Lung cancer radiotherapy using end expiration breath hold technique with respiratory gating for scanners (RGSC) and linear accelerator at Siriraj hospital

Abstract

Respiratory motion, or lung movement resulting from breathing, is an important factor that causes uncertainty in the target position during radiation treatment for lung cancer, and may affect the accuracy and safety of the treatment. This article presents technical and practical guidelines for radiation treatment of lung cancer using the end-expiration breath-hold (EEBH) technique with respiratory gating for scanners (RGSC) and a linear accelerator, covering the patient selection process and preparation procedures, including breath-hold training, computed tomography simulation (CT simulation) under EEBH conditions, and advanced radiation therapy planning. Additionally, it encompasses the process of radiation delivery and position monitoring using kV-kV and cone beam CT (CBCT) images to ensure the consistency of the patient’s radiation position in clinical settings. Furthermore, it discusses the considerations for using EEBH techniques in medical practice, such as patient cooperation, reproducibility of breath holding, pre-treatment training, and position monitoring in each fraction to maintain the quality and safety of treatment. Therefore, these guidelines are technical reports and medical practice. These are not evaluating comparative results. However, this article can serve as a reference guide for radiotherapy treatment workflows in institutions with similar resources and technology.