Table 5 Open in new tab Different...

System 1: Isocentric C-arm linear accelerator with X-ray or MRI guidance (LINAC)
Beam gating for beam on/off control to minimize treated volume due to respiratory motion High-dose rate and fast dose delivery (using FFF beams) High conformity, steep dose gradient, and fast delivery of high dose (using IMRT, IMAT, VMAT, and MLC) 6D treatment couch for compensation of patient's position and orientation detected during verification imaging	Treatment at free breathing ITV concept to cover all predicted target positions based on simulation imaging (e.g. 4DCT and multiple single-phase CT) ITV concept with application of abdominal press to reduce respiratory motion range decreasing treated volume but keeping ‘free‘ breathing Beam gating at selected phase of respiratory cycle (e.g. expiration) controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT acquired using same respiratory phase monitor Treatment at breath-hold Beam gating at selected breath hold controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT	Pre-treatment (repeated during treatment in addition) non-gated 3D CT Pre-treatment (repeated during treatment in addition) gated 3D CT or 4D CT registered to same-phase reference planning CT 3D MRI to match with reference MRI planning images with 2D single-slice MRI of liver dome at breath hold for beam gating
Treatment planning based on: X-ray 3D/4D CT (cone beam CT) 3D MRI

System 1: Isocentric C-arm linear accelerator with X-ray or MRI guidance (LINAC)

Methods and characteristics of dose delivery and verification imaging

Motion management approaches (respiratory motion)

Delivery guidance approaches

Beam gating for beam on/off control to minimize treated volume due to respiratory motion
High-dose rate and fast dose delivery (using FFF beams)
High conformity, steep dose gradient, and fast delivery of high dose (using IMRT, IMAT, VMAT, and MLC)
6D treatment couch for compensation of patient's position and orientation detected during verification imaging

Treatment at free breathing

ITV concept to cover all predicted target positions based on simulation imaging (e.g. 4DCT and multiple single-phase CT)
ITV concept with application of abdominal press to reduce respiratory motion range decreasing treated volume but keeping ‘free‘ breathing
Beam gating at selected phase of respiratory cycle (e.g. expiration) controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT acquired using same respiratory phase monitor

Treatment at breath-hold

Beam gating at selected breath hold controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT

Pre-treatment (repeated during treatment in addition) non-gated 3D CT
Pre-treatment (repeated during treatment in addition) gated 3D CT or 4D CT registered to same-phase reference planning CT
3D MRI to match with reference MRI planning images with 2D single-slice MRI of liver dome at breath hold for beam gating

Treatment planning based on:

X-ray 3D/4D CT (cone beam CT)
3D MRI

System 1: Isocentric C-arm linear accelerator with X-ray or MRI guidance (LINAC)
Beam gating for beam on/off control to minimize treated volume due to respiratory motion High-dose rate and fast dose delivery (using FFF beams) High conformity, steep dose gradient, and fast delivery of high dose (using IMRT, IMAT, VMAT, and MLC) 6D treatment couch for compensation of patient's position and orientation detected during verification imaging	Treatment at free breathing ITV concept to cover all predicted target positions based on simulation imaging (e.g. 4DCT and multiple single-phase CT) ITV concept with application of abdominal press to reduce respiratory motion range decreasing treated volume but keeping ‘free‘ breathing Beam gating at selected phase of respiratory cycle (e.g. expiration) controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT acquired using same respiratory phase monitor Treatment at breath-hold Beam gating at selected breath hold controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT	Pre-treatment (repeated during treatment in addition) non-gated 3D CT Pre-treatment (repeated during treatment in addition) gated 3D CT or 4D CT registered to same-phase reference planning CT 3D MRI to match with reference MRI planning images with 2D single-slice MRI of liver dome at breath hold for beam gating
Treatment planning based on: X-ray 3D/4D CT (cone beam CT) 3D MRI

System 2: Stereotactic robotic system CyberKnife
High-dose rate and fast dose delivery (using FFF beams) Robotic technology for maximum flexibility of beam directions for high conformity and gradient of dose distributions Three types of secondary collimator (including extra-small apertures) for high conformity and gradient of dose distributions Integrated compensation of spatial deviations, including patient orientation and 3D position of target Target tracking (by treatment beams) based on correlation model between target position and signal of LEDs placed on patient's chest to minimize target positional uncertainty and treated volume due to respiratory motion at free breathing	Treatment at free breathing Target tracking using: ICD lead Temporary pacing lead Fiducial placed before therapy delivery	Pre-treatment 6D correction of patient orientation based on pair of X-ray images auto-registered to DRRs On-treatment beam position and direction corrections and tracking based on continuous monitoring of target surrogate 3D position detected from X-ray images correlated with signal of external respiratory monitor

