Hindawi Publishing CorporationBioMed Research InternationalVolume 2013 Article ID 574934 8 pageshttpdxdoiorg1011552013574934

Research ArticleControl of Respiratory Motion by Hypnosis Intervention duringRadiotherapy of Lung Cancer I

Rongmao Li1 Jie Deng2 and Yaoqin Xie13

1 Institute of Biomedical and Health Engineering Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences1068 Xueyuan Anenue Shenzhen University Town Shenzhen 518055 China

2 Zhuhai Psychological Counseling Co Ltd 201-40A Haisong Building 9th Tairan Road Shenzhen 518000 China3 Lab for Wearable Devices Key Lab for Health Informatics of Chinese Academy of Sciences 1068 Xueyuan AnenueShenzhen University Town Shenzhen 518055 China

Correspondence should be addressed to Yaoqin Xie yqxiesiataccn

Received 21 May 2013 Revised 8 July 2013 Accepted 31 July 2013

Academic Editor Ching Chong Jack Yang

Copyright copy 2013 Rongmao Li et al This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use distribution and reproduction in any medium provided the original work is properly cited

The uncertain position of lung tumor during radiotherapy compromises the treatment effect To effectively control respiratorymotion during radiotherapy of lung cancer without any side effects a novel control scheme hypnosis has been introduced inlung cancer treatment In order to verify the suggested method six volunteers were selected with a wide range of distributionof age weight and chest circumference A set of experiments have been conducted for each volunteer under the guidance ofthe professional hypnotist All the experiments were repeated in the same environmental condition The amplitude of respirationhas been recorded under the normal state and hypnosis respectively Experimental results show that the respiration motion ofvolunteers in hypnosis has smaller and more stable amplitudes than in normal state That implies that the hypnosis interventioncan be an alternative way for respiratory control which can effectively reduce the respiratory amplitude and increase the stabilityof respiratory cycle The proposed method will find useful application in image-guided radiotherapy

1 Introduction

Aprerequisite of treatment planning in thoracic radiotherapyis the accurate modeling of respiratory motion of thoracicstructures [1] Much effort has been devoted to address thisissue One of the traditional methods is that the patientsare trained before treatment to make respiration as stableas possible and the depicted planning target volume (PTV)covers the whole area of tumor motion Another methodis the gating technology which synchronizes the treatmentwith the breathing cycle The radiation at the tumor isapplied only during a specific time in the cycle typicallyduring the deepest expiration of the patient and the radiationis ceased once the tumor moves out of the targeted areaOne of the powerful tools for gating is the respiratory posi-tion management (RPM) system [2 3] developed by Varianwhich can detect and track respiratory motion without theneed to train the patient Another respiratory trace generat-ing (RTG) tool was also developed for tracking respiratory

motion [4]The disadvantage of gating technology is the pro-longed treatment time The third method is developed tohave the patient breathe regular by a visual system whichshows a standard breathing curve and the patientrsquos real-timebreathing curve in front of the patient during treatmentThe intervention to the patient is inevitable in the course ofthe treatment which may result in patientrsquos discomfort Theforth method is real-time tumor tracking In current imageguided radiation therapy (IGRT) it becomes increasinglypopular by using implanted metallic or radio frequencyfiducials [5ndash9] In this approach stereoscopic X-ray imagesare taken simultaneously or sequentially during the courseof dose delivery High contrast fiducials are detected onthe projection images and a triangulation algorithm is thenemployed to extract the positions of the fiducials in real-time While the fiducial marker provides a reliable way forreal time tracking implantation of fiducial markers is aninvasive procedure and may result in a number of possiblecomplications such as pneumothorax and hemorrhage [10]

2 BioMed Research International

(a) (b)

Chest

Abdomen

1

2

(c)

Figure 1 Sensors and EEG system used in the experiment (a) the EEG system used to record the electrical signal (b) the sleep sensor usedto detect the respiration motion (c) the schematic diagram of the method to detect the respiration motion

In this paper hypnosis is introduced in radiotherapy forrespiratory control without any side effects As we know hyp-nosis may keep the patient in inner peace during treatmentConsequently the respiration amplitude is reduced andbecomes stable which is an ideal state for radiotherapy Wehypothesized that hypnosis can be a helpful tool for respira-tory control in various treatment procedures such as gatingand real-time tracking

2 Materials and Methods

21 Hypnosis Hypnosis is a state in which a person seemsto be asleep but still can see hear or respond to speechdirected to him [11 12] Hypnotherapy is hypnosis usedfor therapy Under normal state people have regular low-amplitude high-frequency 120572 and uniform-frequency 120573 brainwaves while under light hypnosis state the amplitude of120572 brain waves becomes higher and the frequency becomesuniform Physicians and psychiatrists may use hypnosis totreat depression anxiety eating disorders sleep disorderscompulsive gaming and posttraumatic stress Hypnotherapyhas been successfully applyied in many cases such as fearsphobias habit control pain management and psychologicaltherapy It is widely used in pre- and posttreatment but rarelyused during treatment In this paper hypnosis is used tomake a patientrsquos inner peace and respiration stable duringtreatment

To effectively control respiration during radiotherapy oflung cancer we need to knowwhether hypnosis workswell onstabilizing the respiratory motion and then develop a novelclinical scheme to apply hypnosis in radiotherapy Severalexperiments have been conducted to test the influence ofhypnosis on respiration In these experiments a professionalhypnotist guides volunteers into hypnosis state

Hypnosis technique takes part in an important role in themethod However the technique is not suitable for all clinical

cases Based on the standard score evaluation 10 in normalpeople is highly susceptible population and 10 ismarginallysusceptible population Age imagination self-suggestionand other properties of the subject influence the suscep-tibility So the method cannot be applied for all patientsAn important work before hypnosis is to determine whichpatient is suitable for hypnosis therapy Before hypnosisseveral tests should be done to check the susceptibility of thepatient and to select the suitable patients

22 Sensors and EEG System The electroencephalogram(EEG) system developed by Nihon Kohden Corporationis user-friendly and allows recording the electrical activityof the brain over a short period of time as shown inFigure 1(a) It consists of a notebook PC isolation powersupply advanced electrode junction box and other standardaccessories There is also a full range of optional accessoriesPolysmith software is the worldrsquos most all-inclusive PSGacquisition and analysis program Patient data acquisitionand analysis are integrated into a single software As a part ofEEG system it is used in various environments and providesa comprehensive approach to analyze obtained experimentaldata It is convenient for remote access from the control room[11]

The sleep sensor in Figure 1(b) is a part of the systemthat detects the respiration motion It is tied on the chestand the abdomen of the volunteerThe corresponding signalsare transported to the EEG system for further analysisThe inductance of the bands is exactly proportional tothe transverse section encircled by the band as shown inFigure 1(c) The inductance changes with the breathing ofthe patient It is converted by the electronic circuits of thesystem into an electrical signal in order to accurately andreliably record the respirationwaveformsThe inductive bandcan be easily connected to any compatible system through adedicated interface cable

BioMed Research International 3

0 1 2 3 4 5 6 710

20

30

40

50

60

70

Volunteer number

Mea

n pe

ak (m

m)

Hypnosis breatheNormal breathe

(a)

