title: Management of the baseline shift using a new and simple method for respiratory-gated radiation therapy: detectability and effectiveness of a flexible monitoring system.
abstract: OBJECTIVE
  In respiratory-gated radiation therapy, a baseline shift decreases the accuracy of target coverage and organs at risk (OAR) sparing. The effectiveness of audio-feedback and audio-visual feedback in correcting the baseline shift in the breathing pattern of the patient has been demonstrated previously. However, the baseline shift derived from the intrafraction motion of the patient's body cannot be corrected by these methods. In the present study, the authors designed and developed a simple and flexible system.
  
  
  METHODS
  The system consisted of a web camera and a computer running our in-house software. The in-house software was adapted to template matching and also to no preimage processing. The system was capable of monitoring the baseline shift in the intrafraction motion of the patient's body. Another marker box was used to monitor the baseline shift due to the flexible setups required of a marker box for gated signals. The system accuracy was evaluated by employing a respiratory motion phantom and was found to be within AAPM Task Group 142 tolerance (positional accuracy <2 mm and temporal accuracy <100 ms) for respiratory-gated radiation therapy. Additionally, the effectiveness of this flexible and independent system in gated treatment was investigated in healthy volunteers, in terms of the results from the differences in the baseline shift detectable between the marker positions, which the authors evaluated statistically.
  
  
  RESULTS
  The movement of the marker on the sternum [1.599 +/- 0.622 mm (1 SD)] was substantially decreased as compared with the abdomen [6.547 +/- 0.962 mm (1 SD)]. Additionally, in all of the volunteers, the baseline shifts for the sternum [-0.136 +/- 0.868 (2 SD)] were in better agreement with the nominal baseline shifts than was the case for the abdomen [-0.722 +/- 1.56 mm (2 SD)]. The baseline shifts could be accurately measured and detected using the monitoring system, which could acquire the movement of the marker on the sternum. The baseline shift-monitoring system with the displacement-based methods for highly accurate respiratory-gated treatments should be used to make most of the displacement-based gating methods.
  
  
  CONCLUSIONS
  The advent of intensity modulated radiation therapy and volumetric modulated radiation therapy facilitates margin reduction for the planning target volumes and the OARs, but highly accurate irradiation is needed to achieve target coverage and OAR sparing with a small margin. The baseline shifts can affect treatment not only with the respiratory gating system but also without the system. Our system can manage the baseline shift and also enables treatment irradiation to be undertaken with high accuracy.
authors.affiliation: Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation of Cancer Research, Tokyo 1358550, Japan. hidenobu@stanford.edu
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Tachibana
authors.forename: Nozomi
authors.initials: N
authors.lastname: Kitamura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ito
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawai
authors.forename: Masaru
authors.initials: M
authors.lastname: Nakajima
authors.forename: Akihisa
authors.initials: A
authors.lastname: Tsuda
authors.forename: Hisao
authors.initials: H
authors.lastname: Shiizuka
mesh_terms: D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000295:instrumentation*; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011881:Radiotherapy, Computer-Assisted / Q000295:instrumentation*; D020266:Radiotherapy, Conformal / Q000295:instrumentation*; D015203:Reproducibility of Results; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity