A gated deep inspiration breath-hold radiation therapy technique using a linear position transducer

For patients with thoracic and abdominal lesions, respiration-induced internal organ motion and deformations during radiation therapy are limiting factors for the administration of high radiation dose. To increase the dose to the tumor and to reduce margins, tumor movement during treatment must be minimized. Currently, several types of breath-synchronized systems are in use. These systems include respiratory gating, deep inspiration breath-hold, active breathing control, and voluntary breath-hold. We used a linear position transducer (LPT) to monitor changes in a patient's abdominal cross-sectional area. The LPT tracks changes in body circumference during the respiratory cycle using a strap connected to the LPT and wrapped around the patient's torso. The LPT signal is monitored by a computer that provides a real-time plot of the patient's breathing pattern. In our technique, we use a CT study with multiple gated acquisitions. The Philips Medical Systems Q series CT imaging system is capable of operating in conjunction with a contrast injector. This allows a patient performing the deep inspiration breath-hold maneuver to send a signal to trigger the CT scanner acquisitions. The LPT system, when interfaced to a LINAC, allows treatment to be delivered only during deep inspiration breath-hold periods. Treatment stops automatically if the lung volume drops from a preset value. The whole treatment can be accomplished with 1 to 3 breath-holds. This technique has been used successfully to combine automatically gated radiation delivery with the deep inspiration breath-hold technique. This improves the accuracy of treatment for moving tumors, providing better target coverage, sparing more healthy tissue, and saving machine time.