Abdominal organ motion during inhalation and exhalation breath-holds: pancreatic motion at different lung volumes compared

Purpose Contrary to what is commonly assumed, organs continue to move during breath-holding. We investigated the influence of lung volume on motion magnitude during breath-holding and changes in velocity over the duration of breath-holding. Materials and methods Sixteen healthy subjects performed 60-second inhalation breath-holds in room-air, with lung volumes of ∼100% and ∼70% of the inspiratory capacity, and exhalation breath-holds, with lung volumes of ∼30% and ∼0% of the inspiratory capacity. During breath-holding, we obtained dynamic single-slice magnetic-resonance images with a time-resolution of 0.6 s. We used 2-dimensional image correlation to obtain the diaphragmatic and pancreatic velocity and displacement during breath-holding. Results Organ velocity was largest in the inferior–superior direction and was greatest during the first 10 s of breath-holding, with diaphragm velocities of 0.41 mm/s, 0.29 mm/s, 0.16 mm/s and 0.15 mm/s during BH100%, BH70%, BH30% and BH0%, respectively. Organ motion magnitudes were larger during inhalation breath-holds (diaphragm moved 9.8 and 9.0 mm during BH100% and BH70%, respectively) than during exhalation breath-holds (5.6 and 4.3 mm during BH30% and BH0%, respectively). Conclusion Using exhalation breath-holds rather than inhalation breath-holds and delaying irradiation until after the first 10 s of breath-holding may be advantageous for irradiation of abdominal tumors.