• The Journal of Korean Society for Radiation Therapy
• /
• v.25 no.1
• /
• pp.49-55
• /
• 2013

Purpose: Respiratory Gated Radiation Therapy (RGRT) has been carried out using RPM (Real-time Position Management) Respiratory Gating System (version 1.7.5, varian, USA) in Asan Medical Center. This study was to analyze and evaluate the accuracy of Respiratory Gated Radiation Therapy (RGRT) according to variation of respiration. Materials and Methods: Making variation of respiration using Motion Phantom:QUASAR Programmable Respiratory Motion Phantom (Moudus Medical Device Inc. CANADA) able to adjust respiration pattern randomly was varying period, amplitude and baseline by analyze 50 patient's respiration of lung and liver cancer. One of the variations of respiration is baseline shift gradually downward per 0.01 cm, 0.03 cm, 0.05 cm. The other variation of respiration is baseline shift accidently downward per 0.2 cm, 0.4 cm, 0.6 cm, 0.8 cm. Experiments were performed in the same way that is used RPM Respiratory Gating System (phase gating, usually 30~70% gating) in Asan Medical Center. Results: It was all exposed radiation under one of the conditions of baseline shift gradually downward per 0.01 cm, 0.03 cm, 0.05 cm. Under the other condition of baseline shift accidently downward per 0.2 cm, 0.4 cm, 0.6 cm, 0.8 cm equally radiation was exposed. Conclusion: The variations of baseline shifts didn't accurately reflect on phase gating in RPM Respiratory Gating System. This inexactitude makes serious uncertainty in Respiratory Gated Radiation Therapy. So, Must be stabilized breathing of patient before conducting Respiratory Gated Radiation Therapy. also must be monitored breathing of patient in the middle of treatment. If you observe considerable changes of breathing when conducting Respiratory Gated Radiation Therapy. Stopping treatment immediately and then must be need to recheck treatment site using fluoroscopy. If patient's respiration rechecked using fluoroscopy restabilize, it is possible to restart Respiratory Gated Radiation Therapy.

• Progress in Medical Physics
• /
• v.28 no.3
• /
• pp.92-99
• /
• 2017

In respiratory-induced proton therapy, the accuracy of tracking system and beam controlling is more important than photon therapy. Therefore, a high accuracy motion tracking system that can track internal marker and external surrogate is needed. In this research, our team has installed internal and external marker tracking system at our institution's proton therapy system, and tested the scanning with gating according to the position of marker. The results demonstrate that the developed in-house external/internal marker based gating system can be clinically used for proton therapy system for moving tumor treatment.

• 대한방사선치료학회:학술대회논문집
• /
• 2005.06a
• /
• pp.13-17
• /
• 2005

Introduction : For stereotactic radiosurgery (SRS) of a tumor in the region whose movement due to respiration is significant, like Lung lower lobe, the gated therapy, which delivers radiation dose to the selected respiratory phases when tumor motion is small, was peformed using the Respiratory gating system and its clinical effectiveness was evaluated. Methode and Materials : For two SRS patients with a tumor in Lung lower lobe, a marker block (infrared reflector) was attached on the abdomen. While patient' respiratory cycle was monitored with Real-time Position Management (RPM, Varian, USA), 4D CT was performed (10 phases per a cycle). Phases in which tumor motion did not change rapidly were decided as treatment phases. The treatment volume was contoured on the CT images for selected treatment phases using maximum intensity projection (MIP) method. In order to verify setup reproducibility and positional variation, 4D CT was repeated. Result : Gross tumor volume (GTV) showed maximum movement in superior-inferior direction. For patient $\#$1, motion of GTV was reduced to 2.6 mm in treatment phases ($30\%\~60\%$), while that was 9.4 mm in full phases ($0\%\~90\%$) and for patient $\#$2, it was reduced to 2.3 mm in treatment phases ($30\%\~70\%$), while it was 11.7 mm in full phases ($0\%\~90\%$). When comparing two sets of CT images, setup errors in all the directions were within 3 mm. Conclusion : Since tumor motion was reduced less than 5 mm, the Respiratory gating system for SRS of Lung lower lobe is useful.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.16 no.10
• /
• pp.6932-6939
• /
• 2015

The respiration is one of important factor in the radiation therapy. The existing commercial method of cone-beam computed tomography on LINAC does not consider respiratory motion of patient hence the images are both distorted and inaccurate. In this study, the cone-beam computed tomography images have been reconstructed from back projection radiography of specific phase on breathing cycle which concerned about respiratory movement in radiation therapy. This study investigated how different between cone-beam CT images with and without gating respiratory movement, and this paper provides that guide and implementation of gated cone-beam CT on radiation therapeutic equipment.

