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Investigating the impact of audio instruction and audio-visual biofeedback for lung cancer radiation therapy.

机译：研究音频教学和视听生物反馈对肺癌放射治疗的影响。

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Lung cancer accounts for 13% of all cancers in the Unites States and is the leading cause of deaths among both men and women. The five-year survival for lung cancer patients is approximately 15%.(ACS facts & figures); Respiratory motion decreases accuracy of thoracic radiotherapy during imaging and delivery. To account for respiration, generally margins are added during radiation treatment planning, which may cause a substantial dose delivery to normal tissues and increase the normal tissue toxicity. To alleviate the above-mentioned effects of respiratory motion, several motion management techniques are available which can reduce the doses to normal tissues, thereby reducing treatment toxicity and allowing dose escalation to the tumor. This may increase the survival probability of patients who have lung cancer and are receiving radiation therapy. However the accuracy of these motion management techniques are inhibited by respiration irregularity.; The rationale of this thesis was to study the improvement in regularity of respiratory motion by breathing coaching for lung cancer patients using audio instructions and audio-visual biofeedback. A total of 331 patient respiratory motion traces, each four minutes in length, were collected from 24 lung cancer patients enrolled in an IRB-approved breathing-training protocol. It was determined that audio-visual biofeedback significantly improved the regularity of respiratory motion compared to free breathing and audio instruction, thus improving the accuracy of respiratory gated radiotherapy. It was also observed that duty cycles below 30% showed insignificant reduction in residual motion while above 50% there was a sharp increase in residual motion. The reproducibility of exhale based gating was higher than that of inhale base gating.; Modeling the respiratory cycles it was found that cosine and cosine 4 models had the best correlation with individual respiratory cycles. The overall respiratory motion probability distribution function could be approximated to a normal distribution function. A statistical analysis was also performed to investigate if a patient's physical, tumor or general characteristics played a role in identifying whether he/she responded positively to the coaching type---signified by a reduction in the variability of respiratory motion. The analysis demonstrated that, although there were some characteristics like disease type and dose per fraction that were significant with respect to time-independent analysis, there were no significant time trends observed for the inter-session or intra-session analysis. Based on patient feedback with the existing audio-visual biofeedback system used for the study and research performed on other feedback systems, an improved audio-visual biofeedback system was designed.; It is hoped the widespread clinical implementation of audio-visual biofeedback for radiotherapy will improve the accuracy of lung cancer radiotherapy.
机译：肺癌占美国所有癌症的13％，是男女死亡的主要原因。肺癌患者的五年生存率约为15％。（ACS事实与数据）；呼吸运动会降低成像和分娩过程中胸腔放疗的准确性。为了解决呼吸问题，通常在放射治疗计划期间增加裕度，这可能导致向正常组织的大量剂量输送并增加正常组织的毒性。为了减轻呼吸运动的上述影响，可以使用几种运动管理技术，这些技术可以减少对正常组织的剂量，从而降低治疗毒性并允许剂量增加至肿瘤。这可以增加患有肺癌并且正在接受放射治疗的患者的生存可能性。然而，这些运动管理技术的准确性受到呼吸不规则的限制。本文的理论基础是研究通过语音指导和视听生物反馈对肺癌患者进行呼吸指导来改善呼吸运动规律。从参加IRB批准的呼吸训练方案的24名肺癌患者中收集了总共331条患者呼吸运动轨迹，每条长度为4分钟。已确定，与自由呼吸和音频教学相比，视听生物反馈显着改善了呼吸运动的规律性，从而提高了呼吸门控放疗的准确性。还观察到，占空比低于30％时，残余运动明显减少，而高于50％时，残余运动急剧增加。呼气门控的重现性高于吸入气门控的重现性。在对呼吸周期进行建模时，发现余弦和余弦4模型与各个呼吸周期具有最佳相关性。总体呼吸运动概率分布函数可以近似于正态分布函数。还进行了统计分析，以调查患者的身体，肿瘤或一般特征是否在确定他/她是否对教练类型做出积极反应中发挥作用，这由呼吸运动变异性的降低来表示。分析表明，尽管在时间无关的分析方面有某些特征（如疾病类型和每级剂量）很重要，但在会间或会间分析中没有观察到明显的时间趋势。基于患者的反馈以及用于其他反馈系统的研究和研究的现有视听生物反馈系统，设计了一种改进的视听生物反馈系统。希望用于放射疗法的视听生物反馈的广泛临床实施将提高肺癌放射疗法的准确性。

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