{"entity":{"id":"respiratory-motion-management","kind":"technology","name":"Respiratory motion management (4D-CT, gating, breath-hold, tracking)","aka":[],"tldr":"Ways of dealing with tumours that move as the patient breathes: image the motion, treat only in part of the breathing cycle, hold the breath, or chase the tumour with the beam.","summary":"Lung, liver, pancreas and breast targets move by a centimetre or more with breathing. Four-dimensional CT captures the motion so the target volume can include it or be defined at one phase; respiratory gating switches the beam on only during that phase; deep-inspiration breath-hold freezes the anatomy and, in left breast treatment, moves the heart away from the beam; and real-time tracking with fiducial markers or MRI moves the beam or couch with the tumour. Motion management is what makes stereotactic body radiotherapy safe for small mobile targets.","status":"established","asOf":"2026-09-17","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Respiratory_gating"}],"tags":["radiation-wave1","precision"],"related":[],"cancers":["nsclc","hcc","pancreatic"],"sections":["radiation"],"technologies":["sbrt","mr-linac","imrt-igrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["deep-inspiration-breath-hold","fiducial-markers"],"trials":["chisel"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Measure or constrain respiratory motion so the planned dose lands on the target rather than on the tissue it moves through.","strengths":["Smaller margins and less normal tissue dose","Enables stereotactic treatment of moving targets","Reduces heart dose in breast radiotherapy"],"limitations":["Longer sessions","Some patients cannot hold their breath","Fiducial placement is invasive"],"since":2000},"route":"/technologies/respiratory-motion-management/","neighbours":{"cancer":[{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"c-arm-linac","kind":"technology","name":"C-arm medical linear accelerators (TrueBeam, Versa HD and others)","route":"/technologies/c-arm-linac/"},{"id":"cyberknife","kind":"technology","name":"CyberKnife robotic radiosurgery","route":"/technologies/cyberknife/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"mr-linac","kind":"technology","name":"MR-guided adaptive radiotherapy","route":"/technologies/mr-linac/"},{"id":"respiratory-gating-tumour-tracking-systems","kind":"technology","name":"Respiratory gating and tumour tracking systems (RPM, ABC, Calypso, Synchrony)","route":"/technologies/respiratory-gating-tumour-tracking-systems/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"},{"id":"tomotherapy","kind":"technology","name":"TomoTherapy and Radixact (helical radiotherapy)","route":"/technologies/tomotherapy/"}],"term":[{"id":"deep-inspiration-breath-hold","kind":"term","name":"Deep inspiration breath-hold (DIBH)","route":"/terms/deep-inspiration-breath-hold/"},{"id":"fiducial-markers","kind":"term","name":"Fiducial markers","route":"/terms/fiducial-markers/"}],"trial":[{"id":"chisel","kind":"trial","name":"CHISEL (TROG 09.02)","route":"/trials/chisel/"}],"paper":[{"id":"paper-smyth-dibh-cardiac-sparing-review-jmrs-2015","kind":"paper","name":"The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review","route":"/key-papers/paper-smyth-dibh-cardiac-sparing-review-jmrs-2015/"},{"id":"paper-heartspare-stage-ii-clin-oncol-2017","kind":"paper","name":"The UK HeartSpare Study (Stage II): multicentre evaluation of a voluntary breath-hold technique in patients receiving breast radiotherapy","route":"/key-papers/paper-heartspare-stage-ii-clin-oncol-2017/"}],"roadmap":[{"id":"precision-roadmap","kind":"roadmap","name":"Precision roadmap: margins measured in millimetres → tests that find a target → doses fitted to the person → precision that changes outcomes","route":"/roadmaps/precision-roadmap/"}],"idea":[{"id":"idea-pu-breath-hold-coaching-before-planning","kind":"idea","name":"Breath-hold coaching and home practice a week before the planning scan, in the patient's own language","route":"/ideas/idea-pu-breath-hold-coaching-before-planning/"},{"id":"idea-pu-breath-hold-left-breast-routine","kind":"idea","name":"Deep-breath-hold radiotherapy for every suitable person with left-sided breast cancer","route":"/ideas/idea-pu-breath-hold-left-breast-routine/"},{"id":"idea-pu-breath-hold-visual-feedback","kind":"idea","name":"Let the patient see their own breath-hold on a screen or in video glasses","route":"/ideas/idea-pu-breath-hold-visual-feedback/"}],"company":[{"id":"c-rad","kind":"company","name":"C-RAD","route":"/companies/c-rad/"},{"id":"vision-rt","kind":"company","name":"Vision RT","route":"/companies/vision-rt/"}]}}