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

0

5

10

15

20

25

30

35

40

45

50

RMS

(mm

)(b)

Figure 2 Peak value and maximum root mean square (RMS) of respiratory amplitude for the six volunteers in the normal state (red) and inthe hypnosis state (blue) respectively

Table 1 Physiological parameters of the six volunteers

Parametersvolunteer no 1 2 3 4 5 6

Age (year) 22 22 23 27 23 28

Weight (kg) 56 50 60 55 52 73

Chest circumference (cm) 89 85 91 88 75 100

The parameters setting of the sleep sensor is constantin the whole experimental procedure The sensitivity is10 120583Vmm theCALvoltage is 50120583V the time constant is 03 sand the high-cut filter is 50Hz

23 Experimental Procedure Nine volunteers took part inthe experiment Among them six volunteers were selectedby the hypnotist as suitable subjects for hypnosis with awide range of distribution of age weight and chest cir-cumference as listed in Table 1 Two experiments have beendone with these 6 volunteers One experiment was con-ducted under normal breathing The volunteers peacefullylied on a bed without any motion and speaking for 15minAnother experiment involved breathing under hypnosisThe hypnotist guided the volunteer into hypnosis state anddetermined whether the volunteer is under hypnosis Foreach subject it took about 10min to enter into hypnosisand another 15min to keep the hypnosis state Then thevolunteer was awaken by the hypnotist During the hypnosisprocedure the volunteer was extremely suggestible to thehypnotist These two experiments were repeated two weekslater

3 Experiment and Results

Figure 2 shows the mean peak value and the maximum rootmean square (RMS) of respiratory amplitude for 6 volunteersin the normal state (red points) and in the hypnosis state (bluepoints) respectively The definitions of mean of RMS are

Mean119894equiv

119873119894

sum

119895

119860119895

119894

119873119894

RMS119894= radic

119873119894

sum

119895

(119860119895

119894minusMean

119894)

2

(1)

where 119894 is the number of volunteers and 119873119894is the number

of the peaks for volunteer 119894 It is clear from Figure 2 thatthe peak value in the hypnosis state is much lower than thatin the normal state so as the RMS indicating more stablerespiration in the hypnosis state In treatment planning PTVstands for the entire region tumormay coverThe reduction ofthe mean amplitudes and the RMS is a great help to protectthe patient from the dose The low mean amplitude impliesthe energy of the radiation more concentrated in the tumorand the low RMS implies the more stable for treating

Figure 3 shows the mean cycle of respiration of differentvolunteers under normal state and hypnosis No obviousdifference between these two states is observed

Figure 4 shows the relative ratio between the amplitudeand the time weighted average in a certain range near thepeak The parameter is defined as

Ratio (119905) equivsum119860119894119905119894

119860119905

(2)

4 BioMed Research International

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

8

7

6

5

4

3

2

1

0

Mean cycle

T(s

)

Figure 3 Mean cycle of respiration for different volunteers in the normal state (red) and in the hypnosis state (blue)

where the ratio stands for the displacement around the peakof respiratory waveform The waveform is divided into manysmall time intervals counted by 119894 119905

119894is the time interval119860

119894is

the corresponding amplitude of the wave during the time 119905119860is the amplitude of the waves and 119905 is the time interval of thewave near the peak The ratio for each peak is obtained Thefinal ratio is the mean for all peaks

In Figure 4 the 119909-axis stands for the time interval nearbythe wave peak It can be seen that the relative ratio in thehypnosis state reduced more slowly than that in the normalstate The slower the relative ratio is reduced the more stableis the wave nearby the wave peak

To evaluate the difference between different cycles the120574 index of passing ratio [13ndash15] is introduced as shown inFigure 6 Like the ratio in (2) 120574 passing ratio is anotherquantity to evaluate the similarity between different cyclesIt is defined as

120574 (119909119898) = min Γ (119909

119898 119909119888) forall 119909

119888 (3)

where

Γ (119909119898 119909119888) = radic

1199092(119909119898 119909119888)

Δ1198892

119872

+

1205752(119909119898 119909119888)

Δ1198632

119872

119909 (119909119898 119909119888) =1003816100381610038161003816119909119898minus 119909119888

1003816100381610038161003816

120575 (119909119898 119909119888) = 119863

119898minus 119863119888

(4)

120575 is the difference between different cycles with 119909119898and 119909

119888

119909119898is the time of the template cycle and 119909

119888is the time of

other cycles In the experiment the first starting cycle isselected as the template cycle The 120574 passing ratio is obtainedbetween the template cycle and other cycles Δ119863

119872is the

parameter to estimate the degree of displacement Δ119889119872is the

parameter to estimate the degree of the time to agreement Inour experiments 10 groups of these two parameters are set

to calculate the 120574 passing ratios for different cycles It can beseen from Figure 5 that the 120574 index is relatively stable in thearea of dense curvesTherefore the parameters of 120574 index areselected as 12 and 28

Similar to 120574 passing ratio used in the evaluation in dosedistribution 120574 passing ratio can also be used to estimate thesimilarity of two respiration cycles As we know respiratorymotion may result in the change of dose distribution

Figure 6 shows 1205741228 index curves of passing ratio

between the first cycle and the next 12 adjacent cycles in thehypnosis state (blue curves) and the normal state (red curves)Among these 6 volunteers 5 of them show higher 120574

1228passing ratio curves in the hypnosis state than that in thenormal state which means that cycles of respiration in thehypnosis state are much more stable than that in the normalstateThe only opposite result as shown in Figure 6 (volunteer5) indicates that not all the patients are suitable for respirationcontrol using hypnosis

4 Discussions

In this work a novel method using hypnosis is proposedto control respiratory motion during radiotherapy of lungcancer Since the hypnosis is comfortable for the patient andmakes him peaceful the method allows treating the patientwithout side effects during radiotherapy

As we know the traditional training method is widelyapplied in radiotherapy which is a benefit to most patientsHowever several uncontrollable factors still exist such as thetension and the surrounding influence during the treatingwhich may trade-off the treatment effect In the proposedhypnosis method self-control is not needed for patientsduring the whole treatment procedure Moreover under theguidance of hypnotist the patient could stay in peace stateand feel comfortable during treatment

BioMed Research International 5

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 1

(a)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 2

(b)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 3

(c)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 4

(d)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 5

(e)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 6

(f)

Figure 4 Relative ratio of the wave nearby the peak and the amplitude with time weighted The red and blue points stand for the normalstate and the hypnosis state respectively

6 BioMed Research International

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

03 706 1409 2112 2815 35

18 4221 4924 5627 633 70

120574pa

ssin

g ra

tio (

)

Figure 5 120574 index of passing ratio between the first cycle and the other 13 adjacent cycles with ten different parameters

It is clear that the amplitude nearby wave peak in thehypnosis state is more stable than that in the normal statebecause the mean peak in the hypnosis state is much lowerthan that in the normal state as shown in Figure 2 If thewaveforms of the two states are similar the mean cycles fortwo states should have the same proportion with the meanpeaks However the difference of mean cycle between twostates is not notable as shown in Figure 3 This leads to moreslow reduction of amplitude under the hypnosis state thanthat under the normal state as shown in Figure 7 Again itdemonstrates the stability of respiration under the hypnosisstate

