• Radiation Oncology Journal
• /
• v.26 no.3
• /
• pp.181-188
• /
• 2008

Purpose: In order to enhance the efficiency of respiratory gated 4-dimensional radiation therapy for more regular and stable respiratory period and amplitude, a respiration training system was designed, and its efficacy was evaluated. Materials and Methods: The experiment was designed to measure the difference in respiration regularity following the use of a training system. A total of 11 subjects (9 volunteers and 2 patients) were included in the experiments. Three different breathing signals, including free breathing (free-breathing), guided breathing that followed training software (guided-breathing), and free breathing after the guided-breathing (post guided-breathing), were consecutively recorded in each subject. The peak-to-peak (PTP) period of the breathing signal, standard deviation (SD), peak-amplitude and its SD, area of the one cycle of the breathing wave form, and its root mean square (RMS) were measured and computed. Results: The temporal regularity was significantly improved in guided-breathing since the SD of breathing period reduced (free-breathing 0.568 vs guided-breathing 0.344, p=0.0013). The SD of the breathing period representing the post guided-breathing was also reduced, but the difference was not statistically significant (free-breathing 0.568 vs. guided-breathing 0.512, p=ns). Also the SD of measured amplitude was reduced in guided-breathing (free-breathing 1.317 vs. guided-breathing 1.068, p=0.187), although not significant. This indicated that the tidal volume for each breath was kept more even in guided-breathing compared to free-breathing. There was no change in breathing pattern between free-breathing and guided-breathing. The average area of breathing wave form and its RMS in postguided-breathing, however, was reduced by 7% and 5.9%, respectively. Conclusion: The guided-breathing was more stable and regular than the other forms of breathing data. Therefore, the developed respiratory training system was effective in improving the temporal regularity and maintaining a more even tidal volume.

• Journal of the Korean Society of Radiology
• /
• v.5 no.4
• /
• pp.179-187
• /
• 2011

This study statistically analyzed the difference of the stability of maintaining a respiratory period shown according to position and use of a device to search the tendency and usefulness of a device. The supine position showed better maintaining respiratory cycles than the prone position. The 85% of subjects who showed bad maintenance pattern of a respiratory cycle were significantly different pattern with using belly board. It could be said that there was a significant correlation between the maintenance of a respiratory cycle and relative index of respirational stability(p=0.044, kappa=0.607). The movement due to respiration was one of important considerations in the radiation therapy on chest, abdomen, and even pelvis. This study could contribute to the high quality radiation therapy by statistic analysis of respiratory signals and its application.

• The Journal of Korean Society for Radiation Therapy
• /
• v.24 no.2
• /
• pp.167-174
• /
• 2012

Purpose: The respiration is one of the most important factors in respiratory gating radiation therapy (RGRT). We have developed an unique respiratory guidance system using an audio-visual system in order to support and stabilize individual patient's respiration and evaluated the usefulness of this system. Materials and Methods: Seven patients received the RGRT at our clinic from June 2011 to April 2012. After breathing exercise with the audio-visual system, we measured their spontaneous respiration and their respiration with the audio-visual system respectively. With the measured data, we yielded standard deviations by the superficial contents of respiratory cycles and functions, and analyzed them to examine changes in their breathing before and after the therapy. Results: The PTP (peak to peak) of the standard deviations of the free breathing, the audio guidance system, and the respiratory guidance system were 0.343, 0.148, and 0.078 respectively. The respiratory cycles were 0.645, 0.345, and 0.171 respectively and the superficial contents of the respiratory functions were 2.591, 1.008, and 0.877 respectively. The average values of the differences in the standard deviations among the whole patients at the CT room and therapy room were 0.425 for the PTP, 1.566 for the respiratory cycles, and 3.671 for the respiratory superficial contents. As for the standard deviations before and after the application of the PTP respiratory guidance system, that of the PTP was 0.265, that of the respiratory cycles was 0.474, and that of the respiratory superficial contents. The results of t-test of the values before and after free breathing and the audio-visual guidance system showed that the P-value of the PTP was 0.035, that of the cycles 0.009, and that of the respiratory superficial contents 0.010. Conclusion: The respiratory control could be one of the most important factors in the RGRT which determines the success or failure of a treatment. We were able to get more stable breathing with the audio-visual respiratory guidance system than free breathing or breathing with auditory guidance alone. In particular, the above system was excellent at the reproduction of respiratory cycles in care units. Such a system enables to reduce time due to unstable breathing and to perform more precise and detailed treatment.

