TU-D-202-03: Gating Is the Best ITV Killer.

Respiratory motion has long been recognized as an important factor affecting the precision of radiotherapy. After the introduction of the 4D CT to visualize the respiratory motion in 3D, the internal target volume (ITV) has been widely adopted as simple method to take the motion into account in treatment planning and delivery. The ITV is generated as the union of the CTVs as the patient goes through the respiratory cycle. Many issues have been identified with the ITV. In this session three alternatives for the ITV will be discussed: 1) An alternative motion-inclusive approach with better imaging and smaller margins, called mid-position CT. 2) The tracking approach and 3) The gating approach. The following topics will be addressed by Marcel van Herk ("Is ITV the correct motion encompassing strategy"): Magnitude of respiratory motion, effect of motion on radiotherapy, motion encompassing strategies, and software solutions to assist in motion encompassing strategies. Then Paul Keall ("Make margins simple: Use real-time target tracking") will discuss tracking with: clinical drivers for tracking, current clinical status of tumor tracking, future tumor tracking technology, and margin margin challenges with and without tracking. Finally Daniel Low will discuss gating ("Gating is the best ITV killer"): why ITV in the first place, requirements for planning, requirements at the machine, benefits and costs. The session will end with a discussion and live demo of motion simulation software to illustrate the issues and explain the relative benefit and appropriate uses for the three methods.

LEARNING OBJECTIVES: 1. Explain the 4D imaging and treatment planning process. 2. Summarize the various approaches to deal with respiratory motion during radiotherapy 3. Discuss the tradeoffs involved when choosing one of the three discussed approaches. 4. Explain in which situation each method is the best choice Research is partly funded by Elekta Oncology Systems and the Dutch Cancer Foundation; M. van Herk, Part of the research was funded by Elekta Oncology Systems and the Dutch Cancer Foundation.