Suppose the tumor in the lung rigidly moves with res-piration motion when the tumor is irradiated at the peakof a respiration cycle the dose in tumor is determined bythe mean ratio between the displacement with time weightand the amplitude which is the definition of ratio in (2) Ifthe value of ratio is ldquo1rdquo during the whole cycle apparentlythe waveform is square wave which is an ideal state withouttumor motion

In the experiment six volunteers were selected It mayarouse controversy that the quantity is not enough andthe age or other properties are not generally representativeHowever differences always exist between the volunteersand the patients The major contribution of the proposedmethod is the use of hypnosis during radiotherapy One ofthe challenging problems is how to protect the hypnotist fromradiation exposure which is a key technology for themethodThe ultimate goals of themethod are to treat the patients withleast side effects and to become applicable to a larger numberof patients

Gamma ratio is a parameter to evaluate the similarity oftwo distributions As it is widely used in evaluation of dosedistributions we extend the use of gamma ratio to evaluate

the difference between two respiration waveforms whichmaycause the change of dose distribution during radiotherapyTherefore we choose the gamma ratio as the evaluationmetrics although other parameters can also describe thedifference

This work is a preliminary clinical study instead of a clin-ical study However it is necessary before the further clinicalapplication Although it is limited to the establishment of therelationship between hypnosis and respiratory motion thisestablishment has demonstrated the feasibility of the clinicalapplication of hypnosis during radiotherapy

5 Conclusion

In this work we found that the hypnosis can effectively sta-bilize respiration motion which makes it suitable to controlrespiration during radiotherapy of lung cancer Althoughhypnosis is not applicable to all cases it provides an alterna-tive way for respiratory control without any side effects Thenext problem is how to use hypnosis in clinical conditionsWe will propose a new scheme of respiratory control usinghypnosis in radiotherapy of lung cancer Since it is a noninva-sive method hypnosis intervention will find various clinicalapplications in the near future

Acknowledgments

This work is supported in part by grants from NationalNatural Science Foundation of China (NSFC 81171402)NSFC Joint Research Fund for Overseas Research ChineseHong Kong andMacao Young Scholars (30928030) NationalBasic Research Program 973 (2010CB732606) from Ministryof Science and Technology of China Guangdong Innovative

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

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2 BioMed Research International

(a) (b)

Chest

Abdomen

1

2

(c)

Figure 1 Sensors and EEG system used in the experiment (a) the EEG system used to record the electrical signal (b) the sleep sensor usedto detect the respiration motion (c) the schematic diagram of the method to detect the respiration motion

In this paper hypnosis is introduced in radiotherapy forrespiratory control without any side effects As we know hyp-nosis may keep the patient in inner peace during treatmentConsequently the respiration amplitude is reduced andbecomes stable which is an ideal state for radiotherapy Wehypothesized that hypnosis can be a helpful tool for respira-tory control in various treatment procedures such as gatingand real-time tracking

2 Materials and Methods

21 Hypnosis Hypnosis is a state in which a person seemsto be asleep but still can see hear or respond to speechdirected to him [11 12] Hypnotherapy is hypnosis usedfor therapy Under normal state people have regular low-amplitude high-frequency 120572 and uniform-frequency 120573 brainwaves while under light hypnosis state the amplitude of120572 brain waves becomes higher and the frequency becomesuniform Physicians and psychiatrists may use hypnosis totreat depression anxiety eating disorders sleep disorderscompulsive gaming and posttraumatic stress Hypnotherapyhas been successfully applyied in many cases such as fearsphobias habit control pain management and psychologicaltherapy It is widely used in pre- and posttreatment but rarelyused during treatment In this paper hypnosis is used tomake a patientrsquos inner peace and respiration stable duringtreatment

To effectively control respiration during radiotherapy oflung cancer we need to knowwhether hypnosis workswell onstabilizing the respiratory motion and then develop a novelclinical scheme to apply hypnosis in radiotherapy Severalexperiments have been conducted to test the influence ofhypnosis on respiration In these experiments a professionalhypnotist guides volunteers into hypnosis state

Hypnosis technique takes part in an important role in themethod However the technique is not suitable for all clinical

cases Based on the standard score evaluation 10 in normalpeople is highly susceptible population and 10 ismarginallysusceptible population Age imagination self-suggestionand other properties of the subject influence the suscep-tibility So the method cannot be applied for all patientsAn important work before hypnosis is to determine whichpatient is suitable for hypnosis therapy Before hypnosisseveral tests should be done to check the susceptibility of thepatient and to select the suitable patients

22 Sensors and EEG System The electroencephalogram(EEG) system developed by Nihon Kohden Corporationis user-friendly and allows recording the electrical activityof the brain over a short period of time as shown inFigure 1(a) It consists of a notebook PC isolation powersupply advanced electrode junction box and other standardaccessories There is also a full range of optional accessoriesPolysmith software is the worldrsquos most all-inclusive PSGacquisition and analysis program Patient data acquisitionand analysis are integrated into a single software As a part ofEEG system it is used in various environments and providesa comprehensive approach to analyze obtained experimentaldata It is convenient for remote access from the control room[11]

The sleep sensor in Figure 1(b) is a part of the systemthat detects the respiration motion It is tied on the chestand the abdomen of the volunteerThe corresponding signalsare transported to the EEG system for further analysisThe inductance of the bands is exactly proportional tothe transverse section encircled by the band as shown inFigure 1(c) The inductance changes with the breathing ofthe patient It is converted by the electronic circuits of thesystem into an electrical signal in order to accurately andreliably record the respirationwaveformsThe inductive bandcan be easily connected to any compatible system through adedicated interface cable

BioMed Research International 3

0 1 2 3 4 5 6 710

20

30

40

50

60

70

Volunteer number

Mea

n pe

ak (m

m)

Hypnosis breatheNormal breathe

(a)

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

0

5

10

15

20

25

30

35

40

45

50

RMS

(mm

)(b)

Figure 2 Peak value and maximum root mean square (RMS) of respiratory amplitude for the six volunteers in the normal state (red) and inthe hypnosis state (blue) respectively

Table 1 Physiological parameters of the six volunteers

Parametersvolunteer no 1 2 3 4 5 6

Age (year) 22 22 23 27 23 28

Weight (kg) 56 50 60 55 52 73

Chest circumference (cm) 89 85 91 88 75 100

The parameters setting of the sleep sensor is constantin the whole experimental procedure The sensitivity is10 120583Vmm theCALvoltage is 50120583V the time constant is 03 sand the high-cut filter is 50Hz

23 Experimental Procedure Nine volunteers took part inthe experiment Among them six volunteers were selectedby the hypnotist as suitable subjects for hypnosis with awide range of distribution of age weight and chest cir-cumference as listed in Table 1 Two experiments have beendone with these 6 volunteers One experiment was con-ducted under normal breathing The volunteers peacefullylied on a bed without any motion and speaking for 15minAnother experiment involved breathing under hypnosisThe hypnotist guided the volunteer into hypnosis state anddetermined whether the volunteer is under hypnosis Foreach subject it took about 10min to enter into hypnosisand another 15min to keep the hypnosis state Then thevolunteer was awaken by the hypnotist During the hypnosisprocedure the volunteer was extremely suggestible to thehypnotist These two experiments were repeated two weekslater

