Clinical experience using respiratory gated radiation therapy: Comparison of free-breathing and breath-hold techniques

Berson, Anthony M.; Emery, Richard S.; Rodriguez, L.V.; Richards, Gregory M.; Ng, Tracy; Sanghavi, Seema; Barsa, Jean M.

doi:10.1016/j.ijrobp.2004.03.037

Cited by 149 publications

(116 citation statements)

References 20 publications

Supporting

Mentioning

112

Contrasting

Unclassified

Order By: Relevance

“…Following on from this we also found that the range of inter-fraction displacement observed at this institution (0.41 cm ± 0.28 cm) using a DIBH technique was in keeping with the published literature across a range of breath hold techniques (8,9).…”

Section: Bh Reproducibility and Inter-fraction Motionsupporting

confidence: 86%

Evaluation of a reproducible breath hold technique for the SABR treatment of lower lobe lung tumours

Barrett

Taylor

Rock³

2017

J Radiother Pract

View full text Add to dashboard Cite

AimDeep inspiration breath hold (DIBH) is a method of motion management used in stereotactic ablative body radiotherapy (SABR) for lung tumours. An external gating block marker can be used as a tumour motion surrogate, however, inter-fraction gross target volume (GTV) displacement within DIBH occurs. This study measured this displacement during a reproducible breath hold regime. Additionally, factors such as position of the gating block marker were analysed. Methods and Materials121 cone beam computed tomography scans (CBCTs) from 22 patients who received DIBH SABR were retrospectively evaluated and the magnitude of inter-fraction GTV displacement was calculated for each fraction. This data was analysed to assess if any correlation existed between tumour displacement and variation in the gating block marker position on the patient, the amplitude of BH at CT, the amplitude of BH at treatment and the tumour location.The measured tumour displacement was applied to the original planning CT to evaluate the dosimetric effect on surrounding organs at risk (OARs) using cumulative dose volume histograms (DVHs). ResultsBH amplitude was reproducible within 0.13 cm ± 0.1 cm (mean ± standard deviation).The magnitude of tumour displacement within BH ranged from 0 to 1.52 cm (0.41 cm ± 0.28 cm). Displacement in the superior-inferior (SI), anterior-posterior (AP) and left-right (LR) planes were 0.31cm ± 0.26 cm, 0.16 cm ± 0.18 cm and 0.07 cm ± 0.12 cm respectively. No statistically significant correlation was detected between tumour displacement within DIBH and the factors investigated. The range of variation in OAR dose was -7.0Gy to +3.6Gy with one statistically significant increase in OAR dose observed (oesophagus mean dose increasing by 0.16Gy). FindingsReproducible BH was achievable across a range of patients. Inter-fraction GTV displacement measured 0.41 cm ± 0.28 cm. Due to this low level of motion, the correction of soft tissue moves did not adversely affect OAR dose.

show abstract

Section: Bh Reproducibility and Inter-fraction Motionsupporting

confidence: 86%

Evaluation of a reproducible breath hold technique for the SABR treatment of lower lobe lung tumours

Barrett

Taylor

Rock³

2017

J Radiother Pract

View full text Add to dashboard Cite

show abstract

“…Previous studies have used alternative methods of measuring or gating breathing motion, such as strain gauge determination of abdominal circumference, spirometric measurement of lung volume, and optical tracking of markers, to monitor the respiratory cycles of patients (6)(7)(8)(9). Strain gauges make use of an elastic belt that stretches according to abdominal motion.…”

