Should 4DCT be used for radiotherapy patients with irregular breathing?

4DCT is now widely available at radiotherapy centres across the UK. It has enabled improvements in the outcomes for many patients when combined with techniques such as stereotactic ablative radiotherapy (SABR), as the better knowledge of the tumour location during treatment has helped enable dose escalation and reduce treatment margins. However, irregular breathing is a major issue preventing patient access to 4DCT. For example, a recent survey of SABR centres across the UK found that of 38 centres that responded, all routinely use 4DCT; however 35 centres identified irregular breathing as the main reason 4DCT cannot be used to assess motion.

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