Commissioning and quality assurance for a respiratory training system based on audiovisual biofeedback

Tokihiro Yamamoto,Siddharth Gopalan,Peter G Maxim,Paul J Keall,Guoqiang Cui,Jonathan Berger

doi:10.1120/jacmp.v11i4.3262

Tokihiro Yamamoto, Siddharth Gopalan + Show 4 more

Open Access

https://doi.org/10.1120/jacmp.v11i4.3262

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Abstract

A respiratory training system based on audiovisual biofeedback has been implemented at our institution. It is intended to improve patients' respiratory regularity during four‐dimensional (4D) computed tomography (CT) image acquisition. The purpose is to help eliminate the artifacts in 4D‐CT images caused by irregular breathing, as well as improve delivery efficiency during treatment, where respiratory irregularity is a concern. This article describes the commissioning and quality assurance (QA) procedures developed for this peripheral respiratory training system, the Stanford Respiratory Training (START) system. Using the Varian real‐time position management system for the respiratory signal input, the START software was commissioned and able to acquire sample respiratory traces, create a patient‐specific guiding waveform, and generate audiovisual signals for improving respiratory regularity. Routine QA tests that include hardware maintenance, visual guiding‐waveform creation, auditory sounds synchronization, and feedback assessment, have been developed for the START system. The QA procedures developed here for the START system could be easily adapted to other respiratory training systems based on audiovisual biofeedback.PACS number: 87.56.Fc

Highlights

Respiratory motion poses a significant challenge to the imaging of tumors in the thorax and upper abdomen, causing artifacts during three-dimensional (3D) computed tomography (CT) image acquisition.[1,2] These artifacts manifest themselves in the CT images in different ways, resulting in different errors and, diminishing the accuracy of diagnosis and radiation therapy during treatment planning[3,4] and radiation delivery.[5,6] One approach to reduce the motion artifacts is time-resolved and -stamped CT imaging - correlating respiratory motion in time with 3D-CT image acquisition
This article aims to fill this gap and develop a comprehensive quality assurance (QA) procedure for these systems based on the guidelines in the report of the Association of Physicists in Medicine (AAPM) Task Group 76.(19) In this context, we describe the commissioning and QA procedures developed for the Stanford Respiratory Training (START) system, which include hardware maintenance, software commissioning, interface with existing equipment, function assessment, and personnel training
Because the integrated cable provided by the factory for the video goggles is only about one meter long, an extension VGA/Audio/Power cable bundle (7.6 m for the simulation room and 15.2 m for the treatment room) was used to connect the video goggles with the START system control computer, which was placed outside the simulation and treatment rooms

Summary

Introduction

Respiratory motion poses a significant challenge to the imaging of tumors in the thorax and upper abdomen, causing artifacts during three-dimensional (3D) computed tomography (CT) image acquisition.[1,2] These artifacts manifest themselves in the CT images in different ways, resulting in different errors and, diminishing the accuracy of diagnosis and radiation therapy during treatment planning[3,4] and radiation delivery.[5,6] One approach to reduce the motion artifacts is time-resolved and -stamped CT imaging - correlating respiratory motion in time with 3D-CT image acquisition This is often referred to as four-dimensional (4D) CT.[7,8] With 4D-CT images, one can assess 3D tumor motion and directly incorporate that information into image reconstruction, reducing respiratory motion-related artifacts. A device that can improve respiratory reproducibility of a patient during radiotherapy imaging is highly desirable

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