Section: Discussionmentioning

confidence: 99%

Respiratory Biofeedback during CT-guided Procedures

Locklin

Yanof

Luk

et al. 2007

Journal of Vascular and Interventional Radiology

View full text Add to dashboard Cite

PURPOSE-Respiratory motion can be a complicating factor during image-guided interventions. The ability to reproduce breath-holds may facilitate safer needle-based procedures. The purpose of this study was to evaluate if respiratory biofeedback decreased variability among breath-holds and if the signals from the respiratory bellows belt can be used to measure target motion. MATERIALS AND METHODS-In phase 1 of the study, a respiratory bellows belt was applied to patients before image-guided interventional procedures. Belt stretch from respiratory motion was converted into voltage readings and displayed on a monitor as biofeedback. Patients were asked to perform inspiratory, expiratory, and midcycle breath-holds with and without the biofeedback. The variability in voltage readings between breath-holds with and without biofeedback was compared. In phase 2, the respiratory bellows belt was used during computed tomography (CT)-guided procedures with the patients blinded to the biofeedback. Voltage readings and CT series numbers were recorded as patients were asked to hold their breath during scans. The variability of CT z-axis targets was compared with the variability of voltage readings.RESULTS-A significant decrease in variability was found during expiratory breath-holds (P = . 0083) with trends toward significance with midcycle and inspiratory breath-holds. A positive correlation (Kendall τ = 0.5; P = .024) was shown between CT z-axis and belt stretch variability in subjects who received smaller doses of moderate sedation compared with those who received larger doses or general anesthesia.CONCLUSIONS-Biofeedback may help the patient to have a more consistent breath-hold. The belt could decrease the error and unpredictability from craniocaudal motion of targets during imageguided interventions.PATIENT respiratory motion can be a complicating factor when targeting a tumor for computed tomography (CT)-guided interventional procedures. Respiration-induced motion during the normal breathing cycle can result in significant shifts in tumor position, especially near the diaphragm, in the lung and abdomen (1). Consistent and reproducible breath-holds could reduce procedure time and the number of needle manipulations, promoting a safer procedure. Without a documented measure of their breath-hold position in the respiratory cycle, the patient cannot be expected to precisely reproduce similar pre-and intraprocedural breathholds. The air bellows belt measures chest wall or abdomen excursion and provides patients with visual biofeedback during their respiratory cycle.Address correspondence to J.K.L., National Institutes of Health, Building 10, Room 1C367A, 9000 Rockville Pike, Bethesda, MD 20892; E-mail: locklinj@cc.nih.gov. NIH Public Access MATERIALS AND METHODSIn the present study, a tool consisting of an air bellows belt (Philips Medical Systems, Cleveland, OH) attached to a visual feedback system shown to patients was evaluated for its ability to assist patients to more precisely reproduce preprocedural breath-hold...

show abstract

“…The two main components of the RPM system are a marker block and a tracking camera. ( 16 ) The camera is a charge coupled device (CCD) with an infrared (IR) emitter and was installed on the ceiling of the treatment rooms and on the foot of the bed in the simulation room. Two reflective circular markers on the plastic cuboid block are tracked simultaneously to measure the calibrated vertical motion.…”

Section: Methodsmentioning

confidence: 99%

External respiratory motion analysis and statistics for patients and volunteers

Quirk

Becker

Smith

2013

J Applied Clin Med Phys

View full text Add to dashboard Cite

We analyzed a large patient and volunteer study of external respiratory motion in order to develop a population database of respiratory information. We analyzed 120 lung, liver, and abdominal patients and 25 volunteers without lung disease to determine the extent of motion using the Varian Real‐Time Position Management system. The volunteer respiratory motion was measured for both abdominal and thoracic placement of the RPM box. Evaluation of a subset of 55 patients demonstrates inter‐ and intrafraction variation over treatment. We also calculated baseline drift and duty cycle for patients and volunteers. The mean peak‐to‐peak amplitude (SD) for the patients was 1.0 (0.5) cm, and for the volunteers it was abdomen 0.8 (0.3) cm and thoracic 0.2 (0.2) cm. The mean period (SD) was 3.6 (1.0) s, 4.2 (1.1) s, and 4.1 (0.8) s, and the mean end exhale position (SD) was 60% (6), 58% (7), and 56% (7) for patient, volunteer abdomen, and volunteer thoracic, respectively. Baseline drift was greater than 0.5 cm for 40% of patients. We found statistically significant differences between the patient and volunteer groups. Peak‐to‐peak amplitude was significantly larger for patients than the volunteer abdominal measurement and the volunteer abdominal measurement is significantly larger than the volunteer thoracic measurement. The patient group also exhibited significantly larger baseline drift than the volunteer group. We also found that peak‐to‐peak amplitude was the most variable parameter for both intra‐ and interfraction motion. This database compilation can be used as a resource for expected motion when using external surrogates in radiotherapy applications.PACS number: 87.19.Wx, 87.55.Km

show abstract

Clinical experience using respiratory gated radiation therapy: Comparison of free-breathing and breath-hold techniques

Cited by 149 publications

References 20 publications

Evaluation of a reproducible breath hold technique for the SABR treatment of lower lobe lung tumours

Evaluation of a reproducible breath hold technique for the SABR treatment of lower lobe lung tumours

Respiratory Biofeedback during CT-guided Procedures

External respiratory motion analysis and statistics for patients and volunteers

Contact Info

Product

Resources

About