| Abstract: |
Historically, the evolution of radiation oncology has been closely linked to the advances in medical imaging. Recent breakthroughs in imaging technology, particularly 4D medical imaging, have injected new momentum into radiation oncology, shedding new light on revitalizing this century old treatment modality. This eventually led to the creation of a primitive form of 4D radiation therapy (4DRT). 4DRT can be defined as a combination of using 4D imaging to guide radiation treatment planning, correcting for daily set-up errors through either patient repositioning or plan adaptation, and controlling radiation delivery based on internal or external fiducials that can be continuously tracked. 4DRT introduces the time dimension into the 3DRT in order to compensate for patient motion/changes occurring either during a single fraction (intra-fractional) or between successive fractions (inter-fractional). The major advantages of 4DRT are high-precision dose conformity, minimized normal tissue complication probability, and possible further dose escalation to the target. To maximize the potential benefits of 4D medical imaging and promising improvements in patient survival and quality of life, an integrative and systemic approach to 4DRT is essential. Without such an integrated multi-disciplinary strategy, 4DRT would only remain as an ideal concept. Here, we propose a comprehensive approach that integrates 4D medical imaging into each of the key steps in 4DRT, including 4D simulation, 4D treatment planning, and 4D treatment delivery.
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