МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ
Respiratory motion is a concern in radiotherapy of most sites, including breast cancer. Conventional radiation treatment planning routinely increases the margins around breast target volumes to account for motion. However, few studies have quantified the actual extent of respiratory motion during fr...
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| Date: | 2026 |
| Volume: | 48 |
| Issue: | 2 |
| Pages: | 108-119 |
| ISSN: | 2312-8852 |
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| Language: | English |
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| author | Vinh-Hung, V. Gorobets, O. Kao, W. Gevaert, T. Storme, G. D’Amato, G. Nguyen, N.P. De Ridder, M. |
| author_facet | Vinh-Hung, V. Gorobets, O. Kao, W. Gevaert, T. Storme, G. D’Amato, G. Nguyen, N.P. De Ridder, M. |
| author_institution_txt_mv | [
{
"author": "V. Vinh-Hung",
"institution": "Unite de Radiothérapie République, Clermont-Ferrand, France.",
"orcid": ""
},
{
"author": "O. Gorobets",
"institution": "Department of Administration, Cancer Tech Care Association, Perpignan, France",
"orcid": ""
},
{
"author": "W. Kao",
"institution": "Department of Radiotherapy, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France",
"orcid": ""
},
{
"author": "T. Gevaert",
"institution": "Department of Radiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan, Jette, Belgium",
"orcid": ""
},
{
"author": "G. Storme",
"institution": "Department of Radiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan, Jette, Belgium",
"orcid": ""
},
{
"author": "G. D’Amato",
"institution": "Department of Radiotherapy, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France",
"orcid": ""
},
{
"author": "N.P. Nguyen",
"institution": "Department of Radiation Oncology, Howard University, Washington, DC, USA",
"orcid": "0000-0003-1397-769X"
},
{
"author": "M. De Ridder",
"institution": "Department of Radiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan, Jette, Belgium",
"orcid": ""
}
] |
| author_orcid_str_mv | 0000-0003-1397-769X |
| author_sort | Vinh-Hung, V. |
| baseUrl_str | https://exp-oncology.com.ua/index.php/Exp/oai |
| collection | OJS |
| container_end_page | 119 |
| container_issue | 2 |
| container_start_page | 108 |
| container_title | Експериментальна онкологія |
| container_volume | 48 |
| datestamp_date | 2026-08-21T12:36:19Z |
| description | Respiratory motion is a concern in radiotherapy of most sites, including breast cancer. Conventional radiation treatment planning routinely increases the margins around breast target volumes to account for motion. However, few studies have quantified the actual extent of respiratory motion during free breathing. A review of publicly available four-dimensional computed tomography (4D CT) video data was conducted to estimate the preponderance of breast respiratory motion. Selected videos were those containing sequences displaying movement of the breast/chest wall. Images were visually categorized as showing minimal motion if movements were estimated as ≤ 3 mm, moderate if about 5 mm, and substantial if about 10 mm or more. Respiratory motion of the breast/chest wall was minimal in 22 of the 38 cases (57.9%), moderate in 12 cases (31.6%), and substantial in 4 cases (10.5%). In line with emerging surface-guided data, this video review shows the frequent observation of minimal respiratory motion of the breast/chest wall. These findings question whether routine respiratory-motion–based target expansion is necessary in all patients. |
| doi_str_mv | 10.15407/exp-oncology.2026.02.108 |
| first_indexed | 2026-08-22T01:00:36Z |
| format | Article |
| fulltext |
108 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
■
REVIEW
C i t a t i o n: Vinh-Hung V, Gorobets O, Kao W, Gevaert T, Storme G, D’Amato G, Nguyen NP, De Ridder M. Minimal
respiratory motion of the breast in free breathing: a 4D CT narrative video review. Exp Oncol. 2026; 48(2): 108-119.
https://doi.org/10.15407/exp-oncology.2026.02.108
© PH “Akademperiodyka” of the NAS of Ukraine, 2026. This is an open access article under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/)
It is a trivial fact that respiration keeps the body
supplied with oxygen and protected from excess ac-
cumulation of carbon dioxide [1]. This is carried
out through breathing that moves air in respiratory
cycles alternating inspiratory expansion and expi-
ratory deflation of the lungs. The quiet breathing
rate in a healthy adult is 12—20 breaths per minute
[1, 2], approximately one respiratory cycle every
2—5 seconds. That might affect breast movements
during a radiotherapy session. Depending on the
https://doi.org/10.15407/exp-oncology.2026.02.108
V. Vinh-Hung 1, 2, 3, *, O. Gorobets 3, W. Kao 4,
T. Gevaert 2, G. Storme 2, G. D’Amato 4,
N.P. Nguyen 5, M. De Ridder 2
1 Unite de Radiothérapie République, Clermont-Ferrand, France.
2 Department of Radiotherapy, Universitair Ziekenhuis Brussel,
Laarbeeklaan, Jette, Belgium
3 Department of Administration, Cancer Tech Care Association,
Perpignan, France
4 Department of Radiotherapy, Centre Hospitalier Public du Cotentin,
Cherbourg-en-Cotentin, France
5 Department of Radiation Oncology, Howard University, Washington,
DC, USA
* Correspondence: E-mail: anhxang@gmail.com
MINIMAL RESPIRATORY MOTION
OF THE BREAST IN FREE BREATHING:
A 4D CT NARRATIVE VIDEO REVIEW
Respiratory motion is a concern in radiotherapy of most sites, including breast cancer. Conventional radiation treatment
planning routinely increases the margins around breast target volumes to account for motion. However, few studies have
quantified the actual extent of respiratory motion during free breathing. A review of publicly available four-dimensional
computed tomography (4D CT) video data was conducted to estimate the preponderance of breast respiratory motion.
Selected videos were those containing sequences displaying movement of the breast/chest wall. Images were visually ca
tegorized as showing minimal motion if movements were estimated as ≤ 3 mm, moderate if about 5 mm, and substantial
if about 10 mm or more. Respiratory motion of the breast/chest wall was minimal in 22 of the 38 cases (57.9%), moder-
ate in 12 cases (31.6%), and substantial in 4 cases (10.5%). In line with emerging surface-guided data, this video review
shows the frequent observation of minimal respiratory motion of the breast/chest wall. These findings question whether
routine respiratory-motion–based target expansion is necessary in all patients.
Keywords: breathing control, breast cancer, lung cancer, respiratory cycle, diaphragmatic, four-dimensional computed
tomography, 4D CT, motion tracking, surface-guided radiation therapy, SGRT.
https://doi.org/10.15407/exp-oncology.2026.02.108
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://doi.org/10.15407/exp-oncology.2026.02
mailto:anhxang@gmail.com
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 109
Minimal Respiratory Motion of the Breast in Free Breathing: a 4D CT Narrative Video Review
technique, the time required to deliver a fraction of
2 Gy to the breast and lymph nodes averages 84—
172 s [3]. That is, in the time interval during which
the radiation fraction is delivered, over 42 breath
motions occur, potentially affecting the dose distri-
bution to the tumor bed, breast, chest wall, and
lymph nodes, which may receive insufficient radia-
tion, and affecting non-target tissues, which may
receive excess doses. There is a growing awareness
that respiratory motion management (RMM)
might be the key to ensure the quality of radiation
delivery [4—6]. RMM requires increased medical
supervision and longer treatment times at the ac-
celerator, thereby decreasing patient throughput.
