WE-G-213CD-08: Initial Experience with the Clinical Implementation of a Deep Inspiration Breath Hold for Left Breast...

Current radiation therapy techniques for left breast cancer often struggle to minimize heart exposure. No prior work had fully resolved the integration of real-time monitoring with patient-guided feedback systems. That uncertainty drove the need for reliable protocols during deep inspiration breath hold procedures. It was already known that holding breath shifts the heart away from the radiation field. However, achieving consistent breath holds remains a significant challenge for many patients. This gap motivated the development of new surface imaging tools to track patient positioning. Prior research has shown that visual feedback can improve patient compliance during complex medical procedures. These existing limitations necessitated a thorough evaluation of integrated surface imaging and visual aid systems.

The researchers aimed to evaluate the clinical implementation of a deep inspiration breath hold treatment for left breast radiotherapy. They sought to determine if combining surface imaging with visual aids could improve treatment precision. This study addresses the challenge of maintaining reproducible breath holds during radiation delivery. The authors investigated whether real-time monitoring could effectively minimize heart exposure. They also intended to assess the efficiency of the workflow in a clinical setting. By using video goggles, the team explored how patient feedback influences stability. The study specifically focuses on the reduction of radiation dose to the heart. This work provides insights into the feasibility of integrating advanced imaging tools into standard oncology practices.

The researchers conducted a prospective evaluation of a new clinical workflow involving four patients. They utilized a surface imaging system to monitor patient positioning throughout the treatment sessions. A computed tomography scan acquired at the breath hold position served as the planning reference. The team exported skin contours and isocenters from the planning software into the imaging platform. Patients wore video goggles to receive real-time visual feedback of their breathing signals. Staff performed weekly megavoltage imaging to validate the setup and surface alignment. The beam remained inactive unless the patient surface matched the reference within defined tolerances. This systematic approach ensured consistent monitoring of the breath hold throughout the entire procedure.

The study reports an average displacement of 0.4 mm from the reference surface during breath holds. The average reduction of heart mean dose reached 38% compared to free breathing. Furthermore, the volume receiving 50% of the prescribed dose decreased by 89% on average. The team recorded an average setup time of 14.2 minutes per patient. Total treatment time averaged 16.8 minutes across the observed sessions. Fifteen patients completed the treatment protocol during the evaluation period. Only two patients required exclusion due to an inability to maintain stable breath holds. These results indicate that the integration of surface imaging and visual feedback is highly effective.

The authors propose that their implemented workflow is both effective and efficient for clinical practice. Surface imaging provides adequate real-time information that is valuable to the treatment process. Visual aid has helped patients achieve breath holds with high reproducibility and stability. These findings suggest that the integration of these tools improves the overall quality of care. The researchers indicate that the majority of patients successfully completed the new treatment regimen. A small subset of individuals was excluded due to difficulties in maintaining a stable breath hold. The data demonstrate that this approach significantly reduces heart mean dose and volume exposure. This study confirms the feasibility of using surface imaging for monitoring breath hold accuracy.