scholarly journals Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits

2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Philippe Giraud ◽  
Annie Houle
Keyword(s):  
Respiratory Motion ◽  
Liver Tumors ◽  
Organs At Risk ◽  
Respiratory Gating ◽  
Breath Hold ◽  
Complication Rates ◽  
Abdominal Compression ◽  
Breathing Motion ◽  
Gated Radiotherapy ◽  
Respiratory Movements

Respiratory-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast, and liver tumors. An increased conformality of irradiation fields leading to decreased complication rates of organs at risk is expected. Five main strategies are used to reduce respiratory motion effects: integration of respiratory movements into treatment planning, forced shallow breathing with abdominal compression, breath-hold techniques, respiratory gating techniques, and tracking techniques. Measurements of respiratory movements can be performed either in a representative sample of the general population, or directly on the patient before irradiation. Reduction of breathing motion can be achieved by using either abdominal compression, breath-hold techniques, or respiratory gating techniques. Abdominal compression can be used to reduce diaphragmatic excursions. Breath-hold can be achieved with active techniques, in which airflow of the patient is temporarily blocked by a valve, or passive techniques, in which the patient voluntarily breath-holds. Respiratory gating techniques use external devices to predict the phase of the breathing cycle while the patient breathes freely. Another approach is tumor-tracking technique, which consists of a real-time localization of a constantly moving tumor. This work describes these different strategies and gives an overview of the literature.

Synchronous monitoring of external/internal respiratory motion: validity of respiration-gated radiotherapy for liver tumors

2009 ◽  
Vol 27 (7) ◽  
pp. 285-289 ◽  
Author(s):  
Takeshi Nishioka ◽  
Seiko Nishioka ◽  
Masaki Kawahara ◽  
Shigeru Tanaka ◽  
Hiroki Shirato ◽  
...  
Keyword(s):  
Respiratory Motion ◽  
Liver Tumors ◽  
Gated Radiotherapy ◽  
Synchronous Monitoring

scholarly journals Gated Radiotherapy Development and its Expansion

2019 ◽  
Author(s):  
M J Keikhai Farzaneh ◽  
M Momennezhad ◽  
Sh Naseri
Keyword(s):  
Respiratory Gating ◽  
Skin Surface ◽  
Patient Treatment ◽  
Breath Hold ◽  
Negative Effects ◽  
Motion Management ◽  
Gated Radiotherapy ◽  
Abdominal Tumors ◽  
Laser Monitoring ◽  
Clinical Radiotherapy

One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future.This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.

scholarly journals Effects of deep inspiration breath hold on prone photon or proton irradiation of breast and regional lymph nodes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bruno Speleers ◽  
Max Schoepen ◽  
Francesca Belosi ◽  
Vincent Vakaet ◽  
Wilfried De Neve ◽  
...  
Keyword(s):  
Lung Cancer ◽  
At Risk ◽  
Lymph Node ◽  
Organs At Risk ◽  
Lymph Node Status ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Proton Radiotherapy ◽  
Regional Lymph Nodes ◽  
Deep Inspiration Breath Hold

AbstractWe report on a comparative dosimetrical study between deep inspiration breath hold (DIBH) and shallow breathing (SB) in prone crawl position for photon and proton radiotherapy of whole breast (WB) and locoregional lymph node regions, including the internal mammary chain (LN_MI). We investigate the dosimetrical effects of DIBH in prone crawl position on organs-at-risk for both photon and proton plans. For each modality, we further estimate the effects of lung and heart doses on the mortality risks of different risk profiles of patients. Thirty-one patients with invasive carcinoma of the left breast and pathologically confirmed positive lymph node status were included in this study. DIBH significantly decreased dose to heart for photon and proton radiotherapy. DIBH also decreased lung doses for photons, while increased lung doses were observed using protons because the retracting heart is displaced by low-density lung tissue. For other organs-at-risk, DIBH resulted in significant dose reductions using photons while minor differences in dose deposition between DIBH and SB were observed using protons. In patients with high risks for cardiac and lung cancer mortality, average thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 3.12% (photon DIBH), 4.03% (photon SB), 1.80% (proton DIBH) and 1.66% (proton SB). The radiation-related mortality risk could not outweigh the ~ 8% disease-specific survival benefit of WB + LN_MI radiotherapy in any of the assessed treatments.

Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy

2021 ◽  
Vol 100 (4) ◽  
Keyword(s):  
Breast Cancer ◽  
Radiation Dose ◽  
Organs At Risk ◽  
Left Lung ◽  
Free Breathing ◽  
Partial Mastectomy ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Dose Volume Histograms

Introduction: The purpose of this study was to compare the radiation dose to organs at risk for deep-inspiration breath hold (DIBH) and free-breathing (FB) radiotherapy in patients with lef-sided breast cancer undergoing adjuvant radiotherapy after partial mastectomy. Methods: One hundred patients with left-sided breast cancer underwent DIBH and FB planning computed tomography scans, and the 2 techniques were compared. Dose-volume histograms were analyzed for heart, left anterior descending coronary artery (LAD), and left lung. Results: Radiation dose to heart, LAD, and left lung was significantly lower for DIBH than for free breathing plans. The median mean heart dose for DIBH technique in comparison with FB was 1.21 Gy, and 3.22 Gy respectively; for LAD, 4.67 versus 24.71 Gy; and for left lung 8.32 Gy versus 9.99 Gy. Conclusion: DIBH is an effective technique to reduce cardiac and lung radiation exposure.

Ultrasound-based sensors for respiratory motion assessment in multimodality PET imaging

2021 ◽  
Author(s):  
Bruno Madore ◽  
Gabriela Belsley ◽  
Cheng-Chieh Cheng ◽  
Frank Preiswerk ◽  
Marie Foley Kijewski ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Respiratory Gating ◽  
Sensitive Information ◽  
Internal Organs ◽  
Respiration Monitoring ◽  
Breathing Motion ◽  
Pet Ct ◽  
Motion Phantom ◽  
Motion Assessment

Abstract Breathing motion can displace internal organs by up to several cm; as such, it is a primary factor limiting image quality in medical imaging. Motion can also complicate matters when trying to fuse images from different modalities, acquired at different locations and/or on different days. Currently available devices for monitoring breathing motion often do so indirectly, by detecting changes in the outline of the torso rather than the internal motion itself, and these devices are often fixed to floors, ceilings or walls, and thus cannot accompany patients from one location to another. We have developed small ultrasound-based sensors, referred to as ‘organ configuration motion’ (OCM) sensors, that attach to the skin and provide rich motion-sensitive information. In the present work we tested the ability of OCM sensors to enable respiratory gating during in vivo PET imaging. A motion phantom involving an FDG solution was assembled, and two cancer patients scheduled for a clinical PET/CT exam were recruited for this study. OCM signals were used to help reconstruct phantom and in vivo data into time series of motion-resolved images. As expected, the motion-resolved images captured the underlying motion. In Patient #1, a single large lesion proved to be mostly stationary through the breathing cycle. However, in Patient #2, several small lesions were mobile during breathing, and our proposed new approach captured their breathing-related displacements. In summary, a relatively inexpensive hardware solution was developed here for respiration monitoring. Because the proposed sensors attach to the skin, as opposed to walls or ceilings, they can accompany patients from one procedure to the next, potentially allowing data gathered in different places and at different times to be combined and compared in ways that account for breathing motion.

Influence of human vocal cord movements on airflow and resistance during eupnea

1982 ◽  
Vol 52 (3) ◽  
pp. 773-779 ◽  
Author(s):  
S. J. England ◽  
D. Bartlett ◽  
J. A. Daubenspeck
Keyword(s):  
Vocal Cord ◽  
Respiratory System ◽  
Forced Oscillation Technique ◽  
Quiet Breathing ◽  
Vocal Cords ◽  
Healthy Human ◽  
Breathing Motion ◽  
Human Volunteers ◽  
Respiratory System Resistance ◽  
Respiratory Movements

The pattern of respiratory movements of the vocal cords in relation to airflow and respiratory system resistance was assessed in healthy human volunteers during quiet breathing. Motion pictures of the vocal cords were obtained through a fiber-optic laryngoscope inserted transnasally under topical anesthesia. A simultaneous estimate of lung volume was obtained using either rib cage and abdominal magnetometer coils or an integrated pneumotachograph signal. The vocal cords separated during inspiration and moved closer together during the expiratory phase of each breath. The extent of these movements varied greatly among the subjects. Total respiratory system resistance, assessed by the forced oscillation technique, was negatively correlated with distance between the vocal cords when measured at isoflow points in inspiration and expiration. Analysis of breath-by-breath variations in expiratory airflow and vocal cord position revealed that decreases in airflow accompanied decreases in the distance between the vocal cords. The results of this study indicate that the human larynx participates in the regulation of respiratory airflow by providing a variable, controlled resistance.

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