Radar Technologies in Motion-Adaptive Cancer Radiotherapy

Intra-fractional respiratory management represents one of the greatest challenges of modern cancer radiotherapy (RT), as significant breathing-induced lesion motion might affect target coverage and organs at risk (OARs) sparing, jeopardizing oncological and toxicity outcomes. The detrimental effects on dosage of uncompensated organ motion are exacerbated in RT with charged particles (e.g., protons and carbon ions), due to their higher ballistic selectivity. The simplest strategies to counteract this phenomenon are the use of larger treatment margins and reductions in or control of respiration (e.g., by means of compression belts, breath hold). Gating and tracking, which synchronize beam delivery with the respiratory signal, also represent widely adopted solutions. When tracking the tumor itself or surrogates, invasive procedures (e.g., marker implantation), an unnecessary imaging dose (e.g., in X-ray-based fluoroscopy), or expensive equipment (e.g., magnetic resonance imaging, MRI) is usually required. When chest and abdomen excursions are measured to infer internal tumor displacement, the additional devices needed to perform this task, such as pressure sensors or surface cameras, present inherent limitations that can impair the procedure itself. In this context, radars have intrigued the radiation oncology community, being inexpensive, non-invasive, contactless, and insensitive to obstacles. Even if real-world clinical implementation is still lagging behind, there is a growing body of research unraveling the potential of these devices in this field. The purpose of this narrative review is to provide an overview of the studies that have delved into the potential of radar-based technologies for motion-adaptive photon and particle RT applications.