Cone beam CT verification for active breathing control (ABC)-gated radiotherapy for lung cancer

Kheng-Wei Yeoh, Helen A. McNair, Fiona McDonald, Maria Hawkins, Vibeke N. Hansen, Monica Ramos, Ioanna Fragkandrea, Sarah Bothwell, Trina Herbert, Helen Taylor, Sarah Heyler, Sue Ashley, Michael Brada

Research output: Contribution to journalLetterpeer-review

3 Citations (Scopus)


Radiotherapy dose escalation improves patient outcome in non-small cell lung cancer (NSCLC) [1–5]. To achieve this, motion compensation techniques are often used, e.g. active breathing control (ABC) which allows for relative tumour immobilisation during inspiration breath-hold [6–8]. Although both reduction in dose-volume parameters determining lung toxicity and good reproducibility have been demonstrated with ABC, inter-patient variability exists with significant tumour motion being reported. As a result, image guidance and tumour-directed localisation have been recommended [9,10].
Image guidance with kilovoltage cone beam computerised tomography (CBCT) has been shown to provide accurate bony and soft tissue setup information [11,12]. Deep-inspiration breath-hold with CBCT is also feasible [8] and has been integrated as a verification tool for correction protocols when treating patients with ABC [13]. Current CB imaging software allows automatic matching within a user defined region of interest (ROI) but the selected ROI volume is important and can affect image registration accuracy [14–16]. For patients with lung tumours undergoing free-breathing radiotherapy, studies have shown that ROIs centred on the carina and spine can produce accurate CBCT image registration with advanced tumours [17] whilst soft tissue tumour matching is more accurate with early-staged tumours [18]. With ABC-gated radiotherapy, the optimal automatic registration method for image-guided setup correction has not yet been established. The aim of this study was therefore to evaluate the effect of using four different ROIs (with the Synergy XVI R4.2 software, Elekta, Crawley, UK) with ABC-gated radiotherapy in order to determine the optimum volume for registration.
Original languageEnglish
Pages (from-to)716-719
Number of pages4
JournalActa Oncologica
Issue number5
Early online date25 Nov 2013
Publication statusPublished - 25 Nov 2013


  • lung cancer
  • radiotherapy
  • cone beam computerised tomography (CBCT)


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