System 2: Stereotactic robotic system CyberKnife

Methods and characteristics of dose delivery and verification imaging

Motion management approaches

Delivery guidance approaches

High-dose rate and fast dose delivery (using FFF beams)
Robotic technology for maximum flexibility of beam directions for high conformity and gradient of dose distributions
Three types of secondary collimator (including extra-small apertures) for high conformity and gradient of dose distributions
Integrated compensation of spatial deviations, including patient orientation and 3D position of target
Target tracking (by treatment beams) based on correlation model between target position and signal of LEDs placed on patient's chest to minimize target positional uncertainty and treated volume due to respiratory motion at free breathing

Treatment at free breathing
Target tracking using:

ICD lead
Temporary pacing lead
Fiducial placed before therapy delivery

Pre-treatment 6D correction of patient orientation based on pair of X-ray images auto-registered to DRRs
On-treatment beam position and direction corrections and tracking based on continuous monitoring of target surrogate 3D position detected from X-ray images correlated with signal of external respiratory monitor

System 2: Stereotactic robotic system CyberKnife
High-dose rate and fast dose delivery (using FFF beams) Robotic technology for maximum flexibility of beam directions for high conformity and gradient of dose distributions Three types of secondary collimator (including extra-small apertures) for high conformity and gradient of dose distributions Integrated compensation of spatial deviations, including patient orientation and 3D position of target Target tracking (by treatment beams) based on correlation model between target position and signal of LEDs placed on patient's chest to minimize target positional uncertainty and treated volume due to respiratory motion at free breathing	Treatment at free breathing Target tracking using: ICD lead Temporary pacing lead Fiducial placed before therapy delivery	Pre-treatment 6D correction of patient orientation based on pair of X-ray images auto-registered to DRRs On-treatment beam position and direction corrections and tracking based on continuous monitoring of target surrogate 3D position detected from X-ray images correlated with signal of external respiratory monitor

Table 5

Open in new tab

Different available systems

System 1: Isocentric C-arm linear accelerator with X-ray or MRI guidance (LINAC)
Methods and characteristics of dose delivery and verification imaging	Motion management approaches (respiratory motion)	Delivery guidance approaches
Beam gating for beam on/off control to minimize treated volume due to respiratory motion High-dose rate and fast dose delivery (using FFF beams) High conformity, steep dose gradient, and fast delivery of high dose (using IMRT, IMAT, VMAT, and MLC) 6D treatment couch for compensation of patient's position and orientation detected during verification imaging	Treatment at free breathing ITV concept to cover all predicted target positions based on simulation imaging (e.g. 4DCT and multiple single-phase CT) ITV concept with application of abdominal press to reduce respiratory motion range decreasing treated volume but keeping ‘free‘ breathing Beam gating at selected phase of respiratory cycle (e.g. expiration) controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT acquired using same respiratory phase monitor Treatment at breath-hold Beam gating at selected breath hold controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT	Pre-treatment (repeated during treatment in addition) non-gated 3D CT Pre-treatment (repeated during treatment in addition) gated 3D CT or 4D CT registered to same-phase reference planning CT 3D MRI to match with reference MRI planning images with 2D single-slice MRI of liver dome at breath hold for beam gating
Treatment planning based on: X-ray 3D/4D CT (cone beam CT) 3D MRI

System 1: Isocentric C-arm linear accelerator with X-ray or MRI guidance (LINAC)
Beam gating for beam on/off control to minimize treated volume due to respiratory motion High-dose rate and fast dose delivery (using FFF beams) High conformity, steep dose gradient, and fast delivery of high dose (using IMRT, IMAT, VMAT, and MLC) 6D treatment couch for compensation of patient's position and orientation detected during verification imaging	Treatment at free breathing ITV concept to cover all predicted target positions based on simulation imaging (e.g. 4DCT and multiple single-phase CT) ITV concept with application of abdominal press to reduce respiratory motion range decreasing treated volume but keeping ‘free‘ breathing Beam gating at selected phase of respiratory cycle (e.g. expiration) controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT acquired using same respiratory phase monitor Treatment at breath-hold Beam gating at selected breath hold controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT	Pre-treatment (repeated during treatment in addition) non-gated 3D CT Pre-treatment (repeated during treatment in addition) gated 3D CT or 4D CT registered to same-phase reference planning CT 3D MRI to match with reference MRI planning images with 2D single-slice MRI of liver dome at breath hold for beam gating
Treatment planning based on: X-ray 3D/4D CT (cone beam CT) 3D MRI

