In December 2020, the ACDS conducted a survey of its subscribers on respiratory motion management. The aim of the survey was to capture both what motion management techniques were used by each facility, as well as how the techniques were implemented practically. In the survey, we defined motion management as any treatment technique which aims to mitigate the effects of intra-fractional respiratory and/or cardiac motion. Other forms of motion, such as peristalsis or gross anatomical changes, will not be considered. We defined five (5) motion management strategies:

1. Internal Target Volume (ITV) - any treatment of a target volume which encompasses the entire range of motion of the lesion.
2. Free-breathing Gating - any treatment where delivery of the beam is limited to a portion of the respiratory cycle as the patient breathes normally.
3. Breath-hold Gating - any treatment where the delivery of the beam is limited to a portion of the respiratory cycle which is extended by the patient holding their breath. Note that this strictly refers to breath-hold gating as a motion management strategy, rather than a means of optimising tumour geometry (as is the case in most deep inspiration breath-hold breast treatments utilising tangential beams).
4. Mid Ventilation - any treatment where the target volume is defined using the time- weighted average position of the tumour.
5. Tumour Tracking - any treatment in which the treatment beam is modified/repositioned to account for the motion of the target.

Further, we defined stereotactic ablative body radiotherapy (SABR) as any hypofractionated treatment of five (5) fractions or less with ablative intent. Otherwise, the treatment was considered as conventionally fractionated in this survey. For each motion management strategy that applies, respondents were asked to identify:

• Which treatment sites/types utilise the strategy.
• Which methods of pre-treatment motion limitation (such as immobilisation) are utilised for each treatment site.
• How the motion of the tumour is assessed for each treatment site (what imaging is used, how motion is measured/interpreted).
• Which forms of image guidance are used for each treatment site (what imaging is used, how a match to the reference image is performed).
• What is used as a planning dataset for dosimetric calculation for each combination of treatment site and pre-treatment motion limitation.

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