• The Journal of Korean Society for Radiation Therapy
• /
• v.24 no.2
• /
• pp.123-135
• /
• 2012

Purpose: It is essential to minimize the movement of tumor due to respiratory movement at the time of respiration controlled radiotherapy of non-small cell lung cancer patient. Accordingly, this Study aims to evaluate the usefulness of restricted respiratory period by comparing and analyzing the treatment plans that apply free and restricted respiration period respectively. Materials and Methods: After having conducted training on 9 non-small cell lung cancer patients (tumor n=10) from April to December 2011 by using 'signal monitored-breathing (guided- breathing)' method for the 'free respiratory period' measured on the basis of the regular respiratory period of the patents and 'restricted respiratory period' that was intentionally reduced, total of 10 CT images for each of the respiration phases were acquired by carrying out 4D CT for treatment planning purpose by using RPM and 4-dimensional computed tomography simulator. Visual gross tumor volume (GTV) and internal target volume (ITV) that each of the observer 1 and observer 2 has set were measured and compared on the CT image of each respiratory interval. Moreover, the amplitude of movement of tumor was measured by measuring the center of mass (COM) at the phase of 0% which is the end-inspiration (EI) and at the phase of 50% which is the end-exhalation (EE). In addition, both observers established treatment plan that applied the 2 respiratory periods, and mean dose to normal lung (MDTNL) was compared and analyzed through dose-volume histogram (DVH). Moreover, normal tissue complication probability (NTCP) of the normal lung volume was compared by using dose-volume histogram analysis program (DVH analyzer v.1) and statistical analysis was performed in order to carry out quantitative evaluation of the measured data. Results: As the result of the analysis of the treatment plan that applied the 'restricted respiratory period' of the observer 1 and observer 2, there was reduction rate of 38.75% in the 3-dimensional direction movement of the tumor in comparison to the 'free respiratory period' in the case of the observer 1, while there reduction rate was 41.10% in the case of the observer 2. The results of measurement and comparison of the volumes, GTV and ITV, there was reduction rate of $14.96{\pm}9.44%$ for observer 1 and $19.86{\pm}10.62%$ for observer 2 in the case of GTV, while there was reduction rate of $8.91{\pm}5.91%$ for observer 1 and $15.52{\pm}9.01%$ for observer 2 in the case of ITV. The results of analysis and comparison of MDTNL and NTCP illustrated the reduction rate of MDTNL $3.98{\pm}5.62%$ for observer 1 and $7.62{\pm}10.29%$ for observer 2 in the case of MDTNL, while there was reduction rate of $21.70{\pm}28.27%$ for observer 1 and $37.83{\pm}49.93%$ for observer 2 in the case of NTCP. In addition, the results of analysis of correlation between the resultant values of the 2 observers, while there was significant difference between the observers for the 'free respiratory period', there was no significantly different reduction rates between the observers for 'restricted respiratory period. Conclusion: It was possible to verify the usefulness and appropriateness of 'restricted respiratory period' at the time of respiration controlled radiotherapy on non-small cell lung cancer patient as the treatment plan that applied 'restricted respiratory period' illustrated relative reduction in the evaluation factors in comparison to the 'free respiratory period.

