Ryan Salem

Respiratory Gating Summary, Dos 542 Quality Assurance

Respiratory gating is not performed at my clinical site, so here is a summary of what

respiratory gating is and the current QA and tolerances from AAPM TG 76. Respiratory gating is
a method of treating a patient within a portion of the patients breathing cycle to both stabilize the
tissue to be treated and move healthy tissue and organs at risk away from the treatment field.
Gating is completed by use of an external respiration tracking method or internal fiducial
markings. Because the beam is only turned on during a portion of the patient’s respiratory
motion, treatments last longer and they require more work from the radiation therapists.
When service to the respiratory motion device or hardware or software changes are made,
appropriate testing should be performed. The CT scanner, fluoroscopy devices, or the linear
accelerator are included in these changes. It is recommended that when possible, QA of each
fraction using respiratory management devices should be pursued. It is required that a
reproducible breathing pattern be achieved to allow the use of gating on a patient in simulation
and treatment. Physics should perform the breath coaching and evaluation at least in the
simulation. In simulation, the tumor position must be verified as stable within each breath-hold
for the entire duration of the CT scan, or in segmented CT scans with shorter breath-holds. If a
patient cannot comply with a consistent breathing motion, a backup CT scan is required without
the use of gating. It is recommended that entire treatment fields be delivered in a single breath-
hold. If not, careful documentation should be made about break points in beams. For internal
constancy checks, a program of frequent radiographs throughout treatment is essential to
measure interfractional variations. Daily verification is recommended for the first few
treatments, followed by at least weekly verification to ensure consistent patient anatomy in
breath-holds. Training and education for all staff involved in important, and periodic retraining is
recommended. A physicist should be available to solve any hardware-related problems
associated with the use of respiratory gating.
References:
1. Keall PJ, Mageras GS, Balter JM, et al. The management of respiratory motion in
radiation oncology report of AAPM Task Group 76. Med Phys. 2006;33(10):3874-3900.
https://www.doi.org/10.1118/1.2349696.