Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I: intra-fraction breathing motion management.

Anastasi, Gail; Bertholet, Jenny; Poulsen, Per; Roggen, Toon; Garibaldi, Cristina; Tilly, Nina; Booth, Jeremy T; Oelfke, Uwe; Heijmen, Ben; Aznar, Marianne C (2020). Patterns of practice for adaptive and real-time radiation therapy (POP-ART RT) part I: intra-fraction breathing motion management. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 153, pp. 79-87. Elsevier Scientific Publ. Ireland 10.1016/j.radonc.2020.06.018

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The POP-ART RT study aims to determine to what extent and how intra-fractional real-time respiratory motion management (RRMM) and plan adaptation for inter-fractional anatomical changes (ART), are used in clinical practice and to understand barriers to implementation. Here we report on part I: RRMM MATERIAL AND METHODS: A questionnaire was distributed worldwide to assess current clinical practice, wishes for expansion or new implementation and barriers to implementation. RRMM was defined as inspiration/expiration gating in free-breathing or breath-hold, or tracking where the target and the beam are continuously realigned.


The questionnaire was completed by 200 centres from 41 countries. RRMM was used by 68% of respondents ('users') for a median (range) of 2 (1-6) tumour sites. Eighty-one percent of users applied inspiration breath-hold in at least one tumour site (breast: 96%). External marker was used to guide RRMM by 61% of users. KV/MV imaging was frequently used for liver and pancreas (with fiducials) and for lung (with or without fiducials). Tracking was mainly performed on robotic linacs with hybrid internal-external monitoring. For breast and lung, approximately 75% of respondents used or wished to implement RRMM, which was lower for liver (44%) and pancreas (27%). Seventy-one percent of respondents wished to implement RRMM for a new tumour site. Main barriers were human/financial resources and capacity on the machine.


Sixty-eight percent of respondents used RRMM and 71% wished to implement RRMM for a new tumour site. The main barriers to implementation were human/financial resources and capacity on treatment machines.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology

UniBE Contributor:

Bertholet, Jenny


600 Technology > 610 Medicine & health




Elsevier Scientific Publ. Ireland




Beatrice Scheidegger

Date Deposited:

06 Jul 2020 17:27

Last Modified:

22 Dec 2020 01:31

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Image-guided radiotherapy MR-guided radiotherapy breath hold gating intra-fractional motion real-time respiratory motion management tumour tracking




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