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Purpose . To investigate the effectiveness of respiratory guidance system in 4-dimensional computed tomography (4DCT) based respiratory-gated radiation therapy (RGRT) by comparing respiratory signals and dosimetric analysis of treatment plans.  Methods . The respiratory amplitude and period of the free, the audio device-guided, and the complex system-guided breathing were evaluated in eleven patients with lung or liver cancers. The dosimetric parameters were assessed by comparing free breathing CT plan and 4DCT-based 30–70% maximal intensity projection (MIP) plan.  Results . The use of complex system-guided breathing showed significantly less variation in respiratory amplitude and period compared to the free or audio-guided breathing regarding the root mean square errors (RMSE) of full inspiration ( P  = 0.031), full expiration ( P  = 0.007), and period ( P  = 0.007). The dosimetric parameters including  V   5 Gy ,  V   10 Gy ,  V   20 Gy ,  V   30 Gy ,  V   40 Gy , and  V   50 Gy  of normal liver or lung in 4DCT MIP plan were superior over free breathing CT plan.  Conclusions . The reproducibility and regularity of respiratory amplitude and period were significantly improved with the complex system-guided breathing compared to the free or the audio-guided breathing. In addition, the treatment plan based on the 4D CT-based MIP images acquired with the complex system guided breathing showed better normal tissue sparing than that on the free breathing CT.

biomed research international

Four-Dimensional Computed Tomography Based Respiratory-Gated Radiotherapy with Respiratory Guidance System: Analysis of Respiratory Signals and Dosimetric Comparison