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Soft tissue match on GTV-T
Evaluate every fraction
GTV-T
GTV-N
~ Surrogate
Medulla
~ Columna
Notice large changes
Normal tissue
Pneumonia
Atelectasis
Pleural effusion
Example of adaptive strategy in lung cancer RT
Deviation above tolerance
Same deviation 3 consecutive fx
Adaptive treatment plan
– correct systematic deviation
Large change observed
Same change 3 consecutive fx
Adaptive treatment plan
– correct systematic change
Courtesy of D Møller & L Hoffman, Århus, DK