Allocating RMM to a group of patients implies re-
ducing the availability of machine and human re-
sources to other groups. Hence, a decision to allo-
cate RMM requires hard data on the magnitude,
pattern, and impact of the respiratory motion in
the radiotherapy of the breast.
A recently published study protocol proposed to
analyze four-dimensional computed tomography
(4D CT) acquired for treatment of lung tumors [7].
A 4D CT records multiple 3D CTs tagged with a
respiratory signal in a patient, providing full volu-
metric CT data on the respiratory phases in the pa-
tient. 4D CT imaging is readily available across
continents, in high-, low-, and middle-income
countries [8—10], and is largely endorsed for tho-
racic stereotactic ablative body radiotherapy [5, 9,
11, 12]. Even though not intended for the breast, a
lung tumor thoracic 4D CT also visualizes the
breast movements. Large numbers of 4D CT lung
datasets might be available to study the breast ima
ges from 4D CTs. However, retrieving the datasets
is time-consuming. Considering that the internet
could perhaps provide a faster shortcut to compa-
rable data, the present study conducted a system-
atic search for open-access videos of thoracic 4D
CTs in which the breast or chest walls are displayed
to assess the importance of breast/chest wall respi-
ratory motion.
A total of 38 eligible video cases were identified
(Table). The cases were retrieved from 7 published
web or journal communications [14—20], provi
ding 11 cases; 6 webinar or congress-meeting pre-
sentations providing 9 cases; 5 lectures providing
6 cases; 4 company showcases providing 4 cases;
and 8 web links to 8 stand-alone case views or
case studies, one of which had source image files
available [21]. The videos displayed both lungs in
31 cases, and only a unilateral chest view in 7 cases,
of which 2 were left, and 5 were right. The side of
an identifiable lung tumor, pathology, or treatment
target was bilateral in 1 case, left in 12 cases, and
right in 18 cases.
Counting each video regardless of whether it was
a bilateral or unilateral chest view, chest motion
was scored as minimal in 22 of 38 cases (57.9%),
moderate in 12 cases (31.6%), and substantial in
4 cases (10.5%). Taking into account that bilateral
views provided twice as much information as uni-
lateral views, respiratory motion was minimal in 39
of the combined 69 hemi-thoracic views (56.5%),
moderate or minimal/moderate in 21 (30.4%), and
substantial in 9 (13.0%). Chest motion appeared
minimal in the majority of the video cases, as well
as in the hemi-thoracic views, ≥56.5%. It was sub-
stantial in a minority of the views (≤13%).
Chest wall motion was not uniform in all cases.
Some differences according to chest wall area were
noticeable laterally (cases 3 & 6), longitudinally in
the upper or lower chest (case 10), or focally inward
(case 30). Case 36 commented on sub-millimetric
measurement differences, right vs. left, upper vs.
lower, and outer vs. inner quadrants. Gender could
affect respiratory motion. Gender assessed by the
video captions or by the presence of a breast con-
tour or a breast implant was reasonably identified
in 6 cases, assumed females (Table, cases 8, 12, 29,
34, 35, and 36), and all of them presented minimal
respiratory motion (100%). In contrast, among 8
presumed males (Table, cases 5, 7, 15, 24, 31, 32, 37,
and 38), only 3(37.5%) presented with minimal re-
spiratory motion.
Almost all cases appeared related to a lung tu-
mor or other pulmonary disease. Observations and
motion scoring are summarized in the Table. There
was a single radiotherapy breast case (case 12). It
showed a dose distribution typical of conventional
whole left breast radiotherapy delivered with tan-
gential fields. The dose encroached substantially
into the lungs, as could result from tangential fields
treatment when the planning target volume ex-
panded beyond the breast. The case showed some
notable breathing movement in the upper chest,
but almost none in the lower part facing the heart.
The heart moved into a high-dose region, not from
any movement of the chest but from the dia-
phragm. Any technique implementing any combi
110 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
V. Vinh-Hung, O. Gorobets, W. Kao, T. Gevaert, G. Storme, G. D’Amato, N.P. Nguyen, M. De Ridder
Thoracic 4D CT video records
Case Web link View/
side
Date
of upload Observation Gender
1 https://www.medscape.com/
viewarticle/565577#vp_2
(insert fig2.gif)
B/R 2007.11 Minimal/moderate motion [14] U
2 https://vimeo.com/10718647 B/0 2010.04 Minimal motion. Volume rendering
contrasting large lungs’ motion with barely
any ribs’ motion
U
3 https://youtu.be/b5Ytdxo3nFE B/L 2012.04 @10:27. Minimal motion. @11:47 zoomed
view. Chest motion right > left. Skin markers
barely moving
U
4 https://youtu.be/1uBkvOyp1b8 B/0 2012.05 Moderate motion U
5 https://doi.org/10.1371/journal.
pone.0053799 (Movie S1-S3)
B/R 2013.01 Minimal motion [15] M
6 https://youtu.be/4cEZD-1hJlY B/L 2013.08 @00:22. Minimal motion left (ipsilateral
to lung tumor), substantial motion right
(contralateral)
U
7 https://doi.
org/10.1159/000357448
(file figshare 5/7)
B/0 2014.02 Minimal/moderate motion [16] M
8 https://vimeo.com/87497550 B/L 2014.02 @22:17. Minimal motion. Superb dynamic
volume rendering. Non-moving breasts,
little ribs motion, in contrast with heart,
pulmonary vessels, diaphragm, lung tumor
F
9 https://vimeo.com/88175822 B/0 2014.03 @09:09. Moderate motion U
10 https://vimeo.com/88175822 L/0 2014.03 @12:23. Chest top half non-moving; bottom
half moving moderately
U
11 https://vimeo.com/88175822 L/L 2014.03 @24:22. Coaching effects. Quiet breathing 9
bpm, moderate motion. Coached breathing
14 bpm, substantial motion
U
12 https://youtu.be/d6cgyyIp_Xg B/L 2014.04 Breast case. Minimal motion. The visual
dominance of dose color induces the
perception that the chest wall moves, but in
fact the dose change results from diaphragm-
heart motion
F
13 B/L 2014.04 Minimal motion U
14 https://youtu.be/z3ZT-dt7T7o B/R 2014.05 Moderate motion U
15 https://doi.org/10.2147/COPD.