3 Experiment and Results

Figure 2 shows the mean peak value and the maximum rootmean square (RMS) of respiratory amplitude for 6 volunteersin the normal state (red points) and in the hypnosis state (bluepoints) respectively The definitions of mean of RMS are

Mean119894equiv

119873119894

sum

119895

119860119895

119894

119873119894

RMS119894= radic

119873119894

sum

119895

(119860119895

119894minusMean

119894)

2

(1)

where 119894 is the number of volunteers and 119873119894is the number

of the peaks for volunteer 119894 It is clear from Figure 2 thatthe peak value in the hypnosis state is much lower than thatin the normal state so as the RMS indicating more stablerespiration in the hypnosis state In treatment planning PTVstands for the entire region tumormay coverThe reduction ofthe mean amplitudes and the RMS is a great help to protectthe patient from the dose The low mean amplitude impliesthe energy of the radiation more concentrated in the tumorand the low RMS implies the more stable for treating

Figure 3 shows the mean cycle of respiration of differentvolunteers under normal state and hypnosis No obviousdifference between these two states is observed

Figure 4 shows the relative ratio between the amplitudeand the time weighted average in a certain range near thepeak The parameter is defined as

Ratio (119905) equivsum119860119894119905119894

119860119905

(2)

4 BioMed Research International

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

8

7

6

5

4

3

2

1

0

Mean cycle

T(s

)

Figure 3 Mean cycle of respiration for different volunteers in the normal state (red) and in the hypnosis state (blue)

where the ratio stands for the displacement around the peakof respiratory waveform The waveform is divided into manysmall time intervals counted by 119894 119905

119894is the time interval119860

119894is

the corresponding amplitude of the wave during the time 119905119860is the amplitude of the waves and 119905 is the time interval of thewave near the peak The ratio for each peak is obtained Thefinal ratio is the mean for all peaks

In Figure 4 the 119909-axis stands for the time interval nearbythe wave peak It can be seen that the relative ratio in thehypnosis state reduced more slowly than that in the normalstate The slower the relative ratio is reduced the more stableis the wave nearby the wave peak

To evaluate the difference between different cycles the120574 index of passing ratio [13ndash15] is introduced as shown inFigure 6 Like the ratio in (2) 120574 passing ratio is anotherquantity to evaluate the similarity between different cyclesIt is defined as

120574 (119909119898) = min Γ (119909

119898 119909119888) forall 119909

119888 (3)

where

Γ (119909119898 119909119888) = radic

1199092(119909119898 119909119888)

Δ1198892

119872

+

1205752(119909119898 119909119888)

Δ1198632

119872

119909 (119909119898 119909119888) =1003816100381610038161003816119909119898minus 119909119888

1003816100381610038161003816

120575 (119909119898 119909119888) = 119863

119898minus 119863119888

(4)

120575 is the difference between different cycles with 119909119898and 119909

119888

119909119898is the time of the template cycle and 119909

119888is the time of

other cycles In the experiment the first starting cycle isselected as the template cycle The 120574 passing ratio is obtainedbetween the template cycle and other cycles Δ119863

119872is the

parameter to estimate the degree of displacement Δ119889119872is the

parameter to estimate the degree of the time to agreement Inour experiments 10 groups of these two parameters are set

to calculate the 120574 passing ratios for different cycles It can beseen from Figure 5 that the 120574 index is relatively stable in thearea of dense curvesTherefore the parameters of 120574 index areselected as 12 and 28

Similar to 120574 passing ratio used in the evaluation in dosedistribution 120574 passing ratio can also be used to estimate thesimilarity of two respiration cycles As we know respiratorymotion may result in the change of dose distribution

Figure 6 shows 1205741228 index curves of passing ratio

between the first cycle and the next 12 adjacent cycles in thehypnosis state (blue curves) and the normal state (red curves)Among these 6 volunteers 5 of them show higher 120574

1228passing ratio curves in the hypnosis state than that in thenormal state which means that cycles of respiration in thehypnosis state are much more stable than that in the normalstateThe only opposite result as shown in Figure 6 (volunteer5) indicates that not all the patients are suitable for respirationcontrol using hypnosis

4 Discussions

In this work a novel method using hypnosis is proposedto control respiratory motion during radiotherapy of lungcancer Since the hypnosis is comfortable for the patient andmakes him peaceful the method allows treating the patientwithout side effects during radiotherapy

As we know the traditional training method is widelyapplied in radiotherapy which is a benefit to most patientsHowever several uncontrollable factors still exist such as thetension and the surrounding influence during the treatingwhich may trade-off the treatment effect In the proposedhypnosis method self-control is not needed for patientsduring the whole treatment procedure Moreover under theguidance of hypnotist the patient could stay in peace stateand feel comfortable during treatment

BioMed Research International 5

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 1

(a)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 2

(b)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 3

(c)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 4

(d)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 5

(e)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 6

(f)

Figure 4 Relative ratio of the wave nearby the peak and the amplitude with time weighted The red and blue points stand for the normalstate and the hypnosis state respectively

6 BioMed Research International

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

03 706 1409 2112 2815 35

18 4221 4924 5627 633 70

120574pa

ssin

g ra

tio (

)

Figure 5 120574 index of passing ratio between the first cycle and the other 13 adjacent cycles with ten different parameters

It is clear that the amplitude nearby wave peak in thehypnosis state is more stable than that in the normal statebecause the mean peak in the hypnosis state is much lowerthan that in the normal state as shown in Figure 2 If thewaveforms of the two states are similar the mean cycles fortwo states should have the same proportion with the meanpeaks However the difference of mean cycle between twostates is not notable as shown in Figure 3 This leads to moreslow reduction of amplitude under the hypnosis state thanthat under the normal state as shown in Figure 7 Again itdemonstrates the stability of respiration under the hypnosisstate

Suppose the tumor in the lung rigidly moves with res-piration motion when the tumor is irradiated at the peakof a respiration cycle the dose in tumor is determined bythe mean ratio between the displacement with time weightand the amplitude which is the definition of ratio in (2) Ifthe value of ratio is ldquo1rdquo during the whole cycle apparentlythe waveform is square wave which is an ideal state withouttumor motion

In the experiment six volunteers were selected It mayarouse controversy that the quantity is not enough andthe age or other properties are not generally representativeHowever differences always exist between the volunteersand the patients The major contribution of the proposedmethod is the use of hypnosis during radiotherapy One ofthe challenging problems is how to protect the hypnotist fromradiation exposure which is a key technology for themethodThe ultimate goals of themethod are to treat the patients withleast side effects and to become applicable to a larger numberof patients

Gamma ratio is a parameter to evaluate the similarity oftwo distributions As it is widely used in evaluation of dosedistributions we extend the use of gamma ratio to evaluate

the difference between two respiration waveforms whichmaycause the change of dose distribution during radiotherapyTherefore we choose the gamma ratio as the evaluationmetrics although other parameters can also describe thedifference