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 2005.04a
• /
• pp.59-63
• /
• 2005

Respiration motion causes movement of internal structures in the thorax and abdomen, making accurate delivery of radiation therapy to tumors in those areas a challenge. Accounting for such motion during treatment, therefore, has the potential to reduce margins drawn around the clinical target volume (CTV), resulting in a lower dose to normal tissues (e.g., lung and liver) and thus a lower risk of treatment induced complications. Among the techniques that explicitly account for intrafraction motion are breath-hold, respiration gating, and 4D or tumor-tracking techniques. Respiration gating methods periodically turn the beam on when the patient's respiration signal is in a certain part of the respiratory cycle (generally end-inhale or end-exhale). These techniques require acquisition of some form of respiration motion signal (infrared reflective markers, spirometry, strain gauge, thermistor, video tracking of chest outlines and fluoroscopic tracking of implanted markers are some of the techniques employed to date), which is assumed to be correlated with internal anatomy motion. In preliminary study for the respiratory gating radiation therapy, we performed to measurement of this respiration motion signal. In order to measure the respiratory motion signals of patient, respiration measurement system (RMS) was composed with three sensor (spirometer, thermistor, and belt transducer), 4 channel data acquisition system and mobile computer. For two patients, we performed to evaluation of respiratory cycle and shape with RMS. We observed under this system that respiratory cycle is generally periodic but asymmetric, with the majority of time spent. As expected, RMS traced patient's respiration each other well and be easily handled for application.

• The Journal of Korean Society for Radiation Therapy
• /
• v.17 no.2
• /
• pp.125-131
• /
• 2005

Purpose : For stereotactic radiosurgery (SRS) of a tumor in the region whose movement due to respiration is significant, like Lung lower lobe, the gated therapy, which delivers radiation dose to the selected respiratory phases when tumor motion is small, was performed using the Respiratory gating system and its clinical effectiveness was evaluated. Materials and Methods : For two SRS patients with a tumor in Lung lower lobe, a marker block (infrared reflector) was attached on the abdomen. While patient' respiratory cycle was monitored with Real-time Position Management (RPM, Varian, USA), 4D CT was performed (10 phases per a cycle). Phases in which tumor motion did not change rapidly were decided as treatment phases. The treatment volume was contoured on the CT images for selected treatment phases using maximum intensity projection (MIP) method. In order to verify setup reproducibility and positional variation, 4D CT was repeated. Results : Gross tumor volume (GTV) showed maximum movement in superior-inferior direction. For patient #1, motion of GTV was reduced to 2.6 mm in treatment phases ($30{\sim}60%$), while that was 9.4 mm in full phases ($0{\sim}90%$) and for patient #2, it was reduced to 2.3 mm in treatment phases ($30{\sim}70%$), while it was 11.7 mm in full phases ($0{\sim}90%$). When comparing two sets of CT images, setup errors in all the directions were within 3 mm. Conclusion : Since tumor motion was reduced less than 5 mm, the Respiratory gating system for SRS of Lung lower lobe is useful.

• The Journal of Korean Society for Radiation Therapy
• /
• v.24 no.2
• /
• pp.167-174
• /
• 2012

Purpose: The respiration is one of the most important factors in respiratory gating radiation therapy (RGRT). We have developed an unique respiratory guidance system using an audio-visual system in order to support and stabilize individual patient's respiration and evaluated the usefulness of this system. Materials and Methods: Seven patients received the RGRT at our clinic from June 2011 to April 2012. After breathing exercise with the audio-visual system, we measured their spontaneous respiration and their respiration with the audio-visual system respectively. With the measured data, we yielded standard deviations by the superficial contents of respiratory cycles and functions, and analyzed them to examine changes in their breathing before and after the therapy. Results: The PTP (peak to peak) of the standard deviations of the free breathing, the audio guidance system, and the respiratory guidance system were 0.343, 0.148, and 0.078 respectively. The respiratory cycles were 0.645, 0.345, and 0.171 respectively and the superficial contents of the respiratory functions were 2.591, 1.008, and 0.877 respectively. The average values of the differences in the standard deviations among the whole patients at the CT room and therapy room were 0.425 for the PTP, 1.566 for the respiratory cycles, and 3.671 for the respiratory superficial contents. As for the standard deviations before and after the application of the PTP respiratory guidance system, that of the PTP was 0.265, that of the respiratory cycles was 0.474, and that of the respiratory superficial contents. The results of t-test of the values before and after free breathing and the audio-visual guidance system showed that the P-value of the PTP was 0.035, that of the cycles 0.009, and that of the respiratory superficial contents 0.010. Conclusion: The respiratory control could be one of the most important factors in the RGRT which determines the success or failure of a treatment. We were able to get more stable breathing with the audio-visual respiratory guidance system than free breathing or breathing with auditory guidance alone. In particular, the above system was excellent at the reproduction of respiratory cycles in care units. Such a system enables to reduce time due to unstable breathing and to perform more precise and detailed treatment.

