Investigation of a breathing surrogate prediction algorithm for prospective pulmonary gating

Benjamin M. White, Daniel A. Low, Tianyu Zhao, Sara Wuenschel, Wei Lu, James M. Lamb, Sasa Mutic, Jeffrey D. Bradley, Issam El Naqa

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Purpose: A major challenge of four dimensional computed tomography (4DCT) in treatment planning and delivery has been the lack of respiration amplitude and phase reproducibility during image acquisition. The implementation of a prospective gating algorithm would ensure that images would be acquired only during user-specified breathing phases. This study describes the development and testing of an autoregressive moving average (ARMA) model for human respiratory phase prediction under quiet respiration conditions. Methods: A total of 47 4DCT patient datasets and synchronized respiration records was utilized in this study. Three datasets were used in model development and were removed from further evaluation of the ARMA model. The remaining 44 patient datasets were evaluated with the ARMA model for prediction time steps from 50 to 1000 ms in increments of 50 and 100 ms. Thirty-five of these datasets were further used to provide a comparison between the proposed ARMA model and a commercial algorithm with a prediction time step of 240 ms. Results: The optimal number of parameters for the ARMA model was based on three datasets reserved for model development. Prediction error was found to increase as the prediction time step increased. The minimum prediction time step required for prospective gating was selected to be half of the gantry rotation period. The maximum prediction time step with a conservative 95% confidence criterion was found to be 0.3 s. The ARMA model predicted peak inhalation and peak exhalation phases significantly better than the commercial algorithm. Furthermore, the commercial algorithm had numerous instances of missed breath cycles and falsely predicted breath cycles, while the proposed model did not have these errors. Conclusions: An ARMA model has been successfully applied to predict human respiratory phase occurrence. For a typical CT scanner gantry rotation period of 0.4 s (0.2 s prediction time step), the absolute error was relatively small, 0.06±0.02 s at peak inhalation and 0.05±0.04 s at peak exhalation. The application of the ARMA model for prospective pulmonary gating has been demonstrated.

Original languageEnglish
Pages (from-to)1587-1595
Number of pages9
JournalMedical physics
Issue number3
StatePublished - Mar 2011


  • 4DCT
  • prospective gating
  • quiet respiration


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