Respiratory Gating
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Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5092
Author(s):  
Kim Melanie Kraus ◽  
Cristoforo Simonetto ◽  
Pavel Kundrát ◽  
Vanessa Waitz ◽  
Kai Joachim Borm ◽  
...  

We investigated the potential of respiratory gating to mitigate the motion-caused misdosage in lung stereotactic body radiotherapy (SBRT). For fourteen patients with lung tumors, we investigated treatment plans for a gating window (GW) including three breathing phases around the maximum exhalation phase, GW40-60. For a subset of six patients, we also assessed a preceding three-phase GW20-40 and six-phase GW20-70. We analyzed the target volume, lung, esophagus, and heart doses. Using normal tissue complication probability (NTCP) models, we estimated radiation pneumonitis and esophagitis risks . Compared to plans without gating, GW40-60 significantly reduced doses to organs at risk without impairing the tumor doses. On average, the mean lung dose decreased by 0.6 Gy (p < 0.001), treated lung V20Gy by 2.4% (p = 0.003), esophageal dose to 5cc by 2.0 Gy (p = 0.003), and maximum heart dose by 3.2 Gy (p = 0.009). The model-estimated mean risks of 11% for pneumonitis and 12% for esophagitis without gating decreased upon GW40-60 to 7% and 9%, respectively. For the highest-risk patient, gating reduced the pneumonitis risk from 43% to 32%. Gating is most beneficial for patients with high-toxicity risks. Pre-treatment toxicity risk assessment may help optimize patient selection for gating, as well as GW selection for individual patients.


2021 ◽  
pp. 20201350
Author(s):  
Michael Messerli ◽  
Virginia Liberini ◽  
Hannes Grünig ◽  
Alexander Maurer ◽  
Stephan Skawran ◽  
...  

Objectives: To evaluate the impact of fully automatic motion correction by data-driven respiratory gating (DDG) on positron emission tomography (PET) image quality, lesion detection and patient management. Materials and Methods: A total of 149 patients undergoing PET/CT for cancer (re-)staging were retrospectively included. Patients underwent a PET/CT on a digital detector scanner and for every patient a PET data set where DDG was enabled (PETDDG) and as well as where DDG was not enabled (PETnonDDG) was reconstructed. All PET data sets were evaluated by two readers which rated the general image quality, motion effects and organ contours. Further, both readers reviewed all scans on a case-by-case basis and evaluated the impact of PETDDG on additional apparent lesion, change of report, and change of management. Results: In 85% (n = 126) of the patients, at least one bed position was acquired using DDG, resulting in mean scan time increase of 4:37 min per patient in the whole study cohort (n = 149). General image quality was not rated differently for PETnonDDG and PETDDG images (p = 1.000) while motion effects (i.e. indicating general blurring) was rated significantly lower in PETDDG images and organ contours, including liver and spleen, were rated significantly sharper using PETDDG as compared to PETnonDDG (all p < 0.001). In 27% of patients, PETDDG resulted in a change of the report and in a total of 12 cases (8%), PETDDG resulted in a change of further clinical management. Conclusion: Deviceless DDG provided reliable fully automatic motion correction in clinical routine and increased lesion detectability and changed management in a considerable number of patients. Advances in knowledge: DDG enables PET/CT with respiratory gating to be used routinely in clinical practice without external gating equipment needed.


2021 ◽  
Author(s):  
Gordon Ho ◽  
Todd F. Atwood ◽  
Andrew R. Bruggeman ◽  
Kevin L. Moore ◽  
Elliot McVeigh ◽  
...  

Sensors ◽  
2021 ◽  
Vol 21 (16) ◽  
pp. 5525
Author(s):  
Qi Zhan ◽  
Wenjin Wang ◽  
Xiaorong Ding

To control the spread of coronavirus disease 2019 (COVID-19), it is effective to perform a fast screening of the respiratory rate of the subject at the gate before entering a space to assess the potential risks. In this paper, we examine the potential of a novel yet cost-effective solution, called thermopile-based respiratory gating, to contactlessly screen a subject by measuring their respiratory rate in the scenario with an entrance gate. Based on a customized thermopile array system, we investigate different image and signal processing methods that measure respiratory rate from low-resolution thermal videos, where an automatic region-of-interest selection-based approach obtains a mean absolute error (MAE) of 0.8 breaths per minute. We show the feasibility of thermopile-based respiratory gating and quantify its limitations and boundary conditions in a benchmark (e.g., appearance of face mask, measurement distance and screening time). The technical validation provided by this study is helpful for designing and implementing a respiratory gating solution toward the prevention of the spread of COVID-19 during the pandemic.


Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S150
Author(s):  
Gordon Ho ◽  
Todd Atwood ◽  
Andrew Bruggeman ◽  
Kevin Moore ◽  
Elliot McVeigh ◽  
...  

