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Real-time lesion tracking in radiotherapy

 

Real-time Lesion Tracking in Radiotherapy

 

Chairs: 

  • Barbara Knäusl, Medical Physicist, Medical University of Vienna, Vienna (AT)
  • Christopher Kurz, Medical Physicist, LMU Munich, Munich (DE)
  • Guillaume Landry, Medical Physicist, LMU Munich, Munich (DE)
  • Cristina Garibaldi, Medical Physicist, European Institute of Oncology, Milano (IT)

 

Invited speakers: 

  • Colien Hazelaar, Innovation Physicist, Maastro Clinic, Maastricht (NL)
  • Martin Fast, Medical Physicist, University Medical Center Utrecht, Utrecht (NL)
  • Thierry Gevaert, Medical Physicist, Universitair Ziekenhuis Brussel, Brussel (BE)

 

Motivation:

The adoption of magnetic resonance imaging (MRI) guided radiotherapy (MRIgRT), based on hybrid MRI-linacs, has driven renewed interest in real-time lesion tracking to increase the precision of dose delivery to moving targets. Stimulated by the 2022 ESTRO Physics Workshop on “Next generation MR-guided radiotherapy” and the currently running TrackRAD2025 Grand Challenge, the 2025 ESTRO Physics Workshop on “Real-time lesion tracking in radiotherapy” aims to expand the existing network to X-ray-based tracking and will allow sharing of expertise and methods across modalities.

The main objective of the workshop is thus the development of a network to exchange on the topic of real-time lesion tracking in radiotherapy.

We aim to acknowledge the importance of clinical solutions such as the use of surface guidance, deep inspiration breath hold (DIBH), and free breathing (FB) gated workflows for real-time management of moving lesions.

We will seek to identify challenges for the clinical use of lesion localisation during delivery. This will cover the whole range of beam delivery and adaptation strategies ranging from gating under free breathing or DIBH to continuous beam adaptation via robotic or multileaf collimator (MLC) tracking. Optimal uncertainty estimation and quality assurance approaches to bring novel solutions into the clinics will be addressed.

Finally, we will initiate the organization of the next TrackRAD Grand Challenge including MRI and X-ray tracking to support further innovation in real-time lesion localization in radiotherapy.

 

The main components of real-time motion management workflows, with cine-MRI as an example real-time imaging modality. Reproduced from https://doi.org/10.1016/j.radonc.2023.109970.

 

Workshop structure:

The workshop will begin with an introduction to the content to be covered during the event. We will have three overview introductory talks by invited speakers who will cover the state of the art and research developments in MRI and X-ray based tumor tracking methods, as well as in current clinical motion management workflows. A session will be reserved for discussion of the TrackRAD Grand Challenge and related future planning. Besides breakout groups and plenary discussions on selected topics, the workshop participants will be paired based on their motivation statements to pitch their interests as a basis for a successful networking event. The program will be further refined based on the submitted motivation statements; these should indicate what participants bring and wish to discuss at the workshop.

 

The following sessions are planned:

  1. Introduction to workshop content
    1. Overview on basic principles and nomenclature for X-ray and MRI-based tumor tracking: real-time imaging, target localization, motion prediction/latencies, motion compensation, intra-fraction motion monitoring
    2. Aspects to be addressed: Quality assurance, uncertainty with/without AI, practical challenges and barriers
  2. State of the art of clinical workflows for active motion management techniques: invited lecture (Thierry Gevaert)
    1. Beam tracking approaches
    2. Free breathing phase or exhale or deep inspiration breath hold gating
  3. X-ray tracking: invited lecture (TBD) and selected participant pitches
    1. Markerless vs marker-based
    2. 3D tracking
    3. Tracking algorithms and AI
  4. MRI tracking: invited lecture (Martin Fast) and selected participant pitches
    1. MRI-linacs - state of the art and research opportunities
    2. Management of lesions affected by cardio-respiratory motion
    3. 3D+t motion modelling
  5. Summary of the TrackRAD2025 Challenge and organization of the next event
    1. Inclusion of X-ray tracking
    2. Extension to orthogonal cine-MRI
    3. Data collection and labelling

Based on the submitted motivation statements and the interest of participants, and on pre-workshop online discussions with all participants:

  1. Breakout sessions to pursue discussion of topics obtained from motivation statements
  2. Industry pitches - towards clinical implementation Planned developments presented by industry research and development teams

 

Potential outcomes: 

  1. Establish a joint working group including MRI and X-ray guidance users and researchers
  2. An overview paper on the status of AI real-time lesion tracking and proposals on bringing it into the clinic
  3. TrackRAD2025 Challenge report and set up working group for TrackRAD2027 (MRI+ X-ray)