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In this paper we present a complete description of the breathing synchronized radiotherapy (BSRT) system, which has been jointly developed between the University of California Davis Cancer Center and Varian Associates. BSRT is a description of an emerging radiation oncology procedure, where simulation, CT scan, treatment planning, and radiation treatment are synchronized with voluntary breath-hold, forced breath-hold, or breathing gating. The BSRT system consists of a breathing monitoring system (BMOS) and a linear accelerator gating hardware and software package. Two methods, a video camera-based method and the use of wraparound inductive plethysmography (RespiTrace), generate the BMOS signals. The BMOS signals and the synchronized fluoroscopic images are simultaneously recorded in the simulation room and are later analyzed to define the ideal treatment point (ITP) where organ motion is stationary. The BMOS signals at ITP can be used to gate a CT scanner or a linear accelerator to maintain the same organ configuration as in the simulation. The BSRT system allows breath-hold or gating. This dual role allows the system to be applicable for a variety of patients, i.e., the breath-hold method for those patients who can maintain and reproduce the ITP, and the forced breath-hold or gating method for those who are not ideal for voluntary breath-hold.

Abstract. A method to establish the relationship between CT number and effective density for therapeutic radiations is proposed. We approximated body tissues to mixtures of muscle, air, fat, and bone. Consequently, the relationship can be calibrated only with a CT scan of their substitutes, for which we chose water, air, ethanol, and potassium phosphate solution, respectively. With simple and specific corrections for non-equivalencies of the substitutes, the calibration accuracy of 1% will be achieved. We tested the calibration method with some biological materials to verify that the proposed method would offer accuracy, simplicity, and specificity required for a standard in radiotherapy treatment planning, in particular, with heavy charged particles.

As a result of this study, the authors verified that the new scanning delivery system can produce an accurate 3D dose distribution for the target volume in combination with the planning software.