S100658 (video S1)
B/L 2016.04 Moderate motion. [17] M
16 https://youtu.be/B26NSpw-ZIc B/L 2016.09 @16:55. Minimal motion U
17 https://youtu.be/X6xV5qV988g B/R 2018.03 Moderate motion U
18 https://www.canalc2.tv/
video/15033
R/R 2018.06 @00:36. Moderate motion U
19 https://youtu.be/
nBCCxTZNvsw
B/R 2018.07 Minimal motion. Seek@ 00:10: bone-density
volume rendering. Lung tumor marker + skin
surface markers (6 anterior ExacTrac spheres,
2 lateral lead wires). No motion of surface
markers
U
https://www.medscape.com/viewarticle/565577#vp_2
https://www.medscape.com/viewarticle/565577#vp_2
https://vimeo.com/10718647
https://youtu.be/b5Ytdxo3nFE
https://youtu.be/1uBkvOyp1b8
https://doi.org/10.1371/journal.pone.0053799
https://doi.org/10.1371/journal.pone.0053799
https://youtu.be/4cEZD-1hJlY
https://doi.org/10.1159/000357448
https://doi.org/10.1159/000357448
https://vimeo.com/87497550
https://vimeo.com/88175822
https://vimeo.com/88175822
https://vimeo.com/88175822
https://youtu.be/d6cgyyIp_Xg
https://youtu.be/z3ZT-dt7T7o
https://doi.org/10.2147/COPD.S100658
https://doi.org/10.2147/COPD.S100658
https://youtu.be/B26NSpw-ZIc
https://youtu.be/X6xV5qV988g
https://www.canalc2.tv/video/15033
https://www.canalc2.tv/video/15033
https://youtu.be/nBCCxTZNvsw
https://youtu.be/nBCCxTZNvsw
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 111
Minimal Respiratory Motion of the Breast in Free Breathing: a 4D CT Narrative Video Review
End of Table
Case Web link View/
side
Date
of upload Observation Gender
20 https://youtu.be/hykkaU6BzHk R/R 2018.10 @37:37. Minimal motion U
21 https://youtu.be/iuVo8Wsmckg B/L 2019.11 @00:37. Minimal motion, coronal view. Seek@
01:13: likely same case, sagittal view
U
22 https://youtu.be/
smDsX3KuMtM
R/R 2020.02 @04:12. Minimal motion. @ 05:02,
reconstructed motion is inverted, lung tumor
held as a fixed reference
U
23 https://youtu.be/tI7xkJQnGTs R/R 2020.05 @13:46. Minimal motion (partial view of
lateral ribs)
U
24 https://youtu.be/eyFBu7tN5f0 B/L 2020.05 @00:53. Minimal motion M
25 https://doi.org/10.1016/j.
phro.2021.09.005 (video 3)
B/R 2021.11 Substantial motion. Artifacted CT
reconstruction of the lower third of the
thorax [18]
U
26 https://doi.org/10.1016/j.
phro.2021.09.005 (video 4)
B/R 2021.11 Substantial motion. Artifacted CT
reconstruction of the lower third of the thorax.
Left diaphragm paresis? [18]
U
27 https://doi.org/10.1016/j.
phro.2021.09.005 (video 5)
B/0 2021.11 Substantial motion. Artifacted CT
reconstruction at the middle third. Left
diaphragm paresis? [18]
U
28 https://doi.org/10.1016/j.
phro.2021.09.005 (video 6)
B/R 2021.11 Minimal motion [18] U
29 https://doi.org/10.1016/j.
phro.2021.09.005 (video 7)
B/0 2021.11 Minimal motion [18] F
30 https://youtu.be/IHIt-95gVI8 B/R 2022.04 @00:59, @26:43, @30:24. Overall minimal
motion; substantial localized motion of a rib
in two phases, artifact?
U
31 https://innomd.com/article/62
68e60823ce96793b0fccb8.html
(Figure uCT-ART的4D-CT)
B/L 2022.04 Moderate motion M
32 https://youtu.be/rTMHEu6Xveg B/R 2022.05 @00:35. Moderate motion M
33 https://youtu.be/rTMHEu6Xveg R/R 2022.05 @02:05. Minimal motion U
34 https://www.canalc2.tv/
video/16179
B/R 2022.06 @02:22. Minimal motion F?
35 https://www.canalc2.tv/
video/16179
B/L 2022.06 @02:45. Minimal motion F
36 https://vimeo.com/820286236 B/R 2023.04 Minimal motion. Breasts’ largest
displacements averaged 1.7 mm (range: 1.1,
2.9 mm). ExacTrac sphere surface markers
F
37 https://doi.org/10.1016/j.
phro.2023.100529 (video 2—4)
B/R 2023.12 Substantial motion [19] M?
38 https://doi.org/10.1007/s00134-
024-07643-w (video 1—2)
B/B 2024.09 Minimal motion. Pressure-controlled
ventilation [20]
M
Notes: Rows ordered by upload date. Links checked on April 26, 2026. Motion assessment refers to breast/chest wall
movements. @, timeline pointer to 4D CT if it is not at the beginning of the video. View/side: B — bilateral; R — right;
L — left; 0 — no visible tumor. Date upload: format Year.Month. Row color: grey — web or journal article; blue —
webinar or congressmeeting presentation; orange — lecture; green — company showcase; white — stand-alone case
view or case study. Gender: F — female; M — male; U — uncertain.
https://youtu.be/hykkaU6BzHk
https://youtu.be/iuVo8Wsmckg
https://youtu.be/smDsX3KuMtM
https://youtu.be/smDsX3KuMtM
https://youtu.be/tI7xkJQnGTs
https://youtu.be/eyFBu7tN5f0
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2021.09.005
https://youtu.be/IHIt-95gVI8
https://innomd.com/article/6268e60823ce96793b0fccb8.html
https://innomd.com/article/6268e60823ce96793b0fccb8.html
https://youtu.be/rTMHEu6Xveg
https://youtu.be/rTMHEu6Xveg
https://www.canalc2.tv/video/16179
https://www.canalc2.tv/video/16179
https://www.canalc2.tv/video/16179
https://www.canalc2.tv/video/16179
https://vimeo.com/820286236
https://doi.org/10.1016/j.phro.2023.100529
https://doi.org/10.1016/j.phro.2023.100529
https://doi.org/10.1007/s00134-024-07643-w
https://doi.org/10.1007/s00134-024-07643-w
112 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
V. Vinh-Hung, O. Gorobets, W. Kao, T. Gevaert, G. Storme, G. D’Amato, N.P. Nguyen, M. De Ridder
https://youtu.be/hxRJmnpsSaI nation of zero expansion
margin, prone setup, or deep inspiration breath
hold [22] would have avoided the heart irradiation.
That target margins should widely ensure against
breast respiratory motion is a common radiothe
rapy assumption. The breast is a highly deformable
organ which changes shape with every minute
movement in normal daily life, whether walking,
running, or even at rest when turning or bending
the body. Attached to the chest wall, the breast
moves with breathing movements [23—25]. It fol-
lows that the lack of breast respiratory motion is
counterintuitive.
Contrary to the common assumptions regarding
breast respiratory motion, researchers have observed
little intrafractional motion of the breast during ra-
diotherapy. A Dutch study observed no significant
breast movements; the maximum deviations on por-
tal images were 1.9—3.7 mm [26]. Among 1709 por-
tal images analyzed by Smith et al. [27], intrafraction
variation was minimal; the maximum range for any
patient on any day was 0.25 cm. In Kron et al. [28],
the intra-fraction variation was 1.1 ± 0.2 mm. In Li-
rette et al. [29], intrafraction images demonstrate no
significant respiratory change in the volume of
breast and lung tissue; the standard deviation for the
central lung distance was 1.8 mm. In Prabhakar et
al. [30], the standard deviations in various intrafrac-
tion motion measurements were between 0.7 mm
and 1.36 mm. In a 2012 systematic review of motion
during radiotherapy to the breast in the supine posi-
tion without respiratory motion management, Mi-
chalski et al. [31] reported that the magnitude of in-
trafractional movement was generally very small
and almost the same across the studies reviewed.
