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Respiratory Gating for Radiotherapy

Tsung-Yung Lu
November 28, 2019

Respiratory Gating for Radiotherapy

A Report of Chang Gung Memorial Hospital in RTO

Tsung-Yung Lu

November 28, 2019
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  1. 1 Respiratory Gating for Radiotherapy

  2. OVERVIEW ► Indication ► Real-time Position Management(RPM) ► Active Breathing

    Coordinator(ABC) ► Deep Inspiration Breath-hold (DIBH) ► Calypso 4D Localization System ► MR-guided Radiation Therapy, ViewRay-MRIdian ► Biology-guided Radiation Therapy(BgRT), reflexion 2
  3. 3 Indication

  4. Indication ► Lung ► Breast ► Separates breast from heart

    ► Pancreatic ► Stomach ► Liver ► Prostate ► Whole abdomen for ovarian cancer 4
  5. 5 Real-time Position Management

  6. Real-time Position Management ► non-invasive ► video-based ► measure respiratory

    pattern & range of motion 6
  7. Real-time Position Management 7

  8. Real-time Position Management 8

  9. 9 Active Breathing Coordinator

  10. Active Breathing Coordinator ► clamp on the patient’s nose ►

    Mouthpiece ► Inflate patient’s lungs to a pre-determined volume ► No additional air can enter lungs during the breath hold 10
  11. Active Breathing Coordinator 11

  12. 12 Deep Inspiration Breath-hold

  13. Deep Inspiration Breath-hold ► Primarily for treating left-sided breast cancer

    ► Limiting radiation exposure to the heart and lungs ► DIBH technique: relaxed breathing →deep inspiration →breath-hold →simulation / verification / treatment → relaxed breathing ► Free-breathing breath-hold ► RPM tech ► Spirometry-monitored breath-hold ► ABC tech 13
  14. 14 Calypso 4D Localization System

  15. Calypso 4D Localization System 15

  16. Calypso 4D Localization System ► GPS for the Body ►

    radiofrequency waves ► Three tiny Beacon are implanted into the target tissue 16 https://vimeo.com/60188265
  17. Calypso 4D Localization System 17

  18. Calypso 4D Localization System 18

  19. Calypso 4D Localization System 19

  20. Calypso 4D Localization System 20

  21. 21 MR-guided Radiation Therapy

  22. MR-guided Radiation Therapy 22 Real-time visualization of an adrenal tumor

    PTV, blue contour tracked GTV outside of the PTV, green contour tracked GTV excursions either within the threshold-ROI%, red contour tracked GTV excursions entirely within the threshold-ROI%, red contour
  23. MR-guided Radiation Therapy 23

  24. 24 Biology-guided Radiation Therapy

  25. Biology-guided Radiation Therapy 25

  26. Biology-guided Radiation Therapy 26

  27. REFERENCE 27  Philippe Giraud and Annie Houle, Respiratory Gating

    for Radiotherapy: Main Technical Aspects and Clinical Benefits. ISRN Pulmonology, 2013.  Jeremy D.P. Hoisak, and Todd Pawlicki. The Role of Optical Surface Imaging Systems in Radiation Therapy. Semin Radiat Oncol 28:185-193, 2018.  Carmen Bergom, Adam Currey, al. Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation. Front Oncol, 2018.
  28. Thanks! 28