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Fraction-specific post-treatment quality assurance for active breath-hold radiation therapy

  • Rajesh Thiyagarajan (a1), Arunai Nambiraj (a2), Durai Manigandan (a1), Tamilseivan Singaravelu (a1), Rajesh Selvaraj (a1) and Tejinder Kataria (a1)...

The purpose of this study is to evaluate variation in the treatment hold pattern and quantify its dosimetric impact in breath-hold radiotherapy, using fraction-specific post-treatment quality assurance.

Material and Methods

A patient with lung mets treated using intensity-modulated radiation therapy (IMRT) with active breath coordinator (ABC) was recruited for the study. Treatment beam hold conditions were recorded for all the 25 fractions. The linearity and reproducibility of the dosimetric system were measured. Variation in the dose output of unmodulated open beam with beam hold was studied. Patient-specific quality assurance (PSQA) was performed with and without beam hold, and the results were compared to quantify the dosimetric impact of beam hold.


There was a considerable amount of variation observed in the number of beam hold for the given field and the monitor unit at which the beam held. Linearity and reproducibility of the dosimetric system were found within the acceptable limits. The average difference over the 25 measurements was 0·044% (0·557 to −0·318%) with standard deviation of 0·248.


Patient comfort with the ABC system and responsiveness to the therapist communication help to maintain consistent breathing pattern, in turn consistent treatment delivery pattern. However, the magnitude of dosimetric error is much less than the acceptable limits recommended by IROC. The dosimetric error induced by the beam hold is over and above the dose difference observed in conventional PSQA.

Corresponding author
Author for correspondence: Rajesh Thiyagarajan, Senior Medical Physicist & RSO, Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India. E-mail:
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Cite this article: Thiyagarajan R, Nambiraj A, Manigandan D, Singaravelu T, Selvaraj R, Kataria T. (2019) Fraction-specific post-treatment quality assurance for active breath-hold radiation therapy. Journal of Radiotherapy in Practice page 1 of 9. doi: 10.1017/S1460396919000049

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Journal of Radiotherapy in Practice
  • ISSN: 1460-3969
  • EISSN: 1467-1131
  • URL: /core/journals/journal-of-radiotherapy-in-practice
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