More recently, a comprehensive review of intrafrac-
tional or respiratory motion in breast cancer radio-
therapy also found movements less than 2—3 mm
in most studies [4].
Several factors can explain why most cases
showed minimal respiratory motion of the breast.
Chest expansion in quiet breathing decreases with
age (cancer patients are older than the active popu-
lation), with body mass index (weight increases
with age), and, most importantly, with supine posi-
tion during radiotherapy, which shifts the brea
thing pattern from a thoracic respiration to a pre-
dominantly abdominal respiration [32—34]. Fur-
thermore, reduced chest mobility can be associated
with chronic pulmonary disease [35—37]. Chest
wall pain, or pleural effusion post biopsy, or fidu-
cial implant could also contribute.
Intriguingly, gender appeared to affect respiratory
motion. All 6 of 6 females (100%) presented with
minimal motion, as compared with 3 of 8 males
(37.5%). In 1846, Hutchinson [38] observed that
“the ordinary breathing in the two sexes differs. In
men it is chiefly by the diaphragm; in women chiefly
by the ribs”, corroborated a century and a half later
[39]. During quiet breathing and at vital capacity,
the female ribcage contribution to tidal volume is
higher than in men, particularly in the seated posi-
tion and at different inclinations, but not in the su-
pine position [39]. Verschakelen et al. [32] ob-
served in healthy male and female subjects that the
abdomen contributed more to quiet breathing than
the rib cage in the supine position, in contrast to
standing or sitting. Romei et al. [40] investigated
the effects of posture — from seat without then
with back support at different angles, to supine on
a rigid flat bed — and gender on thoraco-abdomi-
nal motion and breathing pattern. Posture strongly
influenced the displacement of the rib cage, which
decreased from seat position to supine. Abdominal
volume and diameters increased significantly from
seat to supine in women, but not significantly in
men [40]. Thus, there is a complex interplay bet
ween gender, anatomical differences, and breathing
patterns, which is not the purpose of this study to
elucidate. Nevertheless, because diverse types of
support are used in the radiotherapy of breast can-
cer, the effect of the support’s inclination on respi-
ratory motion might warrant attention.
The impact of minimal breathing motion on
breast radiotherapy might be important. Conven-
tional radiotherapy adds 5 mm expansion to clini-
cal breast targets to account for respiratory motion
on top of setup uncertainties [41], up to 15 mm in
the earlier recommendations [42]. Despite a low
incidence of severe pulmonary parenchymal
changes, thoracic radiotherapy for breast cancer
may lead to significant impairment in functional
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crease the doses not only to critical organs but also
to the normal tissues surrounding the targets [36,
44]. Identifying the actual breathing motion might
be critical to avoid applying inadequate motion
management in patients who have no need for such
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ISSN 1812-9269. Experimental Oncology 48 (2). 2026 115
Minimal Respiratory Motion of the Breast in Free Breathing: a 4D CT Narrative Video Review
management [45]. Of interest, various areas of the
breast/chest moved differently, upper vs. lower, an-
terior vs. posterior, and laterally right vs. left. The
differential motion suggests the possibility of indi-
vidualizing margins according to the patient’s
breathing pattern [46].
The study has several limitations. The video re-
view suggests that the breast/chest wall’s respira-
tory motion is minimal. However, some caveats
need to be addressed before generalizing for breast
radiotherapy practice.
• The breast is not a rigid object. Lack of motion
of surface markers does not warrant that a deep-
seated tumor bed or lumpectomy cavity would
not move.
• Breathing continues even though the chest wall
might remain entirely immobile. Intrathoracic or-
gans do move according to diaphragmatic move-
ments and the heart beating, which might affect the
doses delivered to non-target organs. Almost all
videos reviewed in the Table showed the prepon-
derant importance of diaphragm movements. This
is most remarkably illustrated in video case 12 (Ta-
ble), which showed the heart moving into a high-
dose region, not from any breast or chest wall mo-
tion, but from diaphragmatic motion.
• As noted earlier in the discussion, chronic pul-
monary disease reduces chest mobility [35—37].
The majority of the 4D CT videos identified in this
review pertained to lung tumors. Lung cancer and
chronic obstructive pulmonary disease are closely
linked [47, 48], whereas breast cancer patients most
often have normal pulmonary function.
• 4D CT simulation acquires images in a single
simulation session. However, radiotherapy is deli
vered in multiple sessions. The present review
could not identify if a given breathing pattern ob-
served with 4D CT remained the same throughout
the whole course of radiotherapy. The reprodu
cibility of the patient’s respiratory pattern would
need to be assessed.
• Breast surgery may affect breathing motion.
Reduced chest movements in both quiet and deep
breathing on the side of the mastectomy have been
reported in a small study comparing mastectomy
patients with healthy subjects [49].
• The impact of axillary surgery on breast mo-
tion is unknown. A non-negligible incidence of
scapula alata has been observed in a prospective
cohort of breast cancer patients [50]. Scapula alata,
or winged scapula, is a sign of lesion to the long
thoracic nerve. The nerve is responsible for the in-
nervation of the serratus anterior muscle, which
lifts the ribs, assisting in respiration.
Three cases presented with skin-surface fiducials
(cases 3, 19, and 36), two of which are ExacTrac in-
frared reflective spherical markers. ExacTrac mar
kers have been shown to provide sub-millimetric
setup accuracy [51]. The accuracy does not depend
on the marker size (incidentally, 13.2 mm diameter
by caliper and by CT measurement in case 36), but
on the identification of the markers’ centroids. The
video assessment of motion in these cases might be
considered to have millimetric precision.
In cases lacking screen measurement references,
the use of ribs as a surrogate of scale warrants a
Fig. 3. Intrafraction motion, free breathing (FB) compared with deep inspiration breath hold (DIBH) [58]. Intrafraction
variation in mm. Reproduced with permission from Elsevier
116 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
V. Vinh-Hung, O. Gorobets, W. Kao, T. Gevaert, G. Storme, G. D’Amato, N.P. Nguyen, M. De Ridder
note. The size and shape of ribs vary according to
the rib number, location along the rib’s length, pa-
tient’s age, sex, height, and weight (Fig. 1) [52]. The
ribs cannot replace precise measurements, but, like
the fruit size model used in medicine teaching [53]
or the eyeball estimation of left ventricular ejection
fraction used in critical care [54], we hope that the
ribs may help reduce inter-observer variability
when assessing chest wall motion.
The results of this video review correlate with
previous studies. It should be stressed that the re-
view’s simple approach can help highlight studies
of higher precision. Incidence of breathing pat-
terns, confounding by the patient’s condition, and
changes secondary to surgery are issues that will
have to be considered when data become available.
Observations based on mostly lung cancer cases
can only be hypothesis-generating. Further re-
search in breast cancer radiotherapy is needed, no-
tably regarding the use of real-time magnetic reso-
nance imaging [55] and surface imaging [56].
Surface imaging is important. 4D CT can visu-
alize the respiratory motion of the surface (Fig. 2).
But using 4D CT for the sole purpose of imaging
the surface appears to be overkill, besides the is-
sue that extracting measurements from 4D CTs
requires non-negligible computer and human re-
sources [7].
