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<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.2d1 20170631//EN" "JATS-journalpublishing1.dtd">
      <JournalTitle>Cancer Case Reports</JournalTitle>
      <Volume-Issue>Volume 1; Issue 2</Volume-Issue>
      <ArticleType>Cancer Research</ArticleType>
      <ArticleTitle>Fluoroscopic Demonstration of Thoracic Tumor Immobilization with High Frequency Percussive Ventilation</ArticleTitle>
          <FirstName>Ina M</FirstName>
          <FirstName>Thomas M.</FirstName>
      <Abstract>Purpose: The purpose of this first-in-man study is to directly measure thoracic tumor immobilization by high frequency percussive ventilation (HFPV).&#13;
Methods: In an IRB approved protocol (IRB # 2017-046) we screened patients with conspicuous lung tumors that exhibited motion &gt;10 mm to undergo kV fluoroscopy with HFPV. Two sets of consecutive AP (anterior posterior) fluoroscopy frames were acquired during multiple breathing cycles for free- and HFPV- breathing. All images were acquired using our kV source/panel of the therapeutic linear accelerator. Percussions were delivered via the intrapulmonary percussive ventilation device (IPV-2C) and phasitron (Percussionaire Corp., Sagle, Idaho). The baseline settings for the IPV-2C (pressure, frequency, CPAP and inspiration time) were set during an initial training session, but minor adjustments were made prior to imaging at the direction and comfort of the patient.&#13;
Results: Patient recruited was a 69 y.o. female with stage IB (cT2a, cN0, cM0) adenocarcinoma of the LLL with lepidic and acinar growth pattern. She experienced slight discomfort lying flat on the treatment table, however successfully completed HFPV. Peak-to-peak tumor motion during 4DCT sim was 11.0 mm, however patient had already received 4x 10Gy fractions of SBRT when enrolled in the study, and therefore peak-to-peak motion during free-breathing measured with fluoroscopy, at the time of the study, was 6.2 mm. Subsequently, peak-to-peak motion measured with fluoroscopy during HFPV was at 2.7 mm. This resulted in a 57 % tumor motion reduction.&#13;
Conclusion: In this first-in-man study, we have shown that HFPV is a novel respiratory motion technique that can significantly reduce tumor motion.</Abstract>
      <Keywords>HFPV,Tumor Motion Reduction,Respiratory Motion,First-In-Man,Direct Thoracic Tumor Immobilization,Percussive Ventilation</Keywords>
        <Abstract>https://cancercasereports.com/ubijournal-v1copy/journals/abstract.php?article_id=8501&amp;title=Fluoroscopic Demonstration of Thoracic Tumor Immobilization with High Frequency Percussive Ventilation</Abstract>
        <References>Allan PF, Osborn EC, Chung KK, Wanek SM. High-frequency percussive ventilation revisited. J Burn Care Res 2010; 31: 510-520.&#13;
Cuculich PS, Schill MR, Kashani R, Mutic S, Lang A, Cooper D, Faddis M, Gleva M, Noheria A, Smith TW, Hallahan D. Noninvasive cardiac radiation for ablation of ventricular tachycardia. New England Journal of Medicine 2017; 377: 2325-2336.&#13;
Gallagher TJ, Boysen PG, Davidson DD, Miller JR, Leven SB. High-frequency percussive ventilation compared with conventional mechanical ventilation. Critical Care Med 1989; 17: 364-366.&#13;
Pand;eacute;guret N, Ozsahin M, Zeverino M, Belmondo B, Durham AD, Lovis A, Simons J, Long O, Duclos F, Prior J, Denys A. Apnea-like suppression of respiratory motion: First evaluation in radiotherapy. Radiotherapy and Oncology 2016; 118: 220-226.&#13;
Prior JO, Pand;eacute;guret N, Pomoni A, Pappon M, Zeverino M, Belmondo B, Lovis A, Ozsahin M, Vienne M, Bourhis J. Reduction of respiratory motion during PET/CT by pulsatile-flow ventilation: a first clinical evaluation. Journal of Nuclear Medicine 2016; 57: 416-419.&#13;
Reardon CC, Christiansen D, Barnett ED, Cabral HJ. Intrapulmonary percussive ventilation vs incentive spirometry for children with neuromuscular disease. Arch Pediatric Adolescent Medicine 2005; 159: 526-531.&#13;
Sala IM, Nair GB, Maurer B, Guerrero TM. High frequency percussive ventilation for respiratory immobilization in radiotherapy. Technical Innovations and; Patient Support in Radiation Oncology 2019; 9: 8-12.&#13;
Salim A and Martin M. High-frequency percussive ventilation. Critical Care Med 2005; 33: S241-S245.&#13;
Spapen H, Borremans M, Diltoer M, Van Gorp V, Nguyen DN, Honorand;eacute; PM. High-frequency percussive ventilation in severe acute respiratory distress syndrome: A single center experience. Journal of Anaesthesiology Clinical Pharmacology 2014; 30: 65-70.</References>