Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment

We examine 2 strategies for reducing respiration-induced organ motion in radiation treatment: deep inspiration breath hold (DIBH) and respiratory gating. DIBH is a controlled breathing technique in which the patient performs a supervised breath hold during treatment. The technique offers 2 benefits: reduced respiratory motion from the breath hold and increased normal tissue sparing from the increased lung volume. In respiratory-gated treatment, a device external to the patient monitors breathing and allows delivery of radiation only during certain time intervals, synchronous with the patient's respiratory cycle. Gated treatment offers reduced respiratory motion with less patient effort than DIBH. We briefly survey the development of these 2 strategies, describe their clinical implementation for treatment of thoracic and liver tumors at the Memorial Sloan-Kettering Cancer Center, and discuss their advantages and limitations.