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The management of respiratory motion in radiation oncology report of AAPM Task Group 76a)
a)This manuscript is a moderately condensed version of the full report of the Task Group. The full report contains further background material and is available through the AAPM.
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Image of FIG. 1.
FIG. 1.

Coronal views of CT scans of the same patient taken (a) during free breathing (FB) and (b) with respiratory gated scanning at exhalation. From Ref. 140.

Image of FIG. 2.
FIG. 2.

Variations in respiratory patterns from the same patient taken a few minutes apart. The three curves in each plot correspond to infra-red reflector measured patient surface motion in the SI, AP, and ML directions, with each component arbitrarily normalized. In (a), the motion pattern is relatively reproducible in shape, displacement magnitude, and pattern. In (b), the trace is so irregular that it is difficult to distinguish any respiratory pattern. Figure courtesy of Dr. Sonja Dieterich.

Image of FIG. 3.
FIG. 3.

Tumor trajectories (not to scale) in 23 lung tumor patients, measured using implanted markers and real-time stereoscopic fluoroscopy. From Ref. 50.

Image of FIG. 4.
FIG. 4.

Comparison of external marker block motion with internal motion of the clinical target volume (CTV) for a patient with (a) no phase shift and (b) a patient with significant phase shift. The respiratory gating thresholds are set using the external marker block motion. The beam-on pulses are highlighted in red over the internal CTV position. From Ref. 204.

Image of FIG. 5.
FIG. 5.

A lung tumor observed with a flat-panel amorphous silicon detector forming part of the CyberKnife image-guided radiosurgery system. The tumor has four gold fiducial seeds implanted in it to enhance its position measurement. From Ref. 177.

Image of FIG. 6.
FIG. 6.

Recommended clinical process for patients with whom respiratory motion during the radiotherapy process is a concern.


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Lung tumor-motion data. The mean range of motion and the (minimum-maximum) ranges in millimeters for each cohort of subjects. The motion is in three dimensions (SI, AP, LR). AP: anterior-posterior; LR: left-right; SI: superior-inferior.

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Abdominal motion data. The mean range of motion and the (minimum-maximum) ranges in millimeters for each site and each cohort of subjects. The motion is in the superior-inferior (SI) direction.

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Correlation of tumor/organ motion with the respiratory signal. 3D: Three-dimensional; AP: Anterior-posterior; CT: Computed tomography; MRI: Magnetic resonance imaging; s: Second(s); SI: Superior-inferior.

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Summary of intra- and inter-fractional variations for different methods of respiratory management. Abbreviations: BH—breath-hold, ABC—active breathing control, SD—standard deviation, LR—left-right, AP—anterior-posterior, SI—superior-inferior, DIBH—deep inspiration breath-hold, includes setup error, 3D—3-dimensional error, mDIBH moderately deep inspiration breath-hold. (Ref. 200).


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Scitation: The management of respiratory motion in radiation oncology report of AAPM Task Group 76a)