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Treating moving organs with passive protons (1)
A few logical steps (for class or individual solutions):
Immobilise + +
Evaluate the degree of movement (eg 4D-CT or 4D MRI)
Evaluate the incidence of movements on the plan
Define the strategy to treat: free, breath hold, gating,…(tracking)
Evaluate residual movement : residual ITV
Choice of (single or multiple) beam angles
Evaluate (lack of) homogeneity of profils
Realistic margins to apertures & compensator smearing
Recalculate collimator and modulator adapted to the final target…
Recalculate & evaluate doses (4DCT, elastic correlations,…)
Monitor patient setup and treatment (anatomy, beams,…)
Adapt when needed…
Protocols based in external and own experience