Top Line: What breath hold technique is most stable and reproducible during breast radiation?
The Study: In this single center, randomized trial, 66 patients receiving left whole breast radiation with deep inspiration breath hold (DIBH) were randomized to voluntary DIBH using surface guidance or mechanically induced DIBH. The latter required the use of a mechanical ventilator. At simulation, the patient went through a coaching session where they learned to perform DIBH during a sequence of high pressure ventilator phases followed by low pressure phases for exhalation. Using oxygen with an Fi02 of 60%, the sequence consisted of an average 29 second DIBH phase and 4.9 second exhalation phase. Surface imaging was used to define the stability and reproducibility of each DIBH position in each arm. Both measures were non-inferior with mechanically induced DIBH. However, mechanical DIBH resulted in larger lung inflation than voluntary DIBH, which translated to significantly lower mean heart dose (1.3 v 1.5 Gy), mean LAD dose (3 v 5 Gy), and lung dose. Patients also rated the comfort and tolerance of mechanical DIBH similar to that of voluntary DIBH. Finally, the rapid sequencing of mechanical DIBH resulted in faster treatment time (4.2 v 6.2 minutes). However, preparation and setup times were longer resulting in a similar total treatment time (12.5 v 12.5 minutes). These differences likely aren’t enough to make you want to change your practice, but this study is an interesting comparison of DIBH techniques.
TBL: This small randomized trial found that mechanically induced DIBH is as reproducible as voluntary DIBH with similar overall treatment time and possibly a modest improvement in OAR dose. | Loic, Radiother Oncol 2023
The Study: In this single center, randomized trial, 66 patients receiving left whole breast radiation with deep inspiration breath hold (DIBH) were randomized to voluntary DIBH using surface guidance or mechanically induced DIBH. The latter required the use of a mechanical ventilator. At simulation, the patient went through a coaching session where they learned to perform DIBH during a sequence of high pressure ventilator phases followed by low pressure phases for exhalation. Using oxygen with an Fi02 of 60%, the sequence consisted of an average 29 second DIBH phase and 4.9 second exhalation phase. Surface imaging was used to define the stability and reproducibility of each DIBH position in each arm. Both measures were non-inferior with mechanically induced DIBH. However, mechanical DIBH resulted in larger lung inflation than voluntary DIBH, which translated to significantly lower mean heart dose (1.3 v 1.5 Gy), mean LAD dose (3 v 5 Gy), and lung dose. Patients also rated the comfort and tolerance of mechanical DIBH similar to that of voluntary DIBH. Finally, the rapid sequencing of mechanical DIBH resulted in faster treatment time (4.2 v 6.2 minutes). However, preparation and setup times were longer resulting in a similar total treatment time (12.5 v 12.5 minutes). These differences likely aren’t enough to make you want to change your practice, but this study is an interesting comparison of DIBH techniques.
TBL: This small randomized trial found that mechanically induced DIBH is as reproducible as voluntary DIBH with similar overall treatment time and possibly a modest improvement in OAR dose. | Loic, Radiother Oncol 2023