A Review of the Clinical Introduction of 4D Particle Therapy Research Concepts

Overview

Journal Phys Imaging Radiat Oncol

Specialty Oncology

Date 2024 Feb 1

PMID 38298885

Authors

Barbara Knausl

Gabriele Belotti

Jenny Bertholet

Juliane Daartz

Stella Flampouri

Mischa Hoogeman

Antje C Knopf

Haibo Lin

Astrid Moerman

Chiara Paganelli

Antoni Rucinski

Reinhard Schulte

Shing Shimizu

Kristin Stutzer

Xiaodong Zhang

Ye Zhang

Katarzyna Czerska

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Many 4D particle therapy research concepts have been recently translated into clinics, however, remaining substantial differences depend on the indication and institute-related aspects. This work aims to summarise current state-of-the-art 4D particle therapy technology and outline a roadmap for future research and developments.

Material And Methods: This review focused on the clinical implementation of 4D approaches for imaging, treatment planning, delivery and evaluation based on the 2021 and 2022 as well as a review of the most recent surveys, guidelines and scientific papers dedicated to this topic.

Results: Available technological capabilities for motion surveillance and compensation determined the course of each 4D particle treatment. 4D motion management, delivery techniques and strategies including imaging were diverse and depended on many factors. These included aspects of motion amplitude, tumour location, as well as accelerator technology driving the necessity of centre-specific dosimetric validation. Novel methodologies for X-ray based image processing and MRI for real-time tumour tracking and motion management were shown to have a large potential for online and offline adaptation schemes compensating for potential anatomical changes over the treatment course. The latest research developments were dominated by particle imaging, artificial intelligence methods and FLASH adding another level of complexity but also opportunities in the context of 4D treatments.

Conclusion: This review showed that the rapid technological advances in radiation oncology together with the available intrafractional motion management and adaptive strategies paved the way towards clinical implementation.

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