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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
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Fluoroscopy-Guided Motion Management in Particle Therapy: Evolution, Challenges, and AI-Enabled Opportunities.

Feifei Li1, Keith M Furutani1, Chris J Beltran1

  • 1Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA.

Tomography (Ann Arbor, Mich.)
|May 26, 2026
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Fluoroscopy-Guided Particle Therapy (FGPT) improves cancer treatment precision by tracking tumors during radiation delivery. Advances in AI-driven imaging offer promising marker-less tumor tracking, overcoming current limitations.

Keywords:
fluoroscopymachine learningparticle therapy

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Area of Science:

  • Medical Physics
  • Oncology
  • Radiotherapy Technology

Background:

  • Particle therapy offers dosimetric advantages over photon therapy but is challenged by intra-fraction motion.
  • Fluoroscopy-Guided Particle Therapy (FGPT) aims to manage motion via real-time tumor tracking.
  • Flat-panel detector (FPD) technology has advanced FGPT integration and research.

Purpose of the Study:

  • To review the evolution of fluoroscopy technology in particle therapy.
  • To summarize vendor-supported FGPT strategies and emerging AI-based algorithms.
  • To discuss challenges and future directions for marker-less tumor tracking in FGPT.

Main Methods:

  • Review of fluoroscopy technology (image intensifier to FPD).
  • Summary of commercial and research FGPT systems (e.g., RGPT).
  • Survey of AI and machine learning-based image registration algorithms for marker-less tracking.

Main Results:

  • FPDs have enhanced FGPT integration, but marker-less tracking remains a challenge.
  • Traditional image registration struggles with soft-tissue targets in projection imaging.
  • AI and deep learning show potential for reliable marker-less tumor tracking.

Conclusions:

  • Marker-less tumor tracking is crucial for unlocking the full potential of FGPT.
  • AI-driven image registration offers a path toward overcoming current limitations in FGPT.
  • Further research is needed for clinically deployable, reliable marker-less FGPT systems.