Respiratory Gating for Radiotherapy

A Report of Chang Gung Memorial Hospital in RTO

Transcript

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