Deep inspiration breath-hold

Last updated
DIBH treatment Deep Inspiration Breath-Hold.jpg
DIBH treatment

Deep inspiration breath-hold (DIBH) is a method of delivering radiotherapy while limiting radiation exposure to the heart and lungs. [1] It is used primarily for treating left-sided breast cancer.

Contents

The technique involves a patient holding their breath during treatment. In DIBH techniques, treatment is only delivered at certain points in the breathing cycle, where the patient holds their breath. Since the relative positions of organs in the chest naturally changes during breathing, this allows treatment to be delivered to the target (tumour) while other organs are in the optimal position to receive least dose. [2]

Another DIBH treatment Another DIBH treatment.tif
Another DIBH treatment

Treatment Methods

In the DIBH technique, the patient is initially maintained at quiet tidal breathing (i.e. normal, relaxed breathing), [3] followed by a deep inspiration, a deep expiration, a second deep inspiration, and breath-hold. At this point the patient is at approximately 100% vital capacity, and simulation, verification, and treatment take place during this phase of breath-holding. [4] DIBH is performed with several tangential fields for left-sided breast cancer. A patient is instructed to hold the breath while viewing the breathing pattern and the breath-hold position through a head-mounted mirror, thereby ensuring reproducibility of the breath-hold position in each delivery. [5] A pair of video goggles may also be used for monitoring the breathing cycle. Patients who cannot maintain DIBH can still benefit from lung tracking techniques, for example 4DCT. [6]

There are two basic methods of performing DIBH: free-breathing breath-hold, and spirometry-monitored deep inspiration breath hold. [7]

Free-breathing breath-hold

Free-breathing breath-hold, also known as real-time position management (RPM) DIBH utilises an infra-red camera and markers placed on the patient to track movement of their chest, and their breathing. [8] Another device for DIBH is known as Abches that monitors the breathing pattern. [9] With the Abches, a patient is instructed to hold the breath at a specified breathing position by viewing a breathing level indicator, thereby reproducing an identical breath-hold position. [10]

Spirometry-monitored breath-hold

Spirometry based designs are known as active breathing coordinator (ABC) DIBH systems. ABC utilises a mouth piece for the patient which can be used to control the flow of air to provide more reproducible results. [11]

Effectiveness

The DIBH technique provides an advantage to conventional free-breathing treatment by decreasing lung density, reducing normal safety margins, and enabling more accurate treatment. These improvements contribute to the effective exclusion of normal lung tissue from the high-dose region and permit the use of higher treatment doses without increased risks of toxicity. [4]

Treatment of patients with the DIBH technique is feasible in a clinical setting. With this technique, consistent lung inflation levels are achieved in patients, as judged by both spirometry and verification films. Breathing-induced tumor motion is significantly reduced using DIBH compared to free breathing, enabling better target coverage. [12]

Future research

There is currently no clear selection criteria to predict which patients will benefit most from the DIBH technique, other than left breast laterality. There is evidence to suggest parasagittal cardiac contact distance is a promising metric for selection and should be assessed in all future DIBH planning studies. [7]

Related Research Articles

<span class="mw-page-title-main">Radiation therapy</span> Therapy using ionizing radiation, usually to treat cancer

Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor. Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers. The subspecialty of oncology concerned with radiotherapy is called radiation oncology. A physician who practices in this subspecialty is a radiation oncologist.

<span class="mw-page-title-main">External beam radiotherapy</span> Treatment of cancer with ionized radiation

External beam radiation therapy (EBRT) is a compound word that refers to the use of a collimated beam of ionizing radiation from outside the body to treat a disease.

<span class="mw-page-title-main">Brachytherapy</span> Type of radiation therapy

Brachytherapy is a form of radiation therapy where a sealed radiation source is placed inside or next to the area requiring treatment. Brachy is Greek for short. Brachytherapy is commonly used as an effective treatment for cervical, prostate, breast, esophageal and skin cancer and can also be used to treat tumours in many other body sites. Treatment results have demonstrated that the cancer-cure rates of brachytherapy are either comparable to surgery and external beam radiotherapy (EBRT) or are improved when used in combination with these techniques. Brachytherapy can be used alone or in combination with other therapies such as surgery, EBRT and chemotherapy.