In contrast, optical surface scanning systems,
implemented with a surface-guided radiotherapy
(SGRT), do measure and record real-time devia-
tions of selected surface areas during the whole
course of radiotherapy sessions [56]. SGRT is ad-
opted in many radiotherapy centers. In 2023,
France counted 174 centers authorized for external
radiotherapy [57]. The two major providers for
SGRT, C-RAD and VisionRT, reported 130 centers
implementing SGRT in France, i.e., in 3 of 4 cen-
ters. Assuming a similar adoption rate of 75% in
other countries, we expect a tremendous amount
of motion data to emerge. SGRT is changing the
field. Already, a recent SGRT breast study reported
on 102 patients undergoing 1360 fractions [58].
The authors found an average intrafraction motion
of less than 0.4 mm. There was no clinically mea
ningful difference in intrafractional deviation be-
tween free breathing and deep inspiration breath-
hold. The distribution of the respective deviations
was almost identical (Fig. 3).
The previous studies, this video review, and the
emerging surface-guided breast cancer radiothera-
py data may herald a transition toward highly indi-
vidualized margin strategies based on measured
respiratory motion.
In line with emerging surface-guided data in
breast cancer radiotherapy, this video review shows
the preponderance of minimal respiratory motion
of the breast/chest wall. The breast/chest wall may
remain immobile despite large intrathoracic move-
ments. Further studies are needed to identify the
actual prevalence and patterns of breast/chest wall
respiratory motion to individualize planning target
volumes in accordance with the reality of respira-
tory motion.
Funding
The study received no financial support.
Conflict of interest
The authors declare no relevant conflict of interest.
Declaration of generative AI
and AI-assisted technologies
in the manuscript preparation process
The authors used ChatGPT Plus to enhance read-
ability and correct grammar. This was done at the
final draft stage of the manuscript. ChatGPT was
not involved in any other conceptual framework
aspects of the work, such as study design, data anal-
ysis, interpretation, reference sourcing, or manu-
script drafting. After using ChatGPT, the authors
reviewed and edited the content as needed and take
full responsibility for the content of the publication.
REFERENCES
1. Seidel HM, Stewart RW, Ball JW, et al. Mosby’s Guide to Physical Examination - E-Book. St. Louis, Missouri 63043:
Elsevier Health Sciences, 2010. https://books.google.fr/books?id=j7HSCQAAQBAJ (accessed Dec 21, 2023)
2. Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness
severity in the NHS. Updated report of a working party, https://www.rcplondon.ac.uk/projects/outputs/national-
early-warning-score-news-2 (2017, accessed Jan 21, 2024).
https://books.google.fr/books?id=j7HSCQAAQBAJ
https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 117
Minimal Respiratory Motion of the Breast in Free Breathing: a 4D CT Narrative Video Review
3. Hu J, Han G, Lei Y, et al. Dosimetric comparison of three radiotherapy techniques in irradiation of left-sided breast
cancer patients after radical mastectomy. Biomed Res Int. 2020;2020:7131590. https://doi.org/10.1155/2020/7131590
4. Piruzan E, Vosoughi N, Mahdavi SR, et al. Target motion management in breast cancer radiation therapy. Radiol
Oncol. 2021;55(4):393-408. https://doi.org/10.2478/raon-2021-0040
5. Burton A, Beveridge S, Hardcastle N, et al. Adoption of respiratory motion management in radiation therapy. Phys
Imaging Radiat Oncol. 2022;24:21-29. https://doi.org/10.1016/j.phro.2022.09.003
6. Darreon J, Bouilhol G, Aillieres N, et al. Respiratory motion management for external radiotherapy treatment.
Cancer Radiother. 2022;26(1-2):50-58. https://doi.org/10.1016/j.canrad.2021.09.006
7. Vinh-Hung V, Jafari F, De Ridder M. Study protocol to quantify breast-chest wall motion in free breathing, ver-
sion 5.1. Arch Breast Cancer. 2023;10(4):388-393. https://doi.org/10.32768/abc.2023104388-393
8. Islam SM, Vinod SK, Lehman M, et al. Lung cancer radiation therapy in Australia and New Zealand: Patterns of
practice. J Med Imaging Radiat Oncol. 2016;60(5):677-685. https://doi.org/10.1111/1754-9485.12475
9. Antony R, Lonski P, Ungureanu E, et al. Independent review of 4DCT scans used for SABR treatment planning. J
Appl Clin Med Phys. 2020;21(3):62-67. https://doi.org/10.1002/acm2.12825
10. Dang HQ, Nguyen CT, Pham HV, et al. The institutional experience of the implementing 4DCT in NSCLC radio-
therapy planning. Rep Pract Oncol Radiother. 2023;28(4):445-453. https://doi.org/10.5603/RPOR.a2023.0056
11. Hubbard P, Callahan J, Cramb J, et al. Audit of radiation dose delivered in time-resolved four-dimensional com-
puted tomography in a radiotherapy department. J Med Imaging Radiat Oncol. 2015;59(3):346-352. https://doi.
org/10.1111/1754-9485.12284
12. De Oliveira Duarte S, Rancoule C, He MY, et al. Use of 4D-CT for radiotherapy planning and reality in France:
Data from a national survey. Cancer Radiother. 2019;23(5):395-400. https://doi.org/10.1016/j.canrad.2019.02.006
13. Mohr M, Abrams E, Engel C, et al. Geometry of human ribs pertinent to orthopedic chest-wall reconstruction.
J Biomech. 2007;40(6):1310-1317. https://doi.org/10.1016/j.jbiomech.2006.05.017
14. Gandey A. Standardizing radiation dose in 4D-CT imaging can reduce lung injury. Medscape. 2007, https://www.
medscape.com/viewarticle/565577
15. Dzierma Y, Nuesken FG, Fleckenstein J, et al. Visualisation of respiratory tumour motion and co-moving iso-
dose lines in the context of respiratory gating, IMRT and flattening-filter-free beams. PLoS One. 2013;8(1):e53799.
https://doi.org/10.1371/journal.pone.0053799
16. Wielputz MO, Eberhardt R, Puderbach M, et al. Simultaneous assessment of airway instability and respira-
tory dynamics with low-dose 4D-CT in chronic obstructive pulmonary disease: a technical note. Respiration.
