Gating / Breath hold

[Burt Radnolds]

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Trying to upgrade some equipment. For those willing to answer, how are you all currently doing your breath holds and gating? Looking for specifics without getting too crazy in detail. What vendor? What image verification? Simulation details? Cost? Anything you despise and would recommend against?

Appreciate any input.

 

[evilbooyaa]

RPM for 4DCT/BH/Gating.

DIBH for breast - daily port while patient doing DIBH
Breath hold for SBRT - CBCT while patient doing breath hold
Gating - Gated CBCT through the applicable respiratory phases.

Don't know for most of the other questions

 

[scarbrtj]

In all seriousness... who needs high-priced gating tech when a lower tech option would be better. When a patient can hold her breath for 5-plus minutes, well that's something. I have never been super comfortable with a moving fiducial (ie the external tracking device on the skin) far-flung form the target to tell me where the target is. (A clip or fiducial placed near or in the tumor is another story; ie on/off gating during fluoro e.g. or the fancy real time MR tracking.) But for honest, I think it's worth us as a specialty looking at more closely. Gating becomes moot when there's little-to-none resp motion.

 

[Gfunk6]

For a lot of SBRT we use CK (with or without fiducials) to allow for direct tracking.

For linac-based treatments:

1. Liver/lung - we use 4DCT planning and a 4D CBCT prior to each fraction to ensure target doesn't exit PTV. If patient can tolerate it we use DIBH + VMAT which can deliver beams quickly.
2. Left breast - DIBH

 

[RickyScott]

Saw a group at Astro that we’re using cpap to dampen respiratory motion. Not sure why that was not pursued but sounded like a good idea. 500$ solution

for left breast I block heart 95% of time and don’t gate for 2 field breasts. If you are treating imn, pt has bigger fish to fry

 

[RickyScott]

CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer - Radiation Oncology

Purpose Limiting the heart dose in left sided breast cancer radiotherapy is critical. We sought to study the effect of using CPAP (continuous positive airway pressure) as an aid in reducing heart dose in breast cancer radiotherapy. Methods Patients with left sided breast cancer receiving...

ro-journal.biomedcentral.com

 

[PhotonBomb]

Most departments are banning ABC or Breath Hold techniques in light of Covid

 

[radoncgrad2019]

Most departments are banning ABC or Breath Hold techniques in light of Covid

we are for ABC

still allowing DIBH

 

[evilbooyaa]

No issue with DIBH. Understand the reluctance of ABC in an era of concern for respiratory illness.

 

[GI_RadOnc]

Received feedback from hospital infection control and vendor that ABC was safe during this time. We use ABC for left sided breast pateints and upper abdomen patients with clips/stents; MRI guidance is better though for the rest of liver/pancreas.