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254758
Author(s):  
Naoharu Kobayashi

Respiratory motion management is crucial for high-resolution MRI of the heart, lung, liver and kidney. In this article, respiration guide using acoustic sound generated by pulsed gradient waveforms was introduced in the pulmonary ultrashort echo time (UTE) sequence and validated by comparing with retrospective respiratory gating techniques. The validated sound-guided respiration was implemented in non-contrast enhanced renal angiography. In the sound-guided respiration, breathe−in and–out instruction sounds were generated with sinusoidal gradient waveforms with two different frequencies (602 and 321 Hz). Performance of the sound-guided respiration was evaluated by measuring sharpness of the lung-liver interface with a 10–90% rise distance, w10-90, and compared with three respiratory motion managements in a free-breathing UTE scan: without respiratory gating (w/o gating), 0-dimensional k-space navigator (k-point navigator), and image-based self-gating (Img-SG). The sound-guided respiration was implemented in stack-of-stars balanced steady-state free precession with inversion recovery preparation for renal angiography. No subjects reported any discomfort or inconvenience with the sound-guided respiration in pulmonary or renal MRI scans. The lung-liver interface of the UTE images for sound-guided respiration (w10-90 = 6.99 ± 2.90 mm), k-point navigator (8.51 ± 2.71 mm), and Img-SG (7.01 ± 2.06 mm) was significantly sharper than that for w/o gating (17.13 ± 2.91 mm; p < 0.0001 for all of sound-guided respiration, k-point navigator and Img-SG). Sharpness of the lung-liver interface was comparable between sound-guided respiration and Img-SG (p = 0.99), but sound-guided respiration achieved better visualization of pulmonary vasculature. Renal angiography with the sound-guided respiration clearly delineated renal, segmental and interlobar arteries. In conclusion, the gradient sound guided respiration can facilitate a consistent diaphragm position in every breath and achieve performance of respiratory motion management comparable to image-based self-gating.


Author(s):  
Jian-Kuen Wu ◽  
Shih-Han Chen ◽  
Feng-Ming Hsu ◽  
Shu-Hsien Liao ◽  
Yu-Jen Wang

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1523
Author(s):  
Paul Rogowski ◽  
Rieke von Bestenbostel ◽  
Franziska Walter ◽  
Katrin Straub ◽  
Lukas Nierer ◽  
...  

Purpose: To assess the feasibility and early results of online adaptive MR-guided radiotherapy (oMRgRT) of liver tumors. Methods: We retrospectively examined consecutive patients with primary or secondary liver lesions treated at our institution using a 0.35T hybrid MR-Linac (Viewray Inc., Mountain View, CA, USA). Online-adaptive treatment planning was used to account for interfractional anatomical changes, and real-time intrafractional motion management using online 2D cine MRI was performed using a respiratory gating approach. Treatment response and toxicity were assessed during follow-up. Results: Eleven patients and a total of 15 lesions were evaluated. Histologies included cholangiocarcinomas and metastases of neuroendocrine tumors, colorectal carcinomas, sarcomas and a gastrointestinal stroma tumor. The median BED10 of the PTV prescription doses was 84.4 Gy (range 59.5–112.5 Gy) applied in 3–5 fractions and the mean GTV BED10 was in median 147.9 Gy (range 71.7–200.5 Gy). Online plan adaptation was performed in 98% of fractions. The median overall treatment duration was 53 min. The treatment was feasible and successfully completed in all patients. After a median follow-up of five months, no local failure occurred and no ≥ grade two toxicity was observed. OMRgRT resulted in better PTV coverage and fewer OAR constraint violations. Conclusion: Early results of MR-linac based oMRgRT for the primary and secondary liver tumors are promising. The treatment was feasible in all cases and well tolerated with minimal toxicity. The technique should be compared to conventional SBRT in further studies to assess the advantages of the technique.


2021 ◽  
Vol 11 ◽  
Author(s):  
Sangjune Laurence Lee ◽  
Michael Bassetti ◽  
Gert J. Meijer ◽  
Stella Mook

In this review, we outline the potential benefits and the future role of MRI and MR-guided radiotherapy (MRgRT) in the management of esophageal cancer. Although not currently used in most clinical practice settings, MRI is a useful non-invasive imaging modality that provides excellent soft tissue contrast and the ability to visualize cancer physiology. Chemoradiation therapy with or without surgery is essential for the management of locally advanced esophageal cancer. MRI can help stage esophageal cancer, delineate the gross tumor volume (GTV), and assess the response to chemoradiotherapy. Integrated MRgRT systems can help overcome the challenge of esophageal motion due to respiratory motion by using real-time imaging and tumor tracking with respiratory gating. With daily on-table MRI, shifts in tumor position and tumor regression can be taken into account for online-adaptation. The combination of accurate GTV visualization, respiratory gating, and online adaptive planning, allows for tighter treatment volumes and improved sparing of the surrounding normal organs. This could lead to a reduction in radiotherapy induced cardiac toxicity, pneumonitis and post-operative complications. Tumor physiology as seen on diffusion weighted imaging or dynamic contrast enhancement can help individualize treatments based on the response to chemoradiotherapy. Patients with a complete response on MRI can be considered for organ preservation while patients with no response can be offered an earlier resection. In patients with a partial response to chemoradiotherapy, areas of residual cancer can be targeted for dose escalation. The tighter and more accurate targeting enabled with MRgRT may enable hypofractionated treatment schedules.


Author(s):  
Lukas M. Gottwald ◽  
Carmen P.S. Blanken ◽  
João Tourais ◽  
Jouke Smink ◽  
R. Nils Planken ◽  
...  

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