2014;87(4):294-300. https://doi.org/10.1159/000357448
17. Yamashiro T, Moriya H, Tsubakimoto M, et al. Continuous quantitative measurement of the proximal airway di-
mensions and lung density on four-dimensional dynamic-ventilation CT in smokers. Int J Chron Obstruct Pulmon
Dis. 2016;11:755-764. https://doi.org/10.2147/COPD.S100658
18. Szkitsak J, Werner R, Fernolendt S, et al. First clinical evaluation of breathing controlled four-dimensional com-
puted tomography imaging. Phys Imaging Radiat Oncol. 2021;20:56-61. https://doi.org/10.1016/j.phro.2021.09.005
19. Peteani G, Paganelli C, Giovannelli AC, et al. Retrospective reconstruction of four-dimensional magnetic reso-
nance from interleaved cine imaging - A comparative study with four-dimensional computed tomography in the
lung. Phys Imaging Radiat Oncol. 2024;29:100529. https://doi.org/10.1016/j.phro.2023.100529
20. Okamura G, Nishiyama S, Ono S, et al. No ventilation, no ARDS: Insights from four-dimensional computed tomog-
raphy as dynamic imaging. Intensive Care Med. 2024;50(11):1923-1924. https://doi.org/10.1007/s00134-024-07643-w
21. Gorobets O and Vinh-Hung V. Respiratory motion of the breast, or lack thereof: a 4D-CT chest surface case study.
Supplementary data. Zenodo. 2026:Version v1. doi: 10.5281/zenodo.19814073
22. Wang X, Fargier-Bochaton O, Dipasquale G, et al. Is prone free breathing better than supine deep inspiration
breath-hold for left whole-breast radiotherapy? A dosimetric analysis. Strahlenther Onkol. 2021;197(4):317-331.
https://doi.org/10.1007/s00066-020-01731-8
23. De Groote A, Wantier M, Cheron G, et al. Chest wall motion during tidal breathing. J Appl Physiol (1985).
1997;83(5):1531-1537. https://doi.org/10.1152/jappl.1997.83.5.1531
24. Ragnarsdottir M, Kristinsdottir EK. Breathing movements and breathing patterns among healthy men and women
20-69 years of age. Reference values. Respiration. 2006;73(1):48-54. https://doi.org/10.1159/000087456
25. McGhee DE, Steele JR. Breast biomechanics: What do we really know? Physiology (Bethesda). 2020;35(2):144-156.
https://doi.org/10.1152/physiol.00024.2019
26. van Tienhoven G, Lanson JH, Crabeels D, et al. Accuracy in tangential breast treatment set-up: A portal imaging
study. Radiother Oncol. 1991;22(4):317-322. https://doi.org/10.1016/0167-8140(91)90171-c
27. Smith RP, Bloch P, Harris EE, et al. Analysis of interfraction and intrafraction variation during tangential breast
irradiation with an electronic portal imaging device. Int J Radiat Oncol Biol Phys. 2005;62(2):373-378. https://doi.
org/10.1016/j.ijrobp.2004.10.022
28. Kron T, Lee C, Perera F, et al. Evaluation of intra- and inter-fraction motion in breast radiotherapy using electronic
portal cine imaging. Technol Cancer Res Treat. 2004;3(5):443-449. https://doi.org/10.1177/153303460400300505
https://doi.org/10.1155/2020/7131590
https://doi.org/10.2478/raon-2021-0040
https://doi.org/10.1016/j.phro.2022.09.003
https://doi.org/10.1016/j.canrad.2021.09.006
https://doi.org/10.32768/abc.2023104388-393
https://doi.org/10.1111/1754-9485.12475
https://doi.org/10.1002/acm2.12825
https://doi.org/10.5603/RPOR.a2023.0056
https://doi.org/10.1111/1754-9485.12284
https://doi.org/10.1111/1754-9485.12284
https://doi.org/10.1016/j.canrad.2019.02.006
https://doi.org/10.1016/j.jbiomech.2006.05.017
https://www.medscape.com/viewarticle/565577
https://www.medscape.com/viewarticle/565577
https://doi.org/10.1371/journal.pone.0053799
https://doi.org/10.1159/000357448
https://doi.org/10.2147/COPD.S100658
https://doi.org/10.1016/j.phro.2021.09.005
https://doi.org/10.1016/j.phro.2023.100529
https://doi.org/10.1007/s00134-024-07643-w
https://doi.org/10.1007/s00066-020-01731-8
https://doi.org/10.1152/jappl.1997.83.5.1531
https://doi.org/10.1159/000087456
https://doi.org/10.1152/physiol.00024.2019
https://doi.org/10.1016/0167-8140(91)90171-c
https://doi.org/10.1016/j.ijrobp.2004.10.022
https://doi.org/10.1016/j.ijrobp.2004.10.022
https://doi.org/10.1177/153303460400300505
118 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
V. Vinh-Hung, O. Gorobets, W. Kao, T. Gevaert, G. Storme, G. D’Amato, N.P. Nguyen, M. De Ridder
29. Lirette A, Pouliot J, Aubin M, et al. The role of electronic portal imaging in tangential breast irradiation: a prospec-
tive study. Radiother Oncol. 1995;37(3):241-245. https://doi.org/10.1016/0167-8140(95)01653-8
30. Prabhakar R, Rath GK, Julka PK, et al. Reproducibility of tangential breast fields using online electronic portal im-
ages. Rep Pract Oncol Radiother. 2007;12(6):323-328. https://doi.org/10.1016/S1507-1367(10)60072-7
31. Michalski A, Atyeo J, Cox J, et al. Inter- and intra-fraction motion during radiation therapy to the whole breast in
the supine position: A systematic review. J Med Imaging Radiat Oncol. 2012;56(5):499-509. https://doi.org/10.1111/
j.1754-9485.2012.02434.x
32. Verschakelen JA, Demedts MG. Normal thoracoabdominal motions. Influence of sex, age, posture, and breath size.
Am J Respir Crit Care Med. 1995;151(2 Pt 1):399-405. https://doi.org/10.1164/ajrccm.151.2.7842198
33. Kaneko H, Horie J. Breathing movements of the chest and abdominal wall in healthy subjects. Respir Care.
2012;57(9):1442-1451. https://doi.org/10.4187/respcare.01655
34. Mendes LPS, Vieira DSR, Gabriel LS, et al. Influence of posture, sex, and age on breathing pattern and chest wall
motion in healthy subjects. Braz J Phys Ther. 2020;24(3):240-248. https://doi.org/10.1016/j.bjpt.2019.02.007
35. Kaneko H, Shiranita S, Horie J, etal. Reduced chest and abdominal wall mobility and their relationship to lung func-
tion, respiratory muscle strength, and exercise tolerance in subjects with COPD. Respir Care. 2016;61(11):1472-
1480. https://doi.org/10.4187/respcare.04742
36. Reddy RS, Alahmari KA, Silvian PS, et al. Reliability of chest wall mobility and its correlation with lung functions
in healthy nonsmokers, healthy smokers, and patients with COPD. Can Respir J. 2019;2019:5175949. https://doi.
org/10.1155/2019/5175949
37. Derasse M, Lefebvre S, Liistro G, et al. Chest expansion and lung function for healthy subjects and individuals with
pulmonary disease. Respir Care. 2021;66(4):661-668. https://doi.org/10.4187/respcare.08350
38. Hutchinson J. On the capacity of the lungs, and on the respiratory functions, with a view of establishing a pre-
cise and easy method of detecting disease by the spirometer. Med Chir Trans. 1846;29:137-252. https://doi.
org/10.1177/095952874602900113
39. LoMauro A, Aliverti A. Sex differences in respiratory function. Breathe (Sheff). 2018;14(2):131-140. https://doi.
org/10.1183/20734735.000318
40. Romei M, Mauro AL, D’Angelo MG, et al. Effects of gender and posture on thoraco-abdominal kinematics during quiet
breathing in healthy adults. Respir Physiol Neurobiol. 2010;172(3):184-191. https://doi.org/10.1016/j.resp.2010.05.018
41. Frederick A, Quirk S, Grendarova P, et al. An updated approach for deriving PTV margins using image guidance
and deformable dose accumulation. Phys Med Biol. 2022;67(7):075004. https://doi.org/10.1088/1361-6560/ac5ce5
42. Andrieu MN, Dirican B, Ozturk AY, et al. Determination of optimum planning target volume margins for various
tumor sites using electronic portal imaging. Exp Oncol. 2004;26(3):236-239. PMID: 15494694 https://www.ncbi.