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 2005.04a
• /
• pp.59-63
• /
• 2005

Respiration motion causes movement of internal structures in the thorax and abdomen, making accurate delivery of radiation therapy to tumors in those areas a challenge. Accounting for such motion during treatment, therefore, has the potential to reduce margins drawn around the clinical target volume (CTV), resulting in a lower dose to normal tissues (e.g., lung and liver) and thus a lower risk of treatment induced complications. Among the techniques that explicitly account for intrafraction motion are breath-hold, respiration gating, and 4D or tumor-tracking techniques. Respiration gating methods periodically turn the beam on when the patient's respiration signal is in a certain part of the respiratory cycle (generally end-inhale or end-exhale). These techniques require acquisition of some form of respiration motion signal (infrared reflective markers, spirometry, strain gauge, thermistor, video tracking of chest outlines and fluoroscopic tracking of implanted markers are some of the techniques employed to date), which is assumed to be correlated with internal anatomy motion. In preliminary study for the respiratory gating radiation therapy, we performed to measurement of this respiration motion signal. In order to measure the respiratory motion signals of patient, respiration measurement system (RMS) was composed with three sensor (spirometer, thermistor, and belt transducer), 4 channel data acquisition system and mobile computer. For two patients, we performed to evaluation of respiratory cycle and shape with RMS. We observed under this system that respiratory cycle is generally periodic but asymmetric, with the majority of time spent. As expected, RMS traced patient's respiration each other well and be easily handled for application.

• Progress in Medical Physics
• /
• v.23 no.1
• /
• pp.1-7
• /
• 2012

The purpose of this study was to develop the respiratory training system using individual characteristic guiding waveform to reduce the impact of respiratory motion that causes artifact in radiotherapy. In order to evaluate the improvement of respiratory regularity, 5 volunteers were included and their respiratory signals were acquired using the in-house developed belt-type sensor. Respiratory training system needs 10 free breathing cycles of each volunteer to make individual characteristic guiding waveform based on Fourier series and it guides patient's next breathing. For each volunteer, free breathing and guided breathing which uses individual characteristic guiding waveform were performed to acquire the respiratory cycles for 3 min. The root mean square error (RMSE) was computed to analyze improvement of respiratory regularity in period and displacement. It was found that respiratory regularity was improved by using respiratory training system. RMSE of guided breathing decreased up to 40% in displacement and 76% in period compared with free breathing. In conclusion, since the guiding waveform was easy to follow for the volunteers, the respiratory regularity was significantly improved by using in-house developed respiratory training system. So it would be helpful to improve accuracy and efficiency during 4D-RT, 4D-CT.

• The Journal of Korean Society for Radiation Therapy
• /
• v.23 no.2
• /
• pp.83-90
• /
• 2011

Purpose: This study statistically analyzed the difference of the stability of maintaining a respiratory period shown according to position and use of a device to search the tendency and usefulness of a device. Materials and Methods: The study obtained respiratory signals which maintained a respiratory period for 20 minutes each supine and prone position for 11 subjects. The study obtained respiratory signals in a state of using a belly board for 7 patients in a bad condition of a respiratory period in a prone position to analyze a change in respiration and the stability before and after the use of a device. Results: The supine part showed 54.5%, better than the prone part of 36.4% in a case that the stability for maintaining a respiratory period was in a good condition as a fixed respiratory period was well maintained according to the position. 6 patients (85%) showed a maintenance pattern of a respiratory period significantly different before the use and 4 patients showed a significantly good change in the stability for maintaining a respiratory period as a result that belly boards were used for 7 patients that the maintenance of a respiratory period was not in a good condition on a prone position. Conclusion: It seemed that this study could contribute to the maintenance of respiratory period and of respiratory stability as the optimal position for maintenance of respiration and the use of a device such as a belly board were decided through statistic analysis of respiratory signals and its application even if patient position and use of device were decided by the beam arrangement a treatment part of a patient, location of a target, and an expected plan.

• The Journal of Korean Society for Radiation Therapy
• /
• v.26 no.1
• /
• pp.137-147
• /
• 2014