<span class="mw-page-title-main">Proton therapy</span> Medical Procedure

In medicine, proton therapy, or proton radiotherapy, is a type of particle therapy that uses a beam of protons to irradiate diseased tissue, most often to treat cancer. The chief advantage of proton therapy over other types of external beam radiotherapy is that the dose of protons is deposited over a narrow range of depth; hence in minimal entry, exit, or scattered radiation dose to healthy nearby tissues.

Total body irradiation (TBI) is a form of radiotherapy used primarily as part of the preparative regimen for haematopoietic stem cell transplantation. As the name implies, TBI involves irradiation of the entire body, though in modern practice the lungs are often partially shielded to lower the risk of radiation-induced lung injury. Total body irradiation in the setting of bone marrow transplantation serves to destroy or suppress the recipient's immune system, preventing immunologic rejection of transplanted donor bone marrow or blood stem cells. Additionally, high doses of total body irradiation can eradicate residual cancer cells in the transplant recipient, increasing the likelihood that the transplant will be successful.

<span class="mw-page-title-main">Multileaf collimator</span>

A multileaf collimator (MLC) is a Collimator or beam-limiting device that is made of individual "leaves" of a high atomic numbered material, usually tungsten, that can move independently in and out of the path of a radiotherapy beam in order to shape it and vary its intensity.

<span class="mw-page-title-main">Tirapazamine</span> Chemical compound

Tirapazamine (SR-[[4233]]) is an experimental anticancer drug that is activated to a toxic radical only at very low levels of oxygen (hypoxia). Such levels are common in human solid tumors, a phenomenon known as tumor hypoxia. Thus, tirapazamine is activated to its toxic form preferentially in the hypoxic areas of solid tumors. Cells in these regions are resistant to killing by radiotherapy and most anticancer drugs. Thus the combination of tirapazamine with conventional anticancer treatments is particularly effective. As of 2006, tirapazamine is undergoing phase III testing in patients with head and neck cancer and gynecological cancer, and similar trials are being undertaken for other solid tumor types.

<span class="mw-page-title-main">Radiation treatment planning</span>

In radiotherapy, radiation treatment planning (RTP) is the process in which a team consisting of radiation oncologists, radiation therapist, medical physicists and medical dosimetrists plan the appropriate external beam radiotherapy or internal brachytherapy treatment technique for a patient with cancer.

<span class="mw-page-title-main">Tomotherapy</span> Type of radiation therapy

The TomoTherapy platform is a helical radiation therapy delivery system that integrates a linear accelerator and CT technology. It delivers accurate high-quality helical fan-beam image-guided, intensity-modulated radiation therapy (IG-IMRT) from multiple 360-degree rotations around the patient as the treatment table moves. It enables accurate control of the radiation dose so it conforms precisely to the tumor and minimizes dose to healthy tissues. The TomoTherapy platform is designed to deliver image-guided 3D conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and stereotactic radiosurgery (SRS).

Intraoperative radiation therapy (IORT) is radiation therapy that is administered during surgery directly in the operating room.

Particle therapy is a form of external beam radiotherapy using beams of energetic neutrons, protons, or other heavier positive ions for cancer treatment. The most common type of particle therapy as of August 2021 is proton therapy.

A dose-volume histogram (DVH) is a histogram relating radiation dose to tissue volume in radiation therapy planning. DVHs are most commonly used as a plan evaluation tool and to compare doses from different plans or to structures. DVHs were introduced by Michael Goitein and Verhey in 1979. DVH summarizes 3D dose distributions in a graphical 2D format. In modern radiation therapy, 3D dose distributions are typically created in a computerized treatment planning system (TPS) based on a 3D reconstruction of a CT scan. The "volume" referred to in DVH analysis is a target of radiation treatment, a healthy organ nearby a target, or an arbitrary structure.