This work is a preliminary clinical study instead of a clin-ical study However it is necessary before the further clinicalapplication Although it is limited to the establishment of therelationship between hypnosis and respiratory motion thisestablishment has demonstrated the feasibility of the clinicalapplication of hypnosis during radiotherapy

5 Conclusion

In this work we found that the hypnosis can effectively sta-bilize respiration motion which makes it suitable to controlrespiration during radiotherapy of lung cancer Althoughhypnosis is not applicable to all cases it provides an alterna-tive way for respiratory control without any side effects Thenext problem is how to use hypnosis in clinical conditionsWe will propose a new scheme of respiratory control usinghypnosis in radiotherapy of lung cancer Since it is a noninva-sive method hypnosis intervention will find various clinicalapplications in the near future

Acknowledgments

This work is supported in part by grants from NationalNatural Science Foundation of China (NSFC 81171402)NSFC Joint Research Fund for Overseas Research ChineseHong Kong andMacao Young Scholars (30928030) NationalBasic Research Program 973 (2010CB732606) from Ministryof Science and Technology of China Guangdong Innovative

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

BioMed Research International 3

0 1 2 3 4 5 6 710

20

30

40

50

60

70

Volunteer number

Mea

n pe

ak (m

m)

Hypnosis breatheNormal breathe

(a)

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

0

5

10

15

20

25

30

35

40

45

50

RMS

(mm

)(b)

Figure 2 Peak value and maximum root mean square (RMS) of respiratory amplitude for the six volunteers in the normal state (red) and inthe hypnosis state (blue) respectively

Table 1 Physiological parameters of the six volunteers

Parametersvolunteer no 1 2 3 4 5 6

Age (year) 22 22 23 27 23 28

Weight (kg) 56 50 60 55 52 73

Chest circumference (cm) 89 85 91 88 75 100

The parameters setting of the sleep sensor is constantin the whole experimental procedure The sensitivity is10 120583Vmm theCALvoltage is 50120583V the time constant is 03 sand the high-cut filter is 50Hz

23 Experimental Procedure Nine volunteers took part inthe experiment Among them six volunteers were selectedby the hypnotist as suitable subjects for hypnosis with awide range of distribution of age weight and chest cir-cumference as listed in Table 1 Two experiments have beendone with these 6 volunteers One experiment was con-ducted under normal breathing The volunteers peacefullylied on a bed without any motion and speaking for 15minAnother experiment involved breathing under hypnosisThe hypnotist guided the volunteer into hypnosis state anddetermined whether the volunteer is under hypnosis Foreach subject it took about 10min to enter into hypnosisand another 15min to keep the hypnosis state Then thevolunteer was awaken by the hypnotist During the hypnosisprocedure the volunteer was extremely suggestible to thehypnotist These two experiments were repeated two weekslater

3 Experiment and Results

Figure 2 shows the mean peak value and the maximum rootmean square (RMS) of respiratory amplitude for 6 volunteersin the normal state (red points) and in the hypnosis state (bluepoints) respectively The definitions of mean of RMS are

Mean119894equiv

119873119894

sum

119895

119860119895

119894

119873119894

RMS119894= radic

119873119894

sum

119895

(119860119895

119894minusMean

119894)

2

(1)

where 119894 is the number of volunteers and 119873119894is the number

of the peaks for volunteer 119894 It is clear from Figure 2 thatthe peak value in the hypnosis state is much lower than thatin the normal state so as the RMS indicating more stablerespiration in the hypnosis state In treatment planning PTVstands for the entire region tumormay coverThe reduction ofthe mean amplitudes and the RMS is a great help to protectthe patient from the dose The low mean amplitude impliesthe energy of the radiation more concentrated in the tumorand the low RMS implies the more stable for treating

Figure 3 shows the mean cycle of respiration of differentvolunteers under normal state and hypnosis No obviousdifference between these two states is observed

Figure 4 shows the relative ratio between the amplitudeand the time weighted average in a certain range near thepeak The parameter is defined as

Ratio (119905) equivsum119860119894119905119894

119860119905

(2)

4 BioMed Research International

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

8

7

6

5

4

3

2

1

0

Mean cycle

T(s

)

Figure 3 Mean cycle of respiration for different volunteers in the normal state (red) and in the hypnosis state (blue)

where the ratio stands for the displacement around the peakof respiratory waveform The waveform is divided into manysmall time intervals counted by 119894 119905

119894is the time interval119860

119894is

the corresponding amplitude of the wave during the time 119905119860is the amplitude of the waves and 119905 is the time interval of thewave near the peak The ratio for each peak is obtained Thefinal ratio is the mean for all peaks

In Figure 4 the 119909-axis stands for the time interval nearbythe wave peak It can be seen that the relative ratio in thehypnosis state reduced more slowly than that in the normalstate The slower the relative ratio is reduced the more stableis the wave nearby the wave peak

To evaluate the difference between different cycles the120574 index of passing ratio [13ndash15] is introduced as shown inFigure 6 Like the ratio in (2) 120574 passing ratio is anotherquantity to evaluate the similarity between different cyclesIt is defined as

120574 (119909119898) = min Γ (119909

119898 119909119888) forall 119909

119888 (3)

where

Γ (119909119898 119909119888) = radic

1199092(119909119898 119909119888)

Δ1198892

119872

+

1205752(119909119898 119909119888)

Δ1198632

119872

119909 (119909119898 119909119888) =1003816100381610038161003816119909119898minus 119909119888

1003816100381610038161003816

120575 (119909119898 119909119888) = 119863

119898minus 119863119888

(4)

120575 is the difference between different cycles with 119909119898and 119909

119888

119909119898is the time of the template cycle and 119909

119888is the time of

other cycles In the experiment the first starting cycle isselected as the template cycle The 120574 passing ratio is obtainedbetween the template cycle and other cycles Δ119863

119872is the

parameter to estimate the degree of displacement Δ119889119872is the

parameter to estimate the degree of the time to agreement Inour experiments 10 groups of these two parameters are set

to calculate the 120574 passing ratios for different cycles It can beseen from Figure 5 that the 120574 index is relatively stable in thearea of dense curvesTherefore the parameters of 120574 index areselected as 12 and 28

Similar to 120574 passing ratio used in the evaluation in dosedistribution 120574 passing ratio can also be used to estimate thesimilarity of two respiration cycles As we know respiratorymotion may result in the change of dose distribution

Figure 6 shows 1205741228 index curves of passing ratio

between the first cycle and the next 12 adjacent cycles in thehypnosis state (blue curves) and the normal state (red curves)Among these 6 volunteers 5 of them show higher 120574

1228passing ratio curves in the hypnosis state than that in thenormal state which means that cycles of respiration in thehypnosis state are much more stable than that in the normalstateThe only opposite result as shown in Figure 6 (volunteer5) indicates that not all the patients are suitable for respirationcontrol using hypnosis

4 Discussions

In this work a novel method using hypnosis is proposedto control respiratory motion during radiotherapy of lungcancer Since the hypnosis is comfortable for the patient andmakes him peaceful the method allows treating the patientwithout side effects during radiotherapy

