Development and application of a real-time monitoring and feedback system for deep inspiration breath hold based on external marker tracking

Markus Stock, Kristina Kontrisova, Karin Dieckmann, Joachim Bogner, Richard Poetter, Dietmar Georg

Research output: Journal article (peer-reviewed)Journal article

60 Citations (Scopus)


Respiration can cause tumor movements in thoracic regions of up to 3 cm. To minimize motion effects several approaches, such as gating and deep inspiration breath hold (DIBH), are still under development. The goal of our study was to develop and evaluate a noninvasive system for gated DIBH (GDIBH) based on external markers. DIBH monitoring was based on an infrared tracking system and an in-house-developed software. The in-house software provided the breathing curve in real time and was used as on-line information for a prototype of a feedback device. Reproducibility and stability of the breath holds were evaluated without and with feedback. Thirty-five patients undergoing stereotactic body radiotherapy (SBRT) performed DIBH maneuvers after each treatment. For 16 patients dynamic imaging sequences on a multislice CT were used to determine the correlation between tumor and external markers. The relative reproducibility of DIBH maneuvers was improved with the feedback device (74.5% +/- 17.1% without versus 93.0% +/- 4.4% with feedback). The correlation between tumor and marker was good (Pearson correlation coefficient 0.83 +/- 0.17). The regression slopes showed great intersubject variability but on average the internal margin in a DIBH treatment situation could be theoretically reduced by 3 mm with the feedback device. DIBH monitoring could be realized in a noninvasive manner through external marker tracking. We conclude that reduction of internal margins can be achieved with a feedback system but should be performed with great care due to the individual behavior of target motion.

Original languageEnglish
Pages (from-to)2868-2877
Number of pages10
JournalMedical Physics
Issue number8
Publication statusPublished - Aug 2006
Externally publishedYes


  • Artifacts
  • Biofeedback, Psychology/instrumentation
  • Computer Systems
  • Equipment Design
  • Equipment Failure Analysis
  • Humans
  • Inhalation
  • Lung Neoplasms/radiotherapy
  • Monitoring, Physiologic/instrumentation
  • Movement
  • Radiation Protection/methods
  • Radiotherapy, Conformal/instrumentation
  • Reproducibility of Results
  • Restraint, Physical/instrumentation
  • Sensitivity and Specificity


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