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Work package 05

Organ motion - 4D imaging and treatment

Objectives
Inside the patient tumours move on different timescales, from seconds (e.g. breathing) and minutes (e.g. bladder filling) to days (e.g. weight loss) leading to uncertainty in the knowledge of the tumour position. Recent technological advances enable imaging and treatment accounting for this time component (4D imaging and treatment). These technologies are available at a research stage, and the purpose of this work is to bring the techniques to a stage of maturity where they can be brought into clinical routine practice.
Description of work
Task 5.1. 4D PET/CT for treatment planning. The task is focused on development of the image quality of 4D PET/CT. Aspects of this include tumour delineation in 4D scans, image reconstruction, non-rigid registration (input from work package 3), mapping and fusion within and between imaging modalities.
Task 5.2. 4D treatment planning. The task is focused on obtaining the highest target dose with smallest toxicity to OAR based on 4D images. This includes planning for 4D treatment delivery with respect to identification of optimal planning scan(s), evaluation of margins, calculation of dose as function of respiration phase, and computation of verification references for treatment.
Task 5.3. 4D in-room imaging. The task is focused on development of imaging in the treatment room to mimic the planning reference image(s). Specifically, 4D volumetric imaging integrated with the treatment machine will be investigated, and working towards a set of solutions operating independently of treatment machine imaging modalities.
Task 5.4. Dynamic treatment delivery. The task is focused on enabling treatment beam delivery techniques dynamically synchronised with tumour movements. Measurement of the tumour motion will be analysed based on various internal and/or external surrogate motion markers or anatomical landmarks. Synchro¬nisation of the treatment beam can be realised by either tracking the motion dynamically or gating the beam.
Deliverables (projected outcome)
D5.1. The outcome of this work package will be imaging and treatment techniques that provides highly individualized tumour margins, minimized for the specific patient. The results can subsequently be used to either reduce normal tissue irradiation or improve tumour control.