As we know the traditional training method is widelyapplied in radiotherapy which is a benefit to most patientsHowever several uncontrollable factors still exist such as thetension and the surrounding influence during the treatingwhich may trade-off the treatment effect In the proposedhypnosis method self-control is not needed for patientsduring the whole treatment procedure Moreover under theguidance of hypnotist the patient could stay in peace stateand feel comfortable during treatment

BioMed Research International 5

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 1

(a)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 2

(b)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 3

(c)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 4

(d)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 5

(e)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 6

(f)

Figure 4 Relative ratio of the wave nearby the peak and the amplitude with time weighted The red and blue points stand for the normalstate and the hypnosis state respectively

6 BioMed Research International

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

03 706 1409 2112 2815 35

18 4221 4924 5627 633 70

120574pa

ssin

g ra

tio (

)

Figure 5 120574 index of passing ratio between the first cycle and the other 13 adjacent cycles with ten different parameters

It is clear that the amplitude nearby wave peak in thehypnosis state is more stable than that in the normal statebecause the mean peak in the hypnosis state is much lowerthan that in the normal state as shown in Figure 2 If thewaveforms of the two states are similar the mean cycles fortwo states should have the same proportion with the meanpeaks However the difference of mean cycle between twostates is not notable as shown in Figure 3 This leads to moreslow reduction of amplitude under the hypnosis state thanthat under the normal state as shown in Figure 7 Again itdemonstrates the stability of respiration under the hypnosisstate

Suppose the tumor in the lung rigidly moves with res-piration motion when the tumor is irradiated at the peakof a respiration cycle the dose in tumor is determined bythe mean ratio between the displacement with time weightand the amplitude which is the definition of ratio in (2) Ifthe value of ratio is ldquo1rdquo during the whole cycle apparentlythe waveform is square wave which is an ideal state withouttumor motion

In the experiment six volunteers were selected It mayarouse controversy that the quantity is not enough andthe age or other properties are not generally representativeHowever differences always exist between the volunteersand the patients The major contribution of the proposedmethod is the use of hypnosis during radiotherapy One ofthe challenging problems is how to protect the hypnotist fromradiation exposure which is a key technology for themethodThe ultimate goals of themethod are to treat the patients withleast side effects and to become applicable to a larger numberof patients

Gamma ratio is a parameter to evaluate the similarity oftwo distributions As it is widely used in evaluation of dosedistributions we extend the use of gamma ratio to evaluate

the difference between two respiration waveforms whichmaycause the change of dose distribution during radiotherapyTherefore we choose the gamma ratio as the evaluationmetrics although other parameters can also describe thedifference

This work is a preliminary clinical study instead of a clin-ical study However it is necessary before the further clinicalapplication Although it is limited to the establishment of therelationship between hypnosis and respiratory motion thisestablishment has demonstrated the feasibility of the clinicalapplication of hypnosis during radiotherapy

5 Conclusion

In this work we found that the hypnosis can effectively sta-bilize respiration motion which makes it suitable to controlrespiration during radiotherapy of lung cancer Althoughhypnosis is not applicable to all cases it provides an alterna-tive way for respiratory control without any side effects Thenext problem is how to use hypnosis in clinical conditionsWe will propose a new scheme of respiratory control usinghypnosis in radiotherapy of lung cancer Since it is a noninva-sive method hypnosis intervention will find various clinicalapplications in the near future

Acknowledgments

This work is supported in part by grants from NationalNatural Science Foundation of China (NSFC 81171402)NSFC Joint Research Fund for Overseas Research ChineseHong Kong andMacao Young Scholars (30928030) NationalBasic Research Program 973 (2010CB732606) from Ministryof Science and Technology of China Guangdong Innovative

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

4 BioMed Research International

0 1 2 3 4 5 6 7

Volunteer number

Hypnosis breatheNormal breathe

8

7

6

5

4

3

2

1

0

Mean cycle

T(s

)

Figure 3 Mean cycle of respiration for different volunteers in the normal state (red) and in the hypnosis state (blue)

where the ratio stands for the displacement around the peakof respiratory waveform The waveform is divided into manysmall time intervals counted by 119894 119905

119894is the time interval119860

119894is

the corresponding amplitude of the wave during the time 119905119860is the amplitude of the waves and 119905 is the time interval of thewave near the peak The ratio for each peak is obtained Thefinal ratio is the mean for all peaks

In Figure 4 the 119909-axis stands for the time interval nearbythe wave peak It can be seen that the relative ratio in thehypnosis state reduced more slowly than that in the normalstate The slower the relative ratio is reduced the more stableis the wave nearby the wave peak

To evaluate the difference between different cycles the120574 index of passing ratio [13ndash15] is introduced as shown inFigure 6 Like the ratio in (2) 120574 passing ratio is anotherquantity to evaluate the similarity between different cyclesIt is defined as

120574 (119909119898) = min Γ (119909

119898 119909119888) forall 119909

119888 (3)

where

Γ (119909119898 119909119888) = radic

1199092(119909119898 119909119888)

Δ1198892

119872

+

1205752(119909119898 119909119888)

Δ1198632

119872

119909 (119909119898 119909119888) =1003816100381610038161003816119909119898minus 119909119888

1003816100381610038161003816

120575 (119909119898 119909119888) = 119863

119898minus 119863119888

(4)

120575 is the difference between different cycles with 119909119898and 119909

119888

119909119898is the time of the template cycle and 119909

119888is the time of

other cycles In the experiment the first starting cycle isselected as the template cycle The 120574 passing ratio is obtainedbetween the template cycle and other cycles Δ119863

119872is the

parameter to estimate the degree of displacement Δ119889119872is the

parameter to estimate the degree of the time to agreement Inour experiments 10 groups of these two parameters are set

to calculate the 120574 passing ratios for different cycles It can beseen from Figure 5 that the 120574 index is relatively stable in thearea of dense curvesTherefore the parameters of 120574 index areselected as 12 and 28

Similar to 120574 passing ratio used in the evaluation in dosedistribution 120574 passing ratio can also be used to estimate thesimilarity of two respiration cycles As we know respiratorymotion may result in the change of dose distribution

Figure 6 shows 1205741228 index curves of passing ratio

between the first cycle and the next 12 adjacent cycles in thehypnosis state (blue curves) and the normal state (red curves)Among these 6 volunteers 5 of them show higher 120574

1228passing ratio curves in the hypnosis state than that in thenormal state which means that cycles of respiration in thehypnosis state are much more stable than that in the normalstateThe only opposite result as shown in Figure 6 (volunteer5) indicates that not all the patients are suitable for respirationcontrol using hypnosis

4 Discussions

In this work a novel method using hypnosis is proposedto control respiratory motion during radiotherapy of lungcancer Since the hypnosis is comfortable for the patient andmakes him peaceful the method allows treating the patientwithout side effects during radiotherapy

As we know the traditional training method is widelyapplied in radiotherapy which is a benefit to most patientsHowever several uncontrollable factors still exist such as thetension and the surrounding influence during the treatingwhich may trade-off the treatment effect In the proposedhypnosis method self-control is not needed for patientsduring the whole treatment procedure Moreover under theguidance of hypnotist the patient could stay in peace stateand feel comfortable during treatment

BioMed Research International 5

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 1

(a)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 2

(b)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 3

(c)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 4

(d)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 5

(e)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 6

(f)

