Application of visual feedback coaching bar in deep inspiration breath holding during left breast cancer radiotherapy
Li Tantan, Zhang Jianghu, Wang Shulian, Song Yongwen, Tang Yu, Lu Fengyu, Zhang Wei, Wang Zengzhou, Qin Shirui, Zhu Ji, Huan Fukui, Dai Jianrong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract:Objective To evaluate the application of visual feedback coaching method, which is embedded in an optical surface monitoring system, in deep inspiration breath holding during the radiotherapy in left breast cancer patients after breast-conserving surgery. Methods Thirty patients with left breast cancer, who were scheduled to receive the whole breast radiotherapy after breast-conserving surgery, met the requirements of deep inspiration breath holding after respiratory coaching with the visual feedback coaching module in the optical surface monitoring system. Active breathing control equipment was used to control breath-holding state and CT simulation was performed. During treatment, optical surface monitoring system was used to guide radiotherapy. All patients were randomly divided into two groups. In group A (n=15), visual feedback respiratory training method was utilized and not employed in group B (n=15). In group A, the visual feedback coaching bar of the optical surface monitoring system was implemented, while audio interactive method was employed to guide patients to hold their breath. Real-time data of optical body surface monitoring were used to compare the interfraction reproducibility and intrafraction stability of breath holding fraction between two groups. Besides, the number of breath holding and treatment time per fraction were also compared. GraphPad prism 6.0 software was used for data processing and mapping, and SPSS 21.0 software was used for analyzing mean value and normality testing. Results Compared with the control group, the reproducibility in the experiment group was reduced from 1.5 mm to 0.7 mm, the stability was reduced from 1.1 mm to 0.8 mm, the mean number of breath holding required per fraction was decreased from 4.6 to 2.4, the mean beam-on time per fraction from 336s to 235s, and the treatment time per fraction was shortened from 847s to 602s (all P<0.05), respectively. Conclusions The application of visual feedback coaching method can improve the reproducibility and stability of breath holding during radiotherapy for left breast cancer, and it can also effectively reduce the number of breath holding and shorten the treatment time per fraction.
Li Tantan,Zhang Jianghu,Wang Shulian et al. Application of visual feedback coaching bar in deep inspiration breath holding during left breast cancer radiotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(3): 258-261.
[1] Fassi A,Ivaldi GB,Meaglia I,et al.Reproducibility of the external surface position in left-breast DIBH radiotherapy with spirometer-based monitoring[J].J Appl Clin Med Phys,2014,15(1):4494.DOI:10.1120/jacmp.v15i1.4494. [2] McIntosh A,Shoushtari AN,Benedict SH,et al.Quantifying the reproducibility of heart position during treatment and corresponding delivered heart dose in voluntary deep inhalation breath hold for left breast cancer patients treated with external beam radiotherapy[J].Int J Radiat Oncol Biol Phys,2011,81(4):e569-576.DOI:10.1016/j.ijrobp.2011.01.044. [3] Kapanen M,Laaksomaa M,Pehkonen J,et al.Effects of multiple breath hold reproducibility on treatment localization and dosimetric accuracy in radiotherapy of left-sided breast cancer with voluntary deep inspiration breath hold technique[J].Med Dosim,2017,42(3):177-184.DOI:10.1016/j.meddos.2017.02.004. [4] CerviñoLI,Gupta S,Rose MA,et al.Using surface imaging and visual coaching to improve the reproducibility and stability of deep-inspiration breath hold for left-breast-cancer radiotherapy[J].Phys Med Biol,2009,54(22):6853-6865.DOI:10.1088/0031-9155/54/22/007. [5] Tang X,Cullip T,Dooley J,et al.Dosimetric effect due to the motion during deep inspiration breath hold for left-sided breast cancer radiotherapy[J].J Appl Clin Med Phys,2015,16(4):91-99.DOI:10.1120/jacmp.v16i4.5358. [6] Borst GR,Sonke JJ,den Hollander S,et al.Clinical results of image-guided deep inspiration breath hold breast irradiation[J].Int J Radiat Oncol Biol Phys,2010,78(5):1345-1351.DOI:10.1016/j.ijrobp.2009.10.006. [7] Lutz CM,Poulsen PR,Fledelius W,et al.Setup error and motion during deep inspiration breath-hold breast radiotherapy measured with continuous portal imaging[J].Acta Oncol,2016,55(2):193-200.DOI:10.3109/0284186X.2015.1045625. [8] Acharya S,Fischer-Valuck BW,Roach MC,et al.Magnetic resonance (MR) guided accelerated partial-breast irradiation (APBI):MRI soft tissue contrast allows for decreased margins and may improve cosmesis[J].Int J Radiat Oncol,2015,93(3):E10-E11.DOI:10.1016/j.ijrobp.2015.07.570. [9] Mulliez T,Veldeman L,Vercauteren T,et al.Reproducibility of deep inspiration breath hold for prone left-sided whole breast irradiation[J].Radiat Oncol,2015,10(1):1-6.DOI:10.1186/s13014-014-0313-4. [10] Lee HY,Chang JS,Lee IJ,et al.The deep inspiration breath hold technique using Abches reduces cardiac dose in patients undergoing left-sided breast irradiation[J].Radiat Oncol J,2013,31(4):239-246.DOI:10.3857/roj.2013.31.4.239.