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. 2017 Mar 10;2(3):354-362.
doi: 10.1016/j.adro.2017.03.002. eCollection 2017 Jul-Sep.

Audiovisual biofeedback guided breath-hold improves lung tumor position reproducibility and volume consistency

Danny Lee  1   2 , Peter B Greer  3   4 , Carminia Lapuz  3 , Joanna Ludbrook  3 , Perry Hunter  4 , Jameen Arm  4 , Sean Pollock  1 , Kuldeep Makhija  1 , Ricky T O'Brien  1 , Taeho Kim  1   2 , Paul Keall  1
Affiliations

Audiovisual biofeedback guided breath-hold improves lung tumor position reproducibility and volume consistency

Danny Lee et al. Adv Radiat Oncol. .

Abstract

Purpose: Respiratory variation can increase the variability of tumor position and volume, accounting for larger treatment margins and longer treatment times. Audiovisual biofeedback as a breath-hold technique could be used to improve the reproducibility of lung tumor positions at inhalation and exhalation for the radiation therapy of mobile lung tumors. This study aimed to assess the impact of audiovisual biofeedback breath-hold (AVBH) on interfraction lung tumor position reproducibility and volume consistency for respiratory-gated lung cancer radiation therapy.

Methods: Lung tumor position and volume were investigated in 9 patients with lung cancer who underwent a breath-hold training session with AVBH before 2 magnetic resonance imaging (MRI) sessions. During the first MRI session (before treatment), inhalation and exhalation breath-hold 3-dimensional MRI scans with conventional breath-hold (CBH) using audio instructions alone and AVBH were acquired. The second MRI session (midtreatment) was repeated within 6 weeks after the first session. Gross tumor volumes (GTVs) were contoured on each dataset. CBH and AVBH were compared in terms of tumor position reproducibility as assessed by GTV centroid position and position range (defined as the distance of GTV centroid position between inhalation and exhalation) and tumor volume consistency as assessed by GTV between inhalation and exhalation.

Results: Compared with CBH, AVBH improved the reproducibility of interfraction GTV centroid position by 46% (P = .009) from 8.8 mm to 4.8 mm and GTV position range by 69% (P = .052) from 7.4 mm to 2.3 mm. Compared with CBH, AVBH also improved the consistency of intrafraction GTVs by 70% (P = .023) from 7.8 cm3 to 2.5 cm3.

Conclusions: This study demonstrated that audiovisual biofeedback can be used to improve the reproducibility and consistency of breath-hold lung tumor position and volume, respectively. These results may provide a pathway to achieve more accurate lung cancer radiation treatment in addition to improving various medical imaging and treatments by using breath-hold procedures.

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Figures

Figure 1
Figure 1
The MRI setup of AVBH. (a) Exhalation and (b) inhalation breath-hold positions (red line) of the guiding wave (blue line) for two MRI sessions.
Figure 2
Figure 2
Lung tumors during CBH (top) and AVBH (bottom). (a) Contoured inhalation and exhalation breath-hold lung tumors, (b) corresponding inhalation and exhalation GTVs. S1: the first MRI session, S2: the second MRI session.
See this image and copyright information in PMC

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