AAPM Task Group Report 290: Respiratory motion management for particle therapy

TLDR

Respiratory motion causes significant dose uncertainty in particle‑beam therapy for thoracic and abdominal tumors, and this report builds on TG76 to address motion‑management aspects essential for accurate, safe delivery. The report reviews tumor‑motion impact, dosimetric considerations, and current techniques across particle‑beam modes, and offers guidance and risk analysis for quality assurance while outlining future development strategies. It recommends commissioning and facility‑specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‑management techniques, image guidance, monitoring, and vendor‑related decision‑making. Key recommendations include conducting thorough planning studies with retrospective data and establishing SOPs for all motion‑involved sites, and adopting a risk‑based methodology for ongoing quality management.

Abstract

Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion-management techniques, and limitations for different particle-beam delivery modes (i.e., passive scattering, uniform scanning, and pencil-beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion-management procedures to ensure consistency and accuracy, and discusses future development and emerging motion-management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle-beam therapy. To that end, this report produces general recommendations for commissioning and facility-specific dosimetric characterization, motion assessment, treatment planning, active and passive motion-management techniques, image guidance and related decision-making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk-based methodology should be adopted for quality management and ongoing process improvement.