MANAGEMENT OF

RESPIRATORY
MOTION IN
RADIATION
THERAPY

RAJIV KUMAR SINGH

RADIOTHERAPY TECHNOLOGIST
.
MAZUMDAR
SHAW CANCER CENTER

INTRODUCTION

Intrafraction motion is becoming increasingly

important in the era of image-guided Radiotherapy.
Intrafraction motion can be caused by the
respiratory, skeletal muscular, cardiac and
Gastrointestinal systems.
Of these four systems, most of the research and
development to date has been directed towards
accounting for respiratory motion.

PROBLEMS OF RESPIRATORY MOTION

DURING RADIOTHERAPY
A.

Image acquisition limitations

B.

Treatment planning limitations

C.

Radiation delivery limitations

METHODS TO EXPLICITLY ACCOUNT

FOR RESPIRATORY MOTION IN
RADIOTHERAPY

A. Respiratory gating methods

B. Breath-hold methods
1. Deep inspiration breath-hold
2. Active Breathing Control
3. Self-held breath-hold
4. Self-held breath-hold using an External Marker
C. Forced shallow breathing methods
D. Real-time tumor tracking methods

What is ABC?

Active Breathing Coordinator (ABC) is a noninvasive,

advanced technology that helps patients hold
their breath while they receive radiation therapy

The concept of ABC was developed by Dr John Wong at William

Beaumont Hospital (WBH) in 1997.

The basic theory behind the

procedure is for the patient to
perform short, repeated breath-holds
(BH) so that CT imaging and treatment
delivery can be achieved with the
tumor in a stationary position.
During an ABC procedure, a
specifically designed device is utilized
to reproducibly apply the same
breath-holding level for each session.

How ABC works

The ABC consists of a

turbine spirometer, which
measures the relative
airflow and displays a
visual representation of
the respiratory curve on a
laptop computer.

How ABC works

The patient is connected to the system via a length of
tubing and a bacterial filter, with a nose clip to prevent
leakage and increase accuracy of the spirometry
measurement.

How ABC works

How ABC works

After
a
predefined
volume of air (threshold
volume) has passed
through the spirometer,
a small balloon valve
will inflate and occlude
the tube, applying an
assisted Breath Hold
(BH).

How ABC works

At all times the patient is in control of the BH, via a
patient control switch. This switch must be depressed to
initiate an ABC procedure and if released will
automatically open the balloon valve and allow the
patient to breathe freely.

How ABC works

The system is configurable to
each
individual
patient
or
procedure,
with
variable
threshold
levels
and
BH
durations.

PROCESS

END OF 1 ST SEGMENT

AGAIN

WORKFLOW

Initial training session

Appropriate threshold level
BH duration possible has been reported as 1520
seconds

GOAL

To improve the accuracy of treatment delivery

STABILITY

Immobilizing the respiratory motion during

specific breath-holds (intra-breath hold)

VERSATILITIY

Shift the normal structures out of the high

dose region

CONCLUSION
This

has paved the way for alternative

fractionation regimes, such as hypo
fractionation, to be adopted in current clinical
practice.

THANK YOU