Abstract
The advent of image-guided radiation therapy has led to dramatic improvements in the accuracy of treatment delivery in radiotherapy. Such advancements have highlighted the deleterious impact tumor motion can have on both image quality and radiation treatment delivery. One approach to reducing tumor motion irregularities is the use of breathing guidance systems during imaging and treatment. These systems aim to facilitate regular respiratory motion which in turn improves image quality and radiation treatment accuracy. A review of such research has yet to be performed; it was therefore their aim to perform a systematic review of breathing guidance interventions within the fields of radiation oncology and radiology. From August 1-14, 2014, the following online databases were searched: Medline, Embase, PubMed, and Web of Science. Results of these searches were filtered in accordance to a set of eligibility criteria. The search, filtration, and analysis of articles were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses. Reference lists of included articles, and repeat authors of included articles, were hand-searched. The systematic search yielded a total of 480 articles, which were filtered down to 27 relevant articles in accordance to the eligibility criteria. These 27 articles detailed the intervention of breathing guidance strategies in controlled studies assessing its impact on such outcomes as breathing regularity, image quality, target coverage, and treatment margins, recruiting either healthy adult volunteers or patients with thoracic or abdominal lesions. In 21/27 studies, significant (p < 0.05) improvements from the use of breathing guidance were observed. There is a trend toward the number of breathing guidance studies increasing with time, indicating a growing clinical interest. The results found here indicate that further clinical studies are warranted that quantify the clinical impact of breathing guidance, along with the health technology assessment to determine the advantages and disadvantages of breathing guidance.
Highlights
There is a trend towards the number of breathing guidance studies increasing with time, indicating a growing clinical interest
The results found here indicate that further clinical studies are warranted that quantify the clinical impact of breathing guidance, along with the health technology assessment to determine the advantages and disadvantages of breathing guidance
While image-guided radiation therapy (IGRT) has improved the accuracy of radiotherapy by utilizing information 35 about tumor motion and positioning throughout a patient’s treatment, it has shed light on the deleterious impact tumor motion can have on both image quality and radiation treatment delivery
Summary
The advent of image-guided radiation therapy (IGRT) has led to dramatic improvements in the accuracy of treatment delivery in radiotherapy, with the reduction of both random and systematic uncertainties.. The widespread utilization of IGRT has led to the investigation of an increasing number of methods to address breathing motion and tumor and organ movement and the resultant uncertainties they cause. A number of image reconstruction methods and tracking systems have 45 been developed to ameliorate these uncertainties.16-19 Such techniques can be expensive and don’t directly manage the problem of irregular breathing motion. Addressing irregular tumor motion directly at the source by managing the patients’ breathing has been of increasing interest in recent times, with several breathing guidance techniques being developed from simple buzzer signals to interactive guiding interfaces to facilitate regular and predictable tumor motion
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