System 1: Isocentric C-arm linear accelerator with X-ray or MRI guidance (LINAC)

Methods and characteristics of dose delivery and verification imaging

Motion management approaches (respiratory motion)

Delivery guidance approaches

Beam gating for beam on/off control to minimize treated volume due to respiratory motion
High-dose rate and fast dose delivery (using FFF beams)
High conformity, steep dose gradient, and fast delivery of high dose (using IMRT, IMAT, VMAT, and MLC)
6D treatment couch for compensation of patient's position and orientation detected during verification imaging

Treatment at free breathing

ITV concept to cover all predicted target positions based on simulation imaging (e.g. 4DCT and multiple single-phase CT)
ITV concept with application of abdominal press to reduce respiratory motion range decreasing treated volume but keeping ‘free‘ breathing
Beam gating at selected phase of respiratory cycle (e.g. expiration) controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT acquired using same respiratory phase monitor

Treatment at breath-hold

Beam gating at selected breath hold controlled by respiratory phase monitor with target defined and treatment plan optimized on same-phase simulation CT

Pre-treatment (repeated during treatment in addition) non-gated 3D CT
Pre-treatment (repeated during treatment in addition) gated 3D CT or 4D CT registered to same-phase reference planning CT
3D MRI to match with reference MRI planning images with 2D single-slice MRI of liver dome at breath hold for beam gating

Treatment planning based on:

X-ray 3D/4D CT (cone beam CT)
3D MRI

System 2: Stereotactic robotic system CyberKnife
Methods and characteristics of dose delivery and verification imaging	Motion management approaches	Delivery guidance approaches
High-dose rate and fast dose delivery (using FFF beams) Robotic technology for maximum flexibility of beam directions for high conformity and gradient of dose distributions Three types of secondary collimator (including extra-small apertures) for high conformity and gradient of dose distributions Integrated compensation of spatial deviations, including patient orientation and 3D position of target Target tracking (by treatment beams) based on correlation model between target position and signal of LEDs placed on patient's chest to minimize target positional uncertainty and treated volume due to respiratory motion at free breathing	Treatment at free breathing Target tracking using: ICD lead Temporary pacing lead Fiducial placed before therapy delivery	Pre-treatment 6D correction of patient orientation based on pair of X-ray images auto-registered to DRRs On-treatment beam position and direction corrections and tracking based on continuous monitoring of target surrogate 3D position detected from X-ray images correlated with signal of external respiratory monitor

System 2: Stereotactic robotic system CyberKnife
Methods and characteristics of dose delivery and verification imaging	Motion management approaches	Delivery guidance approaches
High-dose rate and fast dose delivery (using FFF beams) Robotic technology for maximum flexibility of beam directions for high conformity and gradient of dose distributions Three types of secondary collimator (including extra-small apertures) for high conformity and gradient of dose distributions Integrated compensation of spatial deviations, including patient orientation and 3D position of target Target tracking (by treatment beams) based on correlation model between target position and signal of LEDs placed on patient's chest to minimize target positional uncertainty and treated volume due to respiratory motion at free breathing	Treatment at free breathing Target tracking using: ICD lead Temporary pacing lead Fiducial placed before therapy delivery	Pre-treatment 6D correction of patient orientation based on pair of X-ray images auto-registered to DRRs On-treatment beam position and direction corrections and tracking based on continuous monitoring of target surrogate 3D position detected from X-ray images correlated with signal of external respiratory monitor

6D, degrees of freedom; FFF, flattening filter free; DRR, digitally reconstructed radiographs; ECG, electrocardio graph; ICD, implantable cardioverter defibrillator; IMAT, intensity-modulated arc therapy; IMRT, intensity-modulated radiotherapy; ITV, internal target volume; MLC, multi-leaf collimator; MRI, magnetic resonance imaging; VMAT, volumetric arc therapy.

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