Related Experiment Video
Updated: Dec 29, 2025
Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
Published on: July 3, 2014
The Feasibility of Implementing Deep Inspiration Breath-Hold for Pediatric Radiation Therapy
Anni Young Lundgaard1, Mirjana Josipovic1, Laura Ann Rechner1
1Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Children aged 5 and older can successfully perform deep inspiration breath-hold (DIBH) for radiation therapy. This technique is feasible and safe for pediatric patients, with high compliance rates observed in a pilot study.
Area of Science:
- Pediatric Oncology
- Radiation Therapy Physics
Background:
- Deep inspiration breath-hold (DIBH) is recommended for adults with mediastinal lymphoma to reduce heart and lung irradiation.
- No previous studies have evaluated DIBH feasibility and compliance in pediatric patients.
Purpose of the Study:
- To investigate the feasibility and compliance of DIBH in children aged 5 years and older.
- To assess the suitability of DIBH equipment and coaching for pediatric use.
Main Methods:
- A pilