Cone beam CT IGRT provides on-line anatomical data of the patient at the treatment couch while new hybrid MRI radiotherapy systems promise to provide this data during the actual radiation delivery itself. To exploit these data, and account for tissue rotations, deformations and tumor regression during radiation therapy delivery, fast, on-line IMRT (re)planning is required.On-line IMRT re-planning needs to re-generate a similar patient specific dose distribution as done in the pre-treatment planning but then for the new state of the anatomy. For this the pre-treatment information has to be propagated to the actual treatment. A fast dose engine is required, which may be, in the case of MRI based IGRT, Monte Carlo based in order to account for the magnetic field induced dose effects. Then robust re-planning methods or class solutions should be available that account efficiently for both rigid and non-rigid anatomical changes while preserving the patient specific pre-treatment dose considerations. Preferably this is all fully automatic, but also fast interactive re-planning is an option, especially in hypo-fractionated (boost) radiotherapy.
- 1.Preservation of pre-treatment prescriptions in the on-line IMRT re-planning
- 2.Fast re-planning techniques and speed limitations for dose engines
- 3.Pros and cons of interactive versus automatic re-planning