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Take home messages

Motion encompassing

ITV

is a reasonable 4D method,

but overestimates the required margin.

4D-CBCT / 4D-CT registration

(e.g. mid-ventilation technique) allows

for smaller margins.

Gated

irradiation (free breathing / breath hold) requires patient

compliance and increases treatment time.

Tracking

technically challenging and requires building and verification

of robust correlation/prediction models.

Tracking and gating

only beneficial for relative large tumor motions

(i.e. > 10-15 mm)

Tracking or Gating?

Clinically probably equivalent, the difference is

dose per beam spread out over region of motion versus somewhat

larger dose concentrated at same location in lung

(different penumbras?).

SBRT 2017 - D. Verellen