C01H063 rev 001

C01H063 rev 001

Respiratory Motion Effect in Radiation Therapy

• Relevant Sites: Thorax, Abdomen, Pelvis, Left Breast

C01H063 rev 001

Respiratory Motion Effect in Radiation Therapy

• Relevant Sites: Thorax, Abdomen, Pelvis• Imaging: Artifacts can cause distortion of the target and OARs volume and

position (OARS = Organs At Risk)

C01H063 rev 001

Respiratory Motion Effect in Radiation Therapy

• Interested Sites: Thorax, Abdomen, Pelvis• Imaging: Artifacts can cause distortion of the target and OARs volume and

position• Treatment Planning: Because of the artifacts registered during imaging

acquisition, larger margins are needed for ensuring adequate target coverage.

C01H063 rev 001

Respiratory Motion Effect in Radiation Therapy

• Relevant Sites: Thorax, Abdomen, Pelvis• Imaging: Artifacts can cause distortion of the target and OARs volume/position• Treatment Planning: Because of the artifacts registered during imaging

acquisition, larger margins are needed for ensuring adequate target coverage

• TREATMENT DELIVERY: blurring of the static dose distribution that causes a deviation between the planned and the actual delivered dose distributions. Stronger effects with treatment plans characterized by steep dose gradients and high modulation degrees

C01H063 rev 001

Voluntary Breath Hold TechniqueIntrafraction motion and in particular respiratory motion, causes inaccuracies in the radiation therapy treatments. The patient is being asked to independently hold their breath at some point in the breathing cycle: •Inspiration (70-80%): DIBH (Pictured)•Exhale •Shallow Breathing Radiation will be delivered during the Shallow Breathing phase. •Target motion is considerably reduced together with anatomy variations •Benefits for the OARs

C01H063 rev 001

• Expandable bellows system • Base unit • 3 LED display • LED display mount • Measurement tool •Wireless extension kit

C01H063 rev 001

• Expandable bellows system • Base unit • 3 LED displays • LED display mount • Measurement tool •Wireless extension kit

C01H063 rev 001

• Expandable bellows system • Base unit • 3 LED displays • LED display mount, multiple versions available • Measurement tool •Wireless extension kit

C01H063 rev 001

• Expandable bellows system • Base unit • 3 LED displays • LED display mount • Measurement tool •Wireless extension kit

C01H063 rev 001

• Expandable bellows system • Base unit • 3 LED displays • LED display mount • Measurement tool •Wireless extension kit

C01H063 rev 001

SYSTEM ARCHITECTURE

C01H063 rev 001

WORKFLOW

• Determine if the patient is a valid candidate for the Breath Hold ES

• Monitor the patient in order to understand the area of maximum breathing induced by thorax/abdomen extension

Planning CT: • Set/Confirm Breath Hold

Sensitivity • Place belt on patient and connect the bellows belt to the base unit • Position the gooseneck and the display •Position reference markings on the patient where belt is placed using tattoos, markers, tape, etc.

C01H063 rev 001

WORKFLOW•Have the patient take an initial comfortable breath in and hold • Zero the system (Reference Point)• Teach the patient to achieve desired breath hold or to breathe around the comfortable breath with the use of the LED light indicators • Acquire the CT images •Take the belt off the patient and insert it into the measurement tool • Expand bellows to illuminate the single red light, record the measurement using the measurement tool•Expand bellows to illuminate the top of the light range desired for patient, record the measurement using measurement tool (shallow breathing)•Contract bellows to illuminate the bottom of the light range desired for patient, record the measurement using measurement tool (shallow breathing)

C01H063 rev 001

WORKFLOW• During All Following Treatment Sessions:

• Set/Confirm sensitivity setting used in CT simulation• Expand the bellows with the measurement tool to the recorded breath hold position • Place the belt on the patient using previous reference points • Initiate treatment when the patient is at desired breath hold point or in between the light

ranges determined in CT Sim

C01H063 rev 001

SENSITIVITY CHART

•The system sensitivity is a choice of the user, having 5 different preset levels to choose from.

C01H063 rev 001

CANDIDATES

•IGRT treatments •Thorax, Abdomen, Left breast •Shallow breathing •DIBH •Improved contouring on CT Images •Great reproducibility •Easy, fast and comfortable system set up •Not invasive (no spirometer) •Portable and standalone •All LINACS •No software •No external devices ( implanted markers, infra-red cameras, etc…)