize, to the extent reasonably possible, the motion and its uncertainties, and then taking the remaining motion and uncertainties into account.
Tumor and organ motion can be classified into three categories (Langen and Jones, 2001), namely, motion of the patient as a whole (relative to some reference object such as the couch top), inter-fraction motion of organs within the patient, and intra-fraction motion of organs within the patient during delivery of a single fraction.
7.2 SUPPORT AND IMMOBILIZATION
It is common to use some method of immobilization to better relate the patient to the treatment equipment. In some special
7.2.1. Proton-specific aspects of immobilization
7.2.2 Immobilization techniques
7.3 LOCALIZATION
7.3.1 Localization based on skin marks
7.3.2 Localization based on bony anatomy
7.3.3 Localization relative to the immobilization device
7.3.4 Localization based on identification of target-volume markers or the tumor itself
7.4 VERIFICATION
7.4.1 Verification using radiography
7.4.2 Verification using positron emission tomography
7.5 ORGAN MOTION
7.5.1 The measurement of organ motion
7.5.2 Organ motion in the absence of special measures
7.5.3 Organ motion under conditions of respiration gating
7.5.4 Organ motion with tumor tracking
7.6 COMPENSATION FOR PATIENT AND ORGAN MOTION
7.6.1 Margins at the periphery of the CTV or OARs: lateral margins
7.6.2 Margins at the periphery of the CTV or OARs: margin in depth
7.6.3 Dose variation within the CTV and OARs: interplay effects
7.6.3.1 Experimental observation of interplay effects
7.6.3.2 Repainting to reduce the influenceof interplay effects
7.7 CONCLUSION