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Motion Management - Coggle Diagram

- - - - robotic arms for the adjustment f the X-ray source position
      - robotic treatment couch
      - dynamic multi-leaf collimators
    - - indirect measurements of surrogate breathing signals and knowledge of the tumor surrogate correlation
        
        correlation with surrogates
        
        spirometria measurements
        
        surface fiducials
        
        Xray radiotherapy
        
        correlation models
        
        sparse data
        
        How to model?
        
        linear + polynomial correlation model
        
        1 more item...
        
        performance
        
        number of images
        
        counts in irregular breathers
        
        image sampling rate
        
        All phases of the breathing cycle need to be included
        
        stable in 1-4 min period
        
        alternative
        
        ANN
        
        Fuzzy logic
      - direct image of the lesion
        
        Marker-based
        
        Xray
        
        EM
        
        Markless
        
        Ultrasound
        
        Real time Xray image registration
        
        MRI
  - - - required
        
        interplay effects (active scanning)
        
        range uncertainties
        
        global models
        
        DRI : Deformable Image Registration
        
        Quantification of range variations
        
        3D imaging and IR localization integration
        
        Daily CBCT
        
        Continuos respiratory motion tracking
        
        Planning 4DCT
        
        requires specific in-beam /off-line QA
- - - - riduction of diaphragmatic excursion
    - - dose delivery during breathing interruption at a predefined phase
  - - - dose delivery during a specific window of the breathing cycle
      - Prospective 4D-CT for treatment planning (amplitude/phase)
      - Same motion tracking technology applied during treatment
      - End-exhale gating most reproducible/stable respiratory state
      - Limitations:
        
        Longer treatment duration
        
        residual motion in the gating window
    - - dynamic beam depositing to follow tumor motion