nlm.nih.gov/pubmed/15494694
43. Suesada MM, Carvalho HA, Albuquerque ALP, et al. Impact of thoracic radiotherapy on respiratory function
and exercise capacity in patients with breast cancer. J Bras Pneumol. 2018;44(6):469-476. https://doi.org/10.1590/
S1806-37562017000000120
44. Kim LH, Goyal S, Haffty BG, et al. Using respiratory motion to guide planning target volume margins for exter-
nal beam partial breast irradiation. Int J Radiat Oncol Biol Phys. 2012;82(4):1303-1306. https://doi.org/10.1016/j.
ijrobp.2011.11.048
45. Persson GF, Nygaard DE, Olsen M, et al. Can audio coached 4D CT emulate free breathing during the treatment
course? Acta Oncol. 2008;47(7):1397-1405. https://doi.org/10.1080/02841860802256442
46. Zhang J, Huang L, Wu F, et al. Tailoring PTV expansion to improve the dosimetry of post modified radical mastec-
tomy intensity-modulated radiotherapy for left-sided breast cancer patients by using 4D CT combined with cone
beam CT. J Appl Clin Med Phys. 2021;22(5):139-146. https://doi.org/10.1002/acm2.13244
47. Durham AL, Adcock IM. The relationship between COPD and lung cancer. Lung Cancer. 2015;90(2):121-127.
https://doi.org/10.1016/j.lungcan.2015.08.017
48. Park HY, Kang D, Shin SH, et al. Chronic obstructive pulmonary disease and lung cancer incidence in never smok-
ers: A cohort study. Thorax. 2020;75(6):506-509. https://doi.org/10.1136/thoraxjnl-2019-213732
49. Lopot F, Ravnik D, Koudelkova K, et al. The influence of woman’s mastectomy on breathing kinematics. In: Arkusz
K, Będziński R, Klekiel T, et al., (eds.). The International Conference of the Polish Society of Biomechanics. Zielona
Góra, Poland: Springer International Publishing, 2018: 36-44.
50. Adriaenssens N, De Ridder M, Lievens P, et al. Scapula alata in early breast cancer patients enrolled in a random-
ized clinical trial of post-surgery short-course image-guided radiotherapy. World J Surg Oncol. 2012;10:86. https://
doi.org/10.1186/1477-7819-10-86
51. Verellen D, Soete G, Linthout N, et al. Quality assurance of a system for improved target localization and patient
set-up that combines real-time infrared tracking and stereoscopic X-ray imaging. Radiother Oncol. 2003;67(1):129-
141. https://doi.org/10.1016/s0167-8140(02)00385-7
52. Holcombe SA, Huang Y, Derstine BA. Population trends in human rib cross-sectional shapes. J Anat. 2024;244(5):792-
802. https://doi.org/10.1111/joa.13999
https://doi.org/10.1016/0167-8140(95)01653-8
https://doi.org/10.1016/S1507-1367(10)60072-7
https://doi.org/10.1111/j.1754-9485.2012.02434.x
https://doi.org/10.1111/j.1754-9485.2012.02434.x
https://doi.org/10.1164/ajrccm.151.2.7842198
https://doi.org/10.4187/respcare.01655
https://doi.org/10.1016/j.bjpt.2019.02.007
https://doi.org/10.4187/respcare.04742
https://doi.org/10.1155/2019/5175949
https://doi.org/10.1155/2019/5175949
https://doi.org/10.4187/respcare.08350
https://doi.org/10.1177/095952874602900113
https://doi.org/10.1177/095952874602900113
https://doi.org/10.1183/20734735.000318
https://doi.org/10.1183/20734735.000318
https://doi.org/10.1016/j.resp.2010.05.018
https://doi.org/10.1088/1361-6560/ac5ce5
https://www.ncbi.nlm.nih.gov/pubmed/15494694
https://www.ncbi.nlm.nih.gov/pubmed/15494694
https://doi.org/10.1590/S1806-37562017000000120
https://doi.org/10.1590/S1806-37562017000000120
https://doi.org/10.1016/j.ijrobp.2011.11.048
https://doi.org/10.1016/j.ijrobp.2011.11.048
https://doi.org/10.1080/02841860802256442
https://doi.org/10.1002/acm2.13244
https://doi.org/10.1016/j.lungcan.2015.08.017
https://doi.org/10.1136/thoraxjnl-2019-213732
https://doi.org/10.1186/1477-7819-10-86
https://doi.org/10.1186/1477-7819-10-86
https://doi.org/10.1016/s0167-8140(02)00385-7
https://doi.org/10.1111/joa.13999
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 119
Minimal Respiratory Motion of the Breast in Free Breathing: a 4D CT Narrative Video Review
53. Margulies R, Miller L. Fruit size as a model for teaching first trimester uterine sizing in bimanual examination.
Obstet Gynecol. 2001;98(2):341-344. https://doi.org/10.1016/s0029-7844(01)01406-5
54. Bergenzaun L, Gudmundsson P, Ohlin H, et al. Assessing left ventricular systolic function in shock: evaluation of
echocardiographic parameters in intensive care. Crit Care. 2011;15(4):R200. https://doi.org/10.1186/cc10368
55. Groot Koerkamp ML, van den Bongard HJGD, Philippens MEP, et al. Intrafraction motion during radiotherapy
of breast tumor, breast tumor bed, and individual axillary lymph nodes on cine magnetic resonance imaging. Phys
Imaging Radiat Oncol. 2022;23:74-79. https://doi.org/10.1016/j.phro.2022.06.015
56. Freislederer P, Kugele M, Ollers M, et al. Correction to: Recent advances in Surface Guided Radiation Therapy.
Radiat Oncol. 2020;15(1):244. https://doi.org/10.1186/s13014-020-01661-w
57. Picart C. Rapport de l’ASN sur l’état de la sûreté nucléaire et de la radioprotection en France en 2023. 92120 Mon-
trouge, France: Autorité de sûreté nucléaire, 2024.
58. Malone C, Ryan S, Nicholson J, et al. Intrafraction motion in surface-guided breast radiation therapy and its im-
plications on a single planning target volume margin strategy. Pract Radiat Oncol. 2025;15(1):e63-e71. https://doi.
org/10.1016/j.prro.2024.06.017
Submitted: October 07, 2024
В. Винх-Хунг 1, 2, 3, О. Горобец 3, В. Као 4, Т. Геверт 2,
Г. Сторм 2, Г. Д’Амато 4, Н.П. Нгуєн 5, М. ДеРіддер 2
1 Центр променевої терапії «Републік»,
Клермон-Феран, Франція
2 Відділення променевої терапії університетської клініки Бельгії,
Лаарбеклаан, Жет, Бельгія
3 Адміністративний відділ асоціації високотехнологічної
онкологічної допомоги, Перпіньян, Франція
4 Відділення променевої терапії державного медичного центру,
Шербур-ан-Котентин, Франція
5 Відділення променевої онкології Говардського університету,
Вашингтон, США
МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ
ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД
ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ
Зміщення пухлини під час дихання слід враховувати при променевій терапії пухлин різної локалізації, вклю-
чаючи рак грудної залози. Зазвичай при плануванні променевої терапії розширюють межі навколо цільового
об’єму, щоб урахувати це зміщення. Однак лише в небагатьох дослідженнях обраховують фактичну величи-
ну зміщення за вільного дихання. В огляді проаналізовано загальнодоступні відеоматеріали з 4D КТ-сканами
з метою оцінювання превалювання дихального зміщення грудей. Скани розділено на категорії в залежності від
візуалізованої величини зміщення, а саме: мінімальне (до 3 мм), помірне (до 5 мм) або суттєве (понад 10 мм).