Purpose : The purpose of this study is to verify the accuracy of dose delivery according to the patient's breathing cycle in Gated Volumetric Modulated Arc Therapy Materials and Methods : TrueBeam STxTM(Varian Medical System, Palo Alto, CA) was used in this experiment. The Computed tomography(CT) images that were acquired with RANDO Phantom(Alderson Research Laboratories Inc. Stamford. CT, USA), using Computerized treatment planning system(Eclipse 10.0, Varian, USA), were used to create VMAT plans using 10MV FFF with 1500 cGy/fx (case 1, 2, 3) and 220 cGy/fx(case 4, 5, 6) of doserate of 1200 MU/min. The regular respiratory period of 1.5, 2.5, 3.5 and 4.5 sec and the patients respiratory period of 2.2 and 3.5 sec were reproduced with the $QUASAR^{TM}$ Respiratory Motion Phantom(Modus Medical Devices Inc), and it was set up to deliver radiation at the phase mode between the ranges of 30 to 70%. The results were measured at respective respiratory conditions by a 2-Dimensional ion chamber array detector(I'mRT Matrixx, IBA Dosimetry, Germany) and a MultiCube Phantom(IBA Dosimetry, Germany), and the Gamma pass rate(3 mm, 3%) were compared by the IMRT analysis program(OmniPro I'mRT system software Version 1.7b, IBA Dosimetry, Germany) Results : The gamma pass rates of Case 1, 2, 3, 4, 5 and 6 were the results of 100.0, 97.6, 98.1, 96.3, 93.0, 94.8% at a regular respiratory period of 1.5 sec and 98.8, 99.5, 97.5, 99.5, 98.3, 99.6% at 2.5 sec, 99.6, 96.6, 97.5, 99.2, 97.8, 99.1% at 3.5 sec and 99.4, 96.3, 97.2, 99.0, 98.0, 99.3% at 4.5 sec, respectively. When a patient's respiration was reproduced, 97.7, 95.4, 96.2, 98.9, 96.2, 98.4% at average respiratory period of 2.2 sec, and 97.3, 97.5, 96.8, 100.0, 99.3, 99.8% at 3.5 sec, respectively. Conclusion : The experiment showed clinically reliable results of a Gamma pass rate of 95% or more when 2.5 sec or more of a regular breathing period and the patient's breathing were reproduced. While it showed the results of 93.0% and 94.8% at a regular breathing period of 1.5 sec of Case 5 and 6, it could be confirmed that the accurate dose delivery could be possible on the most respiratory conditions because based on the results of 100 patients's respiratory period analysis as no one sustained a respiration of 1.5 sec. But, pretreatment dose verification should be precede because we can't exclude the possibility of error occurrence due to extremely short respiratory period, also a training at the simulation and careful monitoring are necessary for a patient to maintain stable breathing. Consequently, more reliable and accurate treatments can be administered.

• Fire Science and Engineering
• /
• v.33 no.4
• /
• pp.83-88
• /
• 2019

This study examined the concentration of combustion gases while considering low ventilation and respiration frequency. A one-quarter-size ISO 9705 room corner test was performed. The concentrations of carbon monoxide and oxygen were measured in each case with the continuous inhalation of combustion gas with low ventilation (2, 6, and 10 LPM) and different respiration frequencies (2 s, 5 s, and infinity). The combustion of a gasoline pool fire in the compartment had a theoretical heat release rate of 5.34 kW. The results show that the deviation of the gas concentrations becomes higher as the low ventilation increases compared to the respiration frequency. In addition, as the respiration frequency increases, the variation in the minimum oxygen concentration is larger than the average value, while in the case of carbon monoxide, the variation in the average value is larger than the maximum value. These results show that the inhalation characteristics of refugees should be considered to investigate fires.

• Proceedings of the Korean Institute of Information and Commucation Sciences Conference
• /
• 2014.05a
• /
• pp.833-835
• /
• 2014

On this study, we have developed respiratory training system to improve stability of respiration, one of the most important factors of Respiratory Gated Radiation Therapy, RGRT. Respiratory training system that we developed was applied to personal respiratory cycle so that it could provide comfortable respiratory triggering to patients. To give sufficient time for practice, we used modular portable device to practice easily and to be undetered by time and place. We have intended to improve efficiency and accuracy by providing it to patients. We are now planning to conduct experiment of 10 peoples to find out stability, degree of durability betterment and regularity of respiration when patients are using respiratory training system. There are three kinds of breathing style. First is free breathing that Individual patients can breathe freely. Second is guide breathing that patients apply to personal respiration cycle through the guiding sight and hearing program. Third is prediction breathing that patients breathe after respiratory training without guiding sight and hearing program. By using these 3 data of respiration method, we have evaluated usability of respiratory training system by quantitatively analyzing respiration period, amplitude and area's variation.