Brainlab Advanced Motion Management¹ Enables Precision Radiotherapy for Moving Lung Tumors – Without Implanted Markers

Brainlab SE, a global medical technology company, today announced CE certification and the EU market launch of its software solution Advanced Motion Management (AMM) for the treatment of lung tumors. AMM combines ExacTrac Dynamic® for positioning and monitoring in image- and surface-guided radiotherapy with the planning software RT Elements Motion Analysis, enabling precise irradiation of lung tumors—regardless of size or disease stage—without the need for implanted markers. Throughout the workflow, AMM supports pre-treatment planning, patient positioning and monitoring. The device monitors respiration, the body surface and the patient’s anatomy separately, so that any deviations are detected immediately, enabling the patient to be repositioned quickly.

Lung tumors that move with respiration during radiotherapy make planning and executing radiation treatment particularly challenging. Every year, more than 55,000 people in Germany are diagnosed with lung cancer.² Because the disease often remains asymptomatic for a long time and is typically detected only at an advanced stage, the prognosis is often poor: the relative 5-year survival rate in Germany is around 25 percent for women and 19 percent for men.³ Tumors detected early are often very small. Radiotherapy, used in around 40 percent of cases,⁴ therefore requires extreme precision. Until now, treatment has largely relied on an Internal Target Volume (ITV)—an enlarged target volume designed to cover the entire range of respiration-induced tumor motion. However, the necessary safety margin also exposes healthy tissue to radiation, increasing the risk of side effects and long-term complications.

New Solution Package for Markerless Tumor Tracking

Lung cancer presents an additional challenge: as part of soft tissue, tumors are difficult to visualize on x-ray images. AMM addresses this by analyzing both tumor motion and the motion of the lung as a whole. This makes it possible to verify the tumor's position before and during treatment without implanting markers.

"For many years, my goal has been to treat lung cancer patients without implanted markers. Together with Brainlab, we spent more than a decade developing this new method—and today it is available across the EU," says Mark De Ridder, CEO of Universitair Ziekenhuis Brussel (Brussels University Hospital). "The central challenge was to precisely correlate respiratory motion with the tumor's position in order to visualize it reliably. We can now plan and perform treatments more efficiently, without placing additional burden on patients. A major advantage of this technology is that it is non-invasive and has very few side effects."

"With Advanced Motion Management, we are making one of the most clinically demanding challenges in radiotherapy easier to manage: tumors that move with respiration. This is a milestone on the path toward more personalized, innovative radiotherapy treatment concepts," says Rainer Birkenbach, CEO of Brainlab SE. "RT Elements demonstrates how our digital ecosystem creates a clinically relevant workflow and supports treatment teams in delivering more precise radiation to tumors while sparing healthy tissue. This opens up new possibilities for patients with lung cancer—in particular, non-invasive alternatives to surgical procedures—especially for tumors that have previously been difficult to treat with radiation due to their size or location."

¹ ExacTrac Dynamic and RT Elements versions required for this workflow are not yet commercially available in several countries.

² dkfz. Krebsinformationsdienst. Deutsches Krebsforschungszentrum in der Helmholtz-Gemeinschaft. Lungenkrebs (Bronchialkarzinom). Available at: https://www.krebsinformationsdienst.de/lungenkrebs (last accessed: 16 September 2026)

³ Robert Koch Institut, Zentrum für Krebsregisterdaten: Lungenkrebs (Bronchialkarzinom). Available at: https://www.krebsdaten.de/Krebs/DE/Content/Krebsarten/Lungenkrebs/lungenkrebs_node.html (last accessed: September 16 2026)

⁴ Cheng M, et al. Modern Radiation Further Improves Survival in Non-Small Cell Lung Cancer: An Analysis of 288,670 Patients. J Cancer. 2019 Jan 1;10(1):168-177. doi: 10.7150/jca.26600. PMID: 30662537; PMCID: PMC6329848.