Мінімальне зміщення відзначено у 22 із 38 випадків (57,9%), помірне — у 12 випадках (31,6%), суттєве — у 4 ви-
падках (10,5%). Проаналізовані дані свідчать про те, що превалює мінімальне зміщення за рахунок дихальних
рухів грудей та грудної клітки, у зв’язку з чим постає питання про доцільність збільшення відступу від меж
цільового об’єму у всіх хворих.
Ключові слова: контроль дихання, рак грудної залози, дихальний цикл, чотиривимірна комп’ютерна томогра-
фія, контроль за дихальними рухами, променева терапія з поверхневим наведенням.
https://doi.org/10.1016/s0029-7844(01)01406-5
https://doi.org/10.1186/cc10368
https://doi.org/10.1016/j.phro.2022.06.015
https://doi.org/10.1186/s13014-020-01661-w
https://doi.org/10.1016/j.prro.2024.06.017
https://doi.org/10.1016/j.prro.2024.06.017
|
| id | oai:ojs2.ex.aqua-time.com.ua:article-641 |
| institution | Experimental Oncology |
| issn | 2312-8852 |
| keywords_txt_mv | |
| language | English |
| last_indexed | 2026-08-22T01:00:36Z |
| publishDate | 2026 |
| publisher | PH Akademperiodyka |
| record_format | ojs |
| resource_txt_mv | exp-oncologycomua/d9/60e12163a2636e8b0819d86ca5a724d9.pdf |
| spelling | oai:ojs2.ex.aqua-time.com.ua:article-6412026-08-21T12:36:19Z MINIMAL RESPIRATORY MOTION OF THE BREAST IN FREE BREATHING: A 4D CT NARRATIVE VIDEO REVIEW МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ Vinh-Hung, V. Gorobets, O. Kao, W. Gevaert, T. Storme, G. D’Amato, G. Nguyen, N.P. De Ridder, M. контроль дихання, рак грудної залози, дихальний цикл, чотиривимірна комп’ютерна томографія, контроль за дихальними рухами, променева терапія з поверхневим наведенням breathing control, breast cancer, lung cancer, respiratory cycle, diaphragmatic, four-dimensional computed tomography, 4D CT, motion tracking, surface-guided radiation therapy, SGRT Respiratory motion is a concern in radiotherapy of most sites, including breast cancer. Conventional radiation treatment planning routinely increases the margins around breast target volumes to account for motion. However, few studies have quantified the actual extent of respiratory motion during free breathing. A review of publicly available four-dimensional computed tomography (4D CT) video data was conducted to estimate the preponderance of breast respiratory motion. Selected videos were those containing sequences displaying movement of the breast/chest wall. Images were visually categorized as showing minimal motion if movements were estimated as ≤ 3 mm, moderate if about 5 mm, and substantial if about 10 mm or more. Respiratory motion of the breast/chest wall was minimal in 22 of the 38 cases (57.9%), moderate in 12 cases (31.6%), and substantial in 4 cases (10.5%). In line with emerging surface-guided data, this video review shows the frequent observation of minimal respiratory motion of the breast/chest wall. These findings question whether routine respiratory-motion–based target expansion is necessary in all patients. Зміщення пухлини під час дихання слід враховувати при променевій терапії пухлин різної локалізації, включаючи рак грудної залози. Зазвичай при плануванні променевої терапії розширюють межі навколо цільового об’єму, щоб урахувати це зміщення. Однак лише в небагатьох дослідженнях обраховують фактичну величину зміщення за вільного дихання. В огляді проаналізовано загальнодоступні відеоматеріали з 4D КТ-сканами з метою оцінювання превалювання дихального зміщення грудей. Скани розділено на категорії в залежності від візуалізованої величини зміщення, а саме: мінімальне (до 3 мм), помірне (до 5 мм) або суттєве (понад 10 мм). Мінімальне зміщення відзначено у 22 із 38 випадків (57,9%), помірне — у 12 випадках (31,6%), суттєве — у 4 випадках (10,5%). Проаналізовані дані свідчать про те, що превалює мінімальне зміщення за рахунок дихальних рухів грудей та грудної клітки, у зв’язку з чим постає питання про доцільність збільшення відступу від меж цільового об’єму у всіх хворих. PH Akademperiodyka 2026-08-21 Article Article application/pdf https://exp-oncology.com.ua/index.php/Exp/article/view/641 10.15407/exp-oncology.2026.02.108 Experimental Oncology; Vol. 48 No. 2 (2026): Experimental Oncology; 108-119 Експериментальна онкологія; Том 48 № 2 (2026): Експериментальна онкологія; 108-119 2312-8852 1812-9269 10.15407/exp-oncology.2026.02 en https://exp-oncology.com.ua/index.php/Exp/article/view/641/471 Copyright (c) 2026 Experimental Oncology https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spellingShingle | контроль дихання рак грудної залози дихальний цикл чотиривимірна комп’ютерна томографія контроль за дихальними рухами променева терапія з поверхневим наведенням Vinh-Hung, V. Gorobets, O. Kao, W. Gevaert, T. Storme, G. D’Amato, G. Nguyen, N.P. De Ridder, M. МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ |
| title | МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ |
| title_alt | MINIMAL RESPIRATORY MOTION OF THE BREAST IN FREE BREATHING: A 4D CT NARRATIVE VIDEO REVIEW |
| title_full | МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ |
| title_fullStr | МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ |
| title_full_unstemmed | МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ |
| title_short | МІНІМАЛЬНЕ ДИХАЛЬНЕ ЗМІЩЕННЯ ГРУДЕЙ ЗА ВІЛЬНОГО ДИХАННЯ: ОПИСОВИЙ ОГЛЯД ВІДЕОМАТЕРІАЛІВ ІЗ 4D КТ СКАНАМИ |
| title_sort | мінімальне дихальне зміщення грудей за вільного дихання: описовий огляд відеоматеріалів із 4d кт сканами |
| topic | контроль дихання рак грудної залози дихальний цикл чотиривимірна комп’ютерна томографія контроль за дихальними рухами променева терапія з поверхневим наведенням |
| topic_facet | контроль дихання рак грудної залози дихальний цикл чотиривимірна комп’ютерна томографія контроль за дихальними рухами променева терапія з поверхневим наведенням breathing control breast cancer lung cancer respiratory cycle diaphragmatic four-dimensional computed tomography 4D CT motion tracking surface-guided radiation therapy SGRT |
| url | https://exp-oncology.com.ua/index.php/Exp/article/view/641 |
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