Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment

Abstract

We examine 2 strategies for reducing respiration-induced organ motion in radiation treatment: deep inspiration breath hold (DIBH) and respiratory gating. DIBH is a controlled breathing technique in which the patient performs a supervised breath hold during treatment. The technique offers 2 benefits: reduced respiratory motion from the breath hold and increased normal tissue sparing from the increased lung volume. In respiratory-gated treatment, a device external to the patient monitors breathing and allows delivery of radiation only during certain time intervals, synchronous with the patient's respiratory cycle. Gated treatment offers reduced respiratory motion with less patient effort than DIBH. We briefly survey the development of these 2 strategies, describe their clinical implementation for treatment of thoracic and liver tumors at the Memorial Sloan-Kettering Cancer Center, and discuss their advantages and limitations.

Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters

“…The first aims to reduce internal respiration induced movement by maintaining a breath-hold, either actively or passively [14][15][16][17] . The second allows the patient to breathe freely with RT delivery either synchronised during a pre-defined phase of the respiratory cycle or continuously delivered while tracking the tumour [18][19][20] .…”

Comparison of breath‐hold and free‐breathing positions of an external fiducial by analysis of respiratory traces

“…Although this is a small study, these results suggest that ${\text{BH}}_{\text{exp}}$ is the more appropriate position for BH radiation therapy. Practically, however, there may be significant normal tissue sparing with the ${\text{BH}}_{\text{insp}}$ protocol as is evident during deep‐inspiration breath hold (DIBH) radiation therapy 16 , 19 , 24 …”

Real‐time 4D dose reconstruction for tracked dynamic MLC deliveries for lung SBRT

“…A stage I lung tumor typically moves a few millimeters up to a few centimeters due to respiratory motion 2 . Assuring dose coverage of the tumor can be accomplished by deep‐inspiration breath‐hold or respiratory gating strategies, 3 at the cost of patient discomfort, longer treatment times, and requiring the patient's collaboration. The motion can also be incorporated into treatment planning, by constructing a planning target volume (PTV) based on an internal target volume (ITV).…”