The role of image guidance in respiratory gated radiotherapy

Respiratory gating for radiotherapy beam delivery is a widely available technique, manufactured and sold by most of the major radiotherapy machine vendors. Respiratory gated beam delivery is intended to limit the irradiation of tumours moving with respiration to selected parts of the respiratory cycle, and thereby enable dose escalation and/or reduction of dose to organs at risk. Without adequate use of respiratory correlated image guidance on a regular basis, respiratory beam gating may however have a detrimental effect on target coverage. Image guidance of tumour respiratory motion is therefore of utmost importance for the safe introduction of respiratory gating. In this short overview, suitable image guidance strategies for respiratory gated radiotherapy are reviewed for two cancer sites; breast cancer and lung tumours.