Figure 4 Relative ratio of the wave nearby the peak and the amplitude with time weighted The red and blue points stand for the normalstate and the hypnosis state respectively

6 BioMed Research International

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

03 706 1409 2112 2815 35

18 4221 4924 5627 633 70

120574pa

ssin

g ra

tio (

)

Figure 5 120574 index of passing ratio between the first cycle and the other 13 adjacent cycles with ten different parameters

It is clear that the amplitude nearby wave peak in thehypnosis state is more stable than that in the normal statebecause the mean peak in the hypnosis state is much lowerthan that in the normal state as shown in Figure 2 If thewaveforms of the two states are similar the mean cycles fortwo states should have the same proportion with the meanpeaks However the difference of mean cycle between twostates is not notable as shown in Figure 3 This leads to moreslow reduction of amplitude under the hypnosis state thanthat under the normal state as shown in Figure 7 Again itdemonstrates the stability of respiration under the hypnosisstate

Suppose the tumor in the lung rigidly moves with res-piration motion when the tumor is irradiated at the peakof a respiration cycle the dose in tumor is determined bythe mean ratio between the displacement with time weightand the amplitude which is the definition of ratio in (2) Ifthe value of ratio is ldquo1rdquo during the whole cycle apparentlythe waveform is square wave which is an ideal state withouttumor motion

In the experiment six volunteers were selected It mayarouse controversy that the quantity is not enough andthe age or other properties are not generally representativeHowever differences always exist between the volunteersand the patients The major contribution of the proposedmethod is the use of hypnosis during radiotherapy One ofthe challenging problems is how to protect the hypnotist fromradiation exposure which is a key technology for themethodThe ultimate goals of themethod are to treat the patients withleast side effects and to become applicable to a larger numberof patients

Gamma ratio is a parameter to evaluate the similarity oftwo distributions As it is widely used in evaluation of dosedistributions we extend the use of gamma ratio to evaluate

the difference between two respiration waveforms whichmaycause the change of dose distribution during radiotherapyTherefore we choose the gamma ratio as the evaluationmetrics although other parameters can also describe thedifference

This work is a preliminary clinical study instead of a clin-ical study However it is necessary before the further clinicalapplication Although it is limited to the establishment of therelationship between hypnosis and respiratory motion thisestablishment has demonstrated the feasibility of the clinicalapplication of hypnosis during radiotherapy

5 Conclusion

In this work we found that the hypnosis can effectively sta-bilize respiration motion which makes it suitable to controlrespiration during radiotherapy of lung cancer Althoughhypnosis is not applicable to all cases it provides an alterna-tive way for respiratory control without any side effects Thenext problem is how to use hypnosis in clinical conditionsWe will propose a new scheme of respiratory control usinghypnosis in radiotherapy of lung cancer Since it is a noninva-sive method hypnosis intervention will find various clinicalapplications in the near future

Acknowledgments

This work is supported in part by grants from NationalNatural Science Foundation of China (NSFC 81171402)NSFC Joint Research Fund for Overseas Research ChineseHong Kong andMacao Young Scholars (30928030) NationalBasic Research Program 973 (2010CB732606) from Ministryof Science and Technology of China Guangdong Innovative

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

BioMed Research International 5

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 1

(a)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 2

(b)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 3

(c)

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 4

(d)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 5

(e)

Hypnosis breatheNormal breathe

0 02 04 06 08 1 12 14065

07

075

08

085

09

095

1

t (s)

Ratio

Volunteer 6

(f)

Figure 4 Relative ratio of the wave nearby the peak and the amplitude with time weighted The red and blue points stand for the normalstate and the hypnosis state respectively

6 BioMed Research International

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

03 706 1409 2112 2815 35

18 4221 4924 5627 633 70

120574pa

ssin

g ra

tio (

)

Figure 5 120574 index of passing ratio between the first cycle and the other 13 adjacent cycles with ten different parameters

It is clear that the amplitude nearby wave peak in thehypnosis state is more stable than that in the normal statebecause the mean peak in the hypnosis state is much lowerthan that in the normal state as shown in Figure 2 If thewaveforms of the two states are similar the mean cycles fortwo states should have the same proportion with the meanpeaks However the difference of mean cycle between twostates is not notable as shown in Figure 3 This leads to moreslow reduction of amplitude under the hypnosis state thanthat under the normal state as shown in Figure 7 Again itdemonstrates the stability of respiration under the hypnosisstate

Suppose the tumor in the lung rigidly moves with res-piration motion when the tumor is irradiated at the peakof a respiration cycle the dose in tumor is determined bythe mean ratio between the displacement with time weightand the amplitude which is the definition of ratio in (2) Ifthe value of ratio is ldquo1rdquo during the whole cycle apparentlythe waveform is square wave which is an ideal state withouttumor motion

In the experiment six volunteers were selected It mayarouse controversy that the quantity is not enough andthe age or other properties are not generally representativeHowever differences always exist between the volunteersand the patients The major contribution of the proposedmethod is the use of hypnosis during radiotherapy One ofthe challenging problems is how to protect the hypnotist fromradiation exposure which is a key technology for themethodThe ultimate goals of themethod are to treat the patients withleast side effects and to become applicable to a larger numberof patients

Gamma ratio is a parameter to evaluate the similarity oftwo distributions As it is widely used in evaluation of dosedistributions we extend the use of gamma ratio to evaluate

the difference between two respiration waveforms whichmaycause the change of dose distribution during radiotherapyTherefore we choose the gamma ratio as the evaluationmetrics although other parameters can also describe thedifference

This work is a preliminary clinical study instead of a clin-ical study However it is necessary before the further clinicalapplication Although it is limited to the establishment of therelationship between hypnosis and respiratory motion thisestablishment has demonstrated the feasibility of the clinicalapplication of hypnosis during radiotherapy

5 Conclusion

In this work we found that the hypnosis can effectively sta-bilize respiration motion which makes it suitable to controlrespiration during radiotherapy of lung cancer Althoughhypnosis is not applicable to all cases it provides an alterna-tive way for respiratory control without any side effects Thenext problem is how to use hypnosis in clinical conditionsWe will propose a new scheme of respiratory control usinghypnosis in radiotherapy of lung cancer Since it is a noninva-sive method hypnosis intervention will find various clinicalapplications in the near future

Acknowledgments

This work is supported in part by grants from NationalNatural Science Foundation of China (NSFC 81171402)NSFC Joint Research Fund for Overseas Research ChineseHong Kong andMacao Young Scholars (30928030) NationalBasic Research Program 973 (2010CB732606) from Ministryof Science and Technology of China Guangdong Innovative

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

6 BioMed Research International

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

03 706 1409 2112 2815 35

18 4221 4924 5627 633 70

120574pa

ssin

g ra

tio (

)

Figure 5 120574 index of passing ratio between the first cycle and the other 13 adjacent cycles with ten different parameters

It is clear that the amplitude nearby wave peak in thehypnosis state is more stable than that in the normal statebecause the mean peak in the hypnosis state is much lowerthan that in the normal state as shown in Figure 2 If thewaveforms of the two states are similar the mean cycles fortwo states should have the same proportion with the meanpeaks However the difference of mean cycle between twostates is not notable as shown in Figure 3 This leads to moreslow reduction of amplitude under the hypnosis state thanthat under the normal state as shown in Figure 7 Again itdemonstrates the stability of respiration under the hypnosisstate

Suppose the tumor in the lung rigidly moves with res-piration motion when the tumor is irradiated at the peakof a respiration cycle the dose in tumor is determined bythe mean ratio between the displacement with time weightand the amplitude which is the definition of ratio in (2) Ifthe value of ratio is ldquo1rdquo during the whole cycle apparentlythe waveform is square wave which is an ideal state withouttumor motion

In the experiment six volunteers were selected It mayarouse controversy that the quantity is not enough andthe age or other properties are not generally representativeHowever differences always exist between the volunteersand the patients The major contribution of the proposedmethod is the use of hypnosis during radiotherapy One ofthe challenging problems is how to protect the hypnotist fromradiation exposure which is a key technology for themethodThe ultimate goals of themethod are to treat the patients withleast side effects and to become applicable to a larger numberof patients

Gamma ratio is a parameter to evaluate the similarity oftwo distributions As it is widely used in evaluation of dosedistributions we extend the use of gamma ratio to evaluate

the difference between two respiration waveforms whichmaycause the change of dose distribution during radiotherapyTherefore we choose the gamma ratio as the evaluationmetrics although other parameters can also describe thedifference

This work is a preliminary clinical study instead of a clin-ical study However it is necessary before the further clinicalapplication Although it is limited to the establishment of therelationship between hypnosis and respiratory motion thisestablishment has demonstrated the feasibility of the clinicalapplication of hypnosis during radiotherapy

5 Conclusion

In this work we found that the hypnosis can effectively sta-bilize respiration motion which makes it suitable to controlrespiration during radiotherapy of lung cancer Althoughhypnosis is not applicable to all cases it provides an alterna-tive way for respiratory control without any side effects Thenext problem is how to use hypnosis in clinical conditionsWe will propose a new scheme of respiratory control usinghypnosis in radiotherapy of lung cancer Since it is a noninva-sive method hypnosis intervention will find various clinicalapplications in the near future

Acknowledgments

This work is supported in part by grants from NationalNatural Science Foundation of China (NSFC 81171402)NSFC Joint Research Fund for Overseas Research ChineseHong Kong andMacao Young Scholars (30928030) NationalBasic Research Program 973 (2010CB732606) from Ministryof Science and Technology of China Guangdong Innovative

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

BioMed Research International 7

Volunteer 1

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

1205741228

pass

ing

ratio

()

(a)

1205741228

pass

ing

ratio

()

Volunteer 2

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(b)

1205741228

pass

ing

ratio

()

Volunteer 3

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(c)

1205741228

pass

ing

ratio

()

Volunteer 4

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(d)

1205741228

pass

ing

ratio

()

Volunteer 5

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(e)

1205741228

pass

ing

ratio

()

Volunteer 6

Hypnosis breatheNormal breathe

2 4 6 8 10 12 140

10

20

30

40

50

60

70

80

90

100

Number of periodicities

(f)

Figure 6 1205741228 passing ratio between the first cycle and the next 13 adjacent cycles in the hypnosis state (blue) and the normal state (red)

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

8 BioMed Research International

minus15 minus1 minus05 0 05 1 150

02

04

06

08

1

Time

Wav

efor

m o

f one

cycle

Normal-like stateHypnosis-like state

Figure 7 Comparison ofwaveforms between the hypnosis-like state(green) and the normal-like state (red) the green curve has themorestable peak than the red curve caused by the amplitudes and thecycles of two curves

Research Team Program (no 2011S013) of China Science andTechnological Program for Dongguanrsquos Higher EducationScience and Research Health Care Institutions (Grant no2011108101001) grant fromComprehensive Strategic Cooper-ation Project of Guangdong province and Chinese Academyof Sciences (Grant no 2011B090300079)

References

[1] L Xing B Thorndyke E Schreibmann et al ldquoOverview ofimage-guided radiation therapyrdquoMedical Dosimetry vol 31 no2 pp 91ndash112 2006

[2] R Wagman E Yorke E Ford et al ldquoRespiratory gating forliver tumors use in dose escalationrdquo International Journal ofRadiation Oncology Biology Physics vol 55 no 3 pp 659ndash6682003

[3] S B Jiang ldquoTechnical aspects of image-guided respiration-gated radiation therapyrdquo Medical Dosimetry vol 31 no 2 pp141ndash151 2006

[4] S Quirk N Becher and W Smith ldquoExternal respiratorymotion shape analysis and custom realistic respiratory tracegenerationrdquoMedical Physics vol 39 no 8 pp 4999ndash5003 2012

[5] R D Wiersma W Mao and L Xing ldquoCombined kV and MVimaging for real-time tracking of implanted fiducial markersrdquoMedical Physics vol 35 no 4 pp 1191ndash1198 2008

[6] P Kupelian T Willoughby A Mahadevan et al ldquoMulti-institutional clinical experience with the Calypso Systemin localization and continuous real-time monitoring of theprostate gland during external radiotherapyrdquo International Jour-nal of Radiation Oncology Biology Physics vol 67 no 4 pp1088ndash1098 2007

[7] W Mao R D Wiersma and L Xing ldquoFast internal markertracking algorithm for onboard MV and kV imaging systemsrdquoMedical Physics vol 35 no 5 pp 1942ndash1949 2008

[8] T R Willoughby P A Kupelian J Pouliot et al ldquoTarget local-ization and real-time tracking using theCalypso 4D localization

system in patients with localized prostate cancerrdquo InternationalJournal of Radiation Oncology Biology Physics vol 65 no 2 pp528ndash534 2006

[9] M J Murphy ldquoFiducial-based targeting accuracy for external-beam radiotherapyrdquoMedical Physics vol 29 no 3 pp 334ndash3442002

[10] B T Collins K Erickson C A Reichner et al ldquoRadicalstereotactic radiosurgery with real-time tumormotion trackingin the treatment of small peripheral lung tumorsrdquo RadiationOncology vol 2 no 1 article 39 2007

[11] S J Lynn O Fassler and J Knox ldquoHypnosis and the alteredstate debate something more or nothing morerdquo ContemporaryHypnosis vol 22 no 1 pp 39ndash45 2005

[12] W C Coe L G Buckner M L Howard and K KobayashildquoHypnosis as role enactment focus on a role specific skillrdquoAmerican Journal of Clinical Hypnosis vol 15 no 1 pp 41ndash451972

[13] D A Low W B Harms S Mutic and J A Purdy ldquoA techniquefor the quantitative evaluation of dose distributionsrdquo MedicalPhysics vol 25 no 5 pp 656ndash661 1998

[14] U J Yeo M L Taylor J R Supple et al ldquoIs it sensible toldquodeformrdquo dose 3D experimental validation of dose-warpingrdquoMedical Physics vol 39 no 8 pp 5065ndash5072 2012

[15] X Gu X Jia and S B Jiang ldquoGPU-based fast gamma indexcalculationrdquo Physics in Medicine and Biology vol 56 no 5 pp1431ndash1441 2011

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom