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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Retrospectively registered

Titles & IDs
Public title
Magnetic Resonance Imaging (MRI) guided audiovisual biofeedback for precise lung cancer radiotherapy
Scientific title
To evaluate the reproducibility of respiratory-related tumour motion in lung cancer patients using the MRI guided audiovisual biofeedback (MRI-AV) system
Secondary ID [1] 286088 0
Nil Known
Universal Trial Number (UTN)
Trial acronym
AVATAR (Audio-Visual biofeedbAck for Tumour motion regulARity)
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Lung Cancer 294089 0
Lung tumour motion consistency throughout medical imaging and radiotherapy procedures 294090 0
Condition category
Condition code
Cancer 294397 294397 0 0
Lung - Non small cell
Cancer 294398 294398 0 0
Lung - Small cell

Study type
Description of intervention(s) / exposure
Lung tumor motion was investigated in lung cancer patients who underwent a breathing training session with AV biofeedback prior to two 3T MRI sessions. The breathing training session was performed to allow patients to become familiar with an AV biofeedback, which utilizes a guiding wave customized for each patient based on a reference breathing pattern. This training session takes approximately 10 minutes. In the first MRI session (pre-treatment) 2D/3D/4D MR images with (1) free breathing (FB) and (2) AV biofeedback were obtained and the second MRI session was repeated within 3 to 6 weeks (mid-treatment). Each MRI session takes approximately 2 hours to perform. All imaging protocols used are already approved clinical procedures.
Intervention code [1] 291081 0
Treatment: Devices
Comparator / control treatment
Free or normal breathing versus breathing using MRI-AV biofeedback guidance
Control group

Primary outcome [1] 294198 0
Tumour motion reproducibility with and without MRI guided audiovisual biofeedback. Results will be evaluated using the root mean square error (RMSE) method and compared using statistical analysis methods such as the students t-test.
Timepoint [1] 294198 0
After a minimum of 15 participants have been recruited. The primary outcome will be assessed following the second MRI session (mid treatment) for each participant.
Secondary outcome [1] 312741 0
Clinical benefit assessed as change in dose delivered to healthy tissues as a result of changes in tumour margins due to more consistant tumor motion achieved with four-dimensional MRI. MRI scans obtained before the start of radiotherapy and during radiotherapy treatment will be used. The treatment planning will be evaluated qualitatively by visual inspection of dose distribution and quantatively by analysing dose-volume metrics derived from dose-volume histograms (DVHs) and functional DVHs.
Timepoint [1] 312741 0
End of recruitment. This outcome will also be assessed following the second MRI session (mid treatment) for each participant.

Key inclusion criteria
Stage I-III lung cancer of any histology to be treated with radical radiotherapy with or without chemotherapy
Ability to have radiological scans, no contraindications to having an MRI scan
Ability to lie flat for about 1 hour 10 minutes
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Metastatic disease
Pregnant women or those mentally impaired
People highly dependent on medical care
People unable to undergo MRI exam

Study design
Purpose of the study
Allocation to intervention
Non-randomised trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Participants are not randomised
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Single group
Other design features
Phase 2 / Phase 3
Type of endpoint(s)
Statistical methods / analysis
According to the preliminary results with 15 healthy human subjects, assuming a type I error rate of 5%, 80% power and a moderate effect size of 0.512 SD for the paired differences between free breathing and MRI-AV biofeedback, a sample size of 15 patients will be required. If we assume that the standard deviations of those differences will be approximately double that of healthy volunteers then the minimal detectable difference will be 0.144 for the diaphragm RMSE in displacement (SD = 0.2). The study will involve consecutive 15 lung cancer participants per system development stage (a total of 60 lung cancer patients).

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 3396 0
Calvary Mater Newcastle - Waratah
Recruitment postcode(s) [1] 9179 0
2298 - Waratah

Funding & Sponsors
Funding source category [1] 290679 0
Government body
Name [1] 290679 0
NHMRC Australian Fellowship
Address [1] 290679 0
GPO Box 1421
Canberra ACT 2601
Country [1] 290679 0
Primary sponsor type
University of Sydney
Radiation Physics Laboratory
Sydney Medical School
Room 474 Blackburn Building D06
University of Sydney NSW 2006
Secondary sponsor category [1] 289372 0
Name [1] 289372 0
Calvary Mater Newcastle
Address [1] 289372 0
Radiation Oncology
Edith Street
Waratah NSW 2298
Country [1] 289372 0

Ethics approval
Ethics application status
Ethics committee name [1] 292310 0
Hunter New England Human Research Ethics Committee
Ethics committee address [1] 292310 0
Locked Bag No 1
New Lambton NSW 2305
Ethics committee country [1] 292310 0
Date submitted for ethics approval [1] 292310 0
Approval date [1] 292310 0
Ethics approval number [1] 292310 0

Brief summary
This study is an imaging study which aims to evaluate whether the use of magnetic resonance imaging (MRI) guided audiovisual biofeedback system can improve the precision of lung cancer radiotherapy.

Who is it for?
You may be eligible to join this study if you are aged 18 years or above and have been diagnosed with stage I-III lung cancer for which you will be treated with radical radiotherapy with or without chemotherapy.

Study details
All participants will attend 3 additional sessions to standard care. The first session is a breathing training session with audiovisual feedback. This will involve a visual display of a respiratory waveguide. Participants will be asked to regulate their breathing to keep a red ball within the blue wave guide. The aim is for the ball to stay within the line by adjusting breathing by the participant. The second and third sessions participants will undergo MRI scans with and without audiovisual feedback. These MRI sessions will occur pre-radiotherapy treatment and mid-treatment (3 to 6 weeks later). All imaging protocols used are approved clinical procedures.

The acquired images will be used to evaluate the reproducibility of respiratory-related tumour motion and whether this leads to improved treatment precision i.e. a reduction in radiotherapy dose delivered to healthy tissues.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 54570 0
Prof Paul Keall
Address 54570 0
Radiation Physics Laboratory
Sydney Medical School
Room 474
Blackburn Building D06
University of Sydney NSW 2006
Country 54570 0
Phone 54570 0
+61 2 93513385
Fax 54570 0
+ 61 2 93514018
Email 54570 0
Contact person for public queries
Name 54571 0
Mrs Joanne Smart
Address 54571 0
Clinical Trial Coordinator Radiation Oncology Calvary Mater Newcastle Edith Street Waratah NSW 2298
Country 54571 0
Phone 54571 0
+61 2 40143947
Fax 54571 0
+61 2 40143945
Email 54571 0
Contact person for scientific queries
Name 54572 0
Prof Paul Keall
Address 54572 0
Radiation Physics Laboratory
Sydney Medical School
Room 474
Blackburn Building D06
University of Sydney NSW 2006
Country 54572 0
Phone 54572 0
+61 2 93513385
Fax 54572 0
+ 61 2 93514018
Email 54572 0

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary