Name of the Procedure:

Intra-fraction Localization and Tracking of Target or Patient Motion During Delivery of Radiation Therapy (G6017)

• Common Names: Intra-fraction Tracking, 3D Positional Tracking
• Technical Terms: Gating, 3D Surface Tracking, Radiation Therapy Motion Management

Summary

Intra-fraction localization and tracking is a procedure used during radiation therapy to monitor and adjust for patient or tumor movement. This helps to ensure the radiation targets the tumor accurately, minimizing exposure to surrounding healthy tissues.

Purpose

The procedure is designed to:

• Accurately deliver radiation to cancerous tissues while protecting healthy tissues.
• Compensate for and adapt to patient movements (e.g., breathing) during radiation sessions.
• Enhance the effectiveness of radiation therapy and reduce side effects.

Indications

• Used for patients undergoing radiation therapy, particularly for tumors in areas prone to movement, such as the lungs, liver, or prostate.
• Indicated for tumors that require high precision in radiation delivery to avoid damaging nearby critical structures.

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Pre-treatment imaging studies such as CT or MRI scans may be performed to map the tumor's location.
• Instructions for comfortable, minimal movement during the procedure will be provided.

Procedure Description

1. Setup: The patient is positioned on the treatment table, often with immobilization devices to minimize movement.
2. Imaging: Initial imaging is performed to locate the tumor precisely.
3. Tracking: Advanced tracking systems (e.g., 3D surface imaging, internal markers, or respiratory gating) continuously monitor the tumor or patient movements.
4. Radiation Delivery: Radiation therapy is delivered, with real-time adjustments made to account for any detected movements.
   • Tools and Equipment: Linear accelerators, imaging systems (CT, MRI), tracking software.
   • Anesthesia: Typically, no anesthesia is needed, but comfort measures are in place.

Duration

Each fraction of treatment usually takes approximately 15 to 30 minutes, depending on the complexity and the movement of the tumor.

Setting

• Performed in specialized radiation therapy departments, hospitals, or outpatient cancer treatment centers.

Personnel

• Radiation Oncologists
• Medical Physicists
• Radiation Therapists
• Technicians specialized in imaging and tracking technologies

Risks and Complications

• Common Risks: Mild skin irritation, fatigue.
• Rare Risks: Incorrect targeting if tracking systems fail, potential radiation exposure to surrounding healthy tissues if movement is not adequately compensated for.
• Management: Continuous monitoring and adjustment, post-treatment care for any adverse effects.

Benefits

• Enhanced precision in targeting the tumor, increasing effectiveness and minimizing damage to healthy tissues.
• Potential for shorter treatment times and fewer side effects.
• Improved treatment outcomes for mobile tumors.

Recovery

• Minimal to no downtime; patients can usually resume normal activities shortly after each session.
• May experience mild side effects such as skin irritation or fatigue, which typically resolve quickly.
• Scheduled follow-up appointments to monitor response to therapy and manage any side effects.

Alternatives

• Conventional radiation therapy without motion tracking.
• Proton therapy, which may offer precision but at higher costs.
• Stereotactic body radiotherapy (SBRT) for certain cases.
• Pros and Cons: Conventional therapy is less precise but more widely available. Advanced options like proton therapy might offer better precision but are less accessible.

Patient Experience

• Generally, the procedure is painless.
• Patients may feel anxiety related to lying still and the use of immobilization devices, which care teams are trained to alleviate.
• Comfort measures include supportive cushions, music, and clear communication from the healthcare team.
• Post-procedure, most patients experience minimal discomfort.