The Radixact Synchrony MLC tracking system successfully met TG-264 guidelines, significantly improving geometric and dosimetric accuracy during real-time tumour tracking. However, practical implementation highlighted necessary adaptations to TG-264 recommendations for non-standard platforms such as Radixact, specifically regarding QA protocols, latency tolerance, and handling of the system's unique characteristics (pneumatic MLC, jaw tracking, and flattening-filter-free beams). Our findings underscore the importance of maintaining conservative margins initially, rigorous QA, specialized staff training, and careful patient selection strategies. Further clinical trials focusing on safe margin reduction strategies are essential for optimizing the clinical benefits of advanced tracking technologies.
Haraldsson et al. (Sun,) studied this question.