Page 11 - ARNM-3-3

Advances in Radiotherapy &

Nuclear Medicine

REVIEW ARTICLE
A comprehensive review of image-guided

techniques in adaptive radiotherapy

Qiman Han † , Zhuhui Yuan † , Bin Qiu , Yi Chen , Yuliang Jiang, Suqing Tian,
Zhe Ji , Runhong Lei , Ping Jiang* , and Junjie Wang*
Department of Radiation Oncology, Peking University Third Hospital, Beijing, China

Abstract

Radiotherapy (RT) is a treatment modality that utilizes various forms of radiation,
such as electrons, photons, protons, and carbon ions, to eradicate tumor cells.
Although RT demonstrates significant efficacy in tumor eradication, it concurrently
causes harm to adjacent normal tissues and organs. The primary challenge in RT
lies in achieving adequate dose delivery to the tumor target area while minimizing
damage to surrounding normal tissues. Traditional RT is typically administered in
fractions during which changes can occur in the patient’s body shape, tumor size
and shape, filling and displacement of organs at risk (OARs) near the target area, and
† These authors contributed equally beam entry distance. Adaptive RT (ART) is a personalized RT approach that enhances
to this work.
tumor local control and reduces toxicity to OARs by correcting both systematic errors,
*Corresponding authors: including anatomical changes or tumor position shifts, through the optimization of
Ping Jiang
(jiangping@bjmu.edu.cn) prescription doses and margins, as well as modifying initial plans when necessary.
Junjie Wang ART encompasses three main modes: offline ART, online ART, and real-time ART.
(junjiewang@pku.edu.cn) Image guidance methods employed in ART include computed tomography (CT),
Citation: Han Q, Yuan Z, Qiu B, cone-beam CT, and magnetic resonance imaging. This review primarily discussed the
et al. A comprehensive review advantages and disadvantages of these three image guidance methods.
of image-guided techniques in
adaptive radiotherapy.
Adv Radiother Nucl Med. Keywords: Adaptive radiotherapy; Image-guided radiotherapy; Cone-beam computed
2025;3(3):3-13.
doi: 10.36922/ARNM025110012 tomography guided adaptive radiotherapy; Magnetic resonance imaging guided
adaptive radiotherapy
Received: March 16, 2025
1st revised: April 21, 2025
2nd revised: June 28, 2025 1. Introduction
Accepted: July 2, 2025
Radiotherapy (RT) is a therapeutic modality that utilizes various forms of radiation,
Published online: July 22, 2025 such as electrons, photons, protons, and carbon ions, to eradicate malignant cells.
Copyright: © 2025 Author(s). Approximately 70% of cancer patients require radiation therapy during their treatment
This is an Open-Access article course. However, although these radiation beams effectively target cancerous cells,
1,2
distributed under the terms of the
Creative Commons Attribution they may also damage surrounding normal tissues and organs, potentially resulting in
License, permitting distribution, acute or chronic adverse effects. Consequently, a pivotal challenge in the field of RT lies
3
and reproduction in any medium, in ensuring precise dose delivery to the tumor site while promptly mitigating radiation-
provided the original work is
properly cited. induced harm to surrounding healthy tissues.
Publisher’s Note: AccScience Conventional RT typically involves fractionating the total radiation dose into multiple
Publishing remains neutral with smaller fractions, administered over several treatment sessions. For instance, in cervical
regard to jurisdictional claims in 4,5
published maps and institutional cancer RT, 25 – 30 fractionated RT were necessary. To ensure precise implementation
affiliations. of the RT plan, physicians and physicists accurately design treatment protocols based

Volume 3 Issue 3 (2025) 3 doi: 10.36922/ARNM025110012