• The Journal of Korean Society for Radiation Therapy
• /
• v.27 no.1
• /
• pp.23-30
• /
• 2015

Purpose : External markers respiratory movement measuring device (RPM; Real-time Position Management, Varian Medical System, USA) Liver Cancer Radiation Therapy Respiratory gated with respiratory signal with irradiation time and the actual research by analyzing the respiratory phase with the breathing motion measurement device respiratory tuning evaluate the accuracy of radiation therapy Materials and Methods : May-September 2014 Novalis Tx. (Varian Medical System, USA) and liver cancer radiotherapy using respiratory gated RPM (Duty Cycle 20%, Gating window 40% ~ 60%) of 16 patients who underwent total when recording the analyzed respiratory movement. After the breathing motion of the external markers recorded on the RPM was reconstructed by breathing through the acts phase analysis, for Beam-on Time and Duty Cycle recorded by using the reconstructed phase breathing breathing with RPM gated the prediction accuracy of the radiation treatment analysis and analyzed the correlation between prediction accuracy and Duty Cycle in accordance with the reproducibility of the respiratory movement. Results : Treatment of 16 patients with respiratory cycle during the actual treatment plan was analyzed with an average difference -0.03 seconds (range -0.50 seconds to 0.09 seconds) could not be confirmed statistically significant difference between the two breathing (p = 0.472). The average respiratory period when treatment is 4.02 sec (${\pm}0.71sec$), the average value of the respiratory cycle of the treatment was characterized by a standard deviation 7.43% (range 2.57 to 19.20%). Duty Cycle is that the actual average 16.05% (range 13.78 to 17.41%), average 56.05 got through the acts of the show and then analyzed% (range 39.23 to 75.10%) is planned in respiratory research phase (40% to 60%) in was confirmed. The investigation on the correlation between the ratio Duty Cycle and planned respiratory phase and the standard deviation of the respiratory cycle was analyzed in each -0.156 (p = 0.282) and -0.385 (p = 0.070). Conclusion : This study is to analyze the acts after the breathing motion of the external markers recorded during the actual treatment was confirmed in a reproducible ratios of actual treatment of breathing motion during treatment, and Duty Cycle, planned respiratory gated window. Minimizing an error of the treatment plan using 4DCT and enhance the respiratory training and respiratory signal monitoring for effective treatment it is determined to be necessary.

• The Journal of the Korea Contents Association
• /
• v.15 no.9
• /
• pp.395-402
• /
• 2015

when the radiation therapy of chest and abdomen, evaluation of the tumor motion and the data was used to minimize damage to normal tissues by separating the tumor and normal tissue and maximize tumor therapeutic effect. Lung and liver cancer each 20 patients based on the 50% top phase using 4D-CT simulation and Light speed-16 of shooting equipment 30 ~ 70 % gating phase interval and 0 ~90 % movement in the full phase interval was measured. If the full phase 0 ~ 90% with gating phase 30~70% of tumors in the liver and lung is shown the biggest difference compared to the motion and the size of the GTV was the largest difference in the I(inferior), full phase 0~90% degree of tumor motion only when a relatively large, gating phase to 30~70% of the tumor when the movement has been found that the reduced average 7.1mm. In the 4D-CT simulation comparing the motion value when the full phase 0~90 % and gating phase 30~70 % when the motion value, twice in the gating phase 30~70 % more than full phase 0~90 % showed a small movement value. The exposure to normal tissues, based on the results obtained from the 4D-CT simulation can be significantly alleviated, After treatment will reduce pain and disability in patients with radiation is expected to be able to effective treatment.

• Progress in Medical Physics
• /
• v.17 no.3
• /
• pp.136-143
• /
• 2006

The respiratory gating radiation therapy which Irradiates only in the stable respiratory period with analyzing the periodic motion of a reflective marker on the patient's abdomen has been applied to the precise radiation treatment in order to minimize the effect of organ motion induced by the respiration. This respiratory gating system establishes irradiation region using the amplitude-based or phase-based method. Although phase-based method Is preferred because of the stability in the real treatment conditions, it has some limits to explain the exact correlation between the marker motion and organ motion. Even when the variation of amplitude which can introduce target motion considered as an error is produced, the phase-based method has the possibility to irradiate including the error positions. In this study, the error analysis program was developed for the verification of the tumor position's variation correlated with the variation of marker's amplitude which can be occurred during a phase-based respiratory sating treatment. The analysis program was tested with a virtual treatment record file and with a record file using moving phantom which were modified considering the irregular amplitude's variation simulating the real clinical situations. In both cases, accurate discrimination of error points and error calculation were produced. When the treatment record files of a real patient were analyzed with the program, the accurate recognition and calculation of the error points were also verified. The analysis program developed in this study will be applied as a useful tool for the analysis of errors due to the irregular variation of patients' respiration during the phase-base respiratory gating radiation treatment.