Commissioning and quality assurance for a respiratory training system based on audiovisual biofeedback

A respiratory training system based on audiovisual biofeedback has been implemented at our institution. It is intended to improve patients' respiratory regularity during four-dimensional (4D) computed tomography (CT) image acquisition. The purpose is to help eliminate the artifacts in 4D-CT images caused by irregular breathing, as well as improve delivery efficiency during treatment, where respiratory irregularity is a concern. This article describes the commissioning and quality assurance (QA) procedures developed for this peripheral respiratory training system, the Stanford Respiratory Training (START) system. Using the Varian real-time position management system for the respiratory signal input, the START software was commissioned and able to acquire sample respiratory traces, create a patient-specific guiding waveform, and generate audiovisual signals for improving respiratory regularity. Routine QA tests that include hardware maintenance, visual guiding-waveform creation, auditory sounds synchronization, and feedback assessment, have been developed for the START system. The QA procedures developed here for the START system could be easily adapted to other respiratory training systems based on audiovisual biofeedback.