<span class="mw-page-title-main">Brain metastasis</span> Cancer that has metastasized (spread) to the brain from another location in the body

A brain metastasis is a cancer that has metastasized (spread) to the brain from another location in the body and is therefore considered a secondary brain tumor. The metastasis typically shares a cancer cell type with the original site of the cancer. Metastasis is the most common cause of brain cancer, as primary tumors that originate in the brain are less common. The most common sites of primary cancer which metastasize to the brain are lung, breast, colon, kidney, and skin cancer. Brain metastases can occur in patients months or even years after their original cancer is treated. Brain metastases have a poor prognosis for cure, but modern treatments are allowing patients to live months and sometimes years after the diagnosis.

<span class="mw-page-title-main">Targeted intra-operative radiotherapy</span> Method of targeted radiotherapy after surgical removal of tumours

Targeted intra-operative radiotherapy, also known as targeted IORT, is a technique of giving radiotherapy to the tissues surrounding a cancer after its surgical removal, a form of intraoperative radiation therapy. The technique was designed in 1998 at the University College London. In patients having lumpectomy for breast cancer, the TARGIT-A(lone) randomized controlled trial tested whether TARGIT within a risk-adapted approach is non-inferior to conventional course of external beam postoperative radiotherapy given over several weeks.

Financial toxicity describes the negative impact medical expenses can have on patients in terms of their health related quality of life, leading to negative mental and physical effects as well as, in some cases, bankruptcy, loss of job or income, or even homelessness.

Interventional oncology is a subspecialty field of interventional radiology that deals with the diagnosis and treatment of cancer and cancer-related problems using targeted minimally invasive procedures performed under image guidance. Interventional oncology has developed to a separate pillar of modern oncology and it employs X-ray, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) to help guide miniaturized instruments to allow targeted and precise treatment of solid tumours located in various organs of the human body, including but not limited to the liver, kidneys, lungs, and bones. Interventional oncology treatments are routinely carried out by interventional radiologists in appropriate settings and facilities.

Eleanor D. Montague was an American radiologist and educator who established breast-conserving therapy in the United States and improved radiation therapy techniques. She became a member of the Texas Women's Hall of Fame in 1993.

<span class="mw-page-title-main">4DCT</span>

Four-dimensional computed tomography (4DCT) is a type of CT scanning which records multiple images over time. It allows playback of the scan as a video, so that physiological processes can be observed and internal movement can be tracked. The name is derived from the addition of time to traditional 3D computed tomography. Alternatively, the phase of a particular process, such as respiration, may be considered the fourth dimension.

<span class="mw-page-title-main">Daniel Przybysz</span> Brazilian radiation oncologist

Dr. Daniel Przybysz is a Brazilian Radiation-Oncologist. His practice is mainly focused on lung cancer treatment and high technology approaches toward better patient care.

Surface-guided radiation therapy (SGRT) is the process of using 3D imaging to position and track movement of radiation therapy patients during treatment.

References

  1. Hanley, Joseph; Debois, Marc M.; Mah, Dennis; Mageras, Gikas S.; Raben, Adam; Rosenzweig, Kenneth; Mychalczak, Borys; Schwartz, Lawrence H.; Gloeggler, Paul J.; Lutz, Wendell; Ling, C.Clifton (1999). "Deep inspiration breath-hold technique for lung tumors: the potential value of target immobilization and reduced lung density in dose escalation". International Journal of Radiation Oncology, Biology, Physics. 45 (3): 603–611. doi:10.1016/S0360-3016(99)00154-6. PMID   10524412.
  2. Morris, Frog. "Deep Inspiration Breath Hold technique • Radiotherapy UK" . Retrieved 2022-03-08.
  3. Palmer, John; Allen, Julian; Mayer, Oscar (2004-05-01). "Tidal Breathing Analysis". NeoReviews. 5 (5): e186–e193. doi:10.1542/neo.5-5-e186. ISSN   1526-9906.
  4. 1 2 Rosenzweig, Kenneth E; Hanley, Joseph; Mah, Dennis; Mageras, Gig; Hunt, Margie; Toner, Sean; Burman, Chandra; Ling, C.C; Mychalczak, Borys; Fuks, Zvi; Leibel, Steven A (2000). "The deep inspiration breath-hold technique in the treatment of inoperable non–small-cell lung cancer". International Journal of Radiation Oncology, Biology, Physics. 48 (1): 81–87. doi:10.1016/S0360-3016(00)00583-6. PMID   10924975.
  5. Lee, Ha Yoon; Chang, Jee Suk; Lee, Ik Jae; Park, Kwangwoo; Kim, Yong Bae; Suh, Chang Ok; Kim, Jun Won; Keum, Ki Chang (2013). "The deep inspiration breath hold technique using Abches reduces cardiac dose in patients undergoing left-sided breast irradiation". Radiation Oncology Journal. 31 (4): 239–246. doi:10.3857/roj.2013.31.4.239. ISSN   2234-1900. PMC   3912239 . PMID   24501713.
  6. Image-guided radiation therapy. J. Daniel Bourland. Boca Raton: Taylor & Francis. 2012. ISBN   978-1-4398-0274-8. OCLC   778508742.{{cite book}}: CS1 maint: others (link)
  7. 1 2 Latty, Drew; Stuart, Kirsty E.; Wang, Wei; Ahern, Verity (2015). "Review of deep inspiration breath‐hold techniques for the treatment of breast cancer". Journal of Medical Radiation Sciences. 62 (1): 74–81. doi:10.1002/jmrs.96. ISSN   2051-3895. PMC   4364809 . PMID   26229670.
  8. Stereotactic body radiation therapy : principles and practices. Yasushi Nagata. Tokyo. 2015. ISBN   978-4-431-54883-6. OCLC   917152789.{{cite book}}: CS1 maint: others (link)
  9. Onishi, Hiroshi; Kawakami, Hideyuki; Marino, Kan; Komiyama, Takafumi; Kuriyama, Kengo; Araya, Masayuki; Saito, Ryo; Aoki, Shinichi; Araki, Tsutomu (2010). "A Simple Respiratory Indicator for Irradiation during Voluntary Breath Holding: A One-Touch Device without Electronic Materials". Radiology. 255 (3): 917–923. doi:10.1148/radiol.10090890. ISSN   0033-8419. PMID   20501729.
  10. Saito, Masahide; Kajihara, Daichi; Suzuki, Hidekazu; Komiyama, Takafumi; Marino, Kan; Aoki, Shinichi; Ueda, Koji; Sano, Naoki; Onishi, Hiroshi (2022-01-11). "Reproducibility of deep inspiration breath‐hold technique for left‐side breast cancer with respiratory monitoring device, Abches". Journal of Applied Clinical Medical Physics. 23 (4): e13529. doi:10.1002/acm2.13529. ISSN   1526-9914. PMC   8992950 . PMID   35018712. S2CID   245879028.
  11. Radiation therapy techniques and treatment planning for breast cancer. Jennifer R. Bellon, Julia S. Wong, Shannon M. MacDonald, Alice Y. Ho. Cham. 2016. ISBN   978-3-319-40392-2. OCLC   961874437.{{cite book}}: CS1 maint: others (link)
  12. Mah, Dennis; Hanley, Joseph; Rosenzweig, Kenneth E; Yorke, Ellen; Braban, Louise; Ling, C.Clifton; Leibel, Stephen A; Mageras, Gikas (2000). "Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer". International Journal of Radiation Oncology, Biology, Physics. 48 (4): 1175–1185. doi:10.1016/S0360-3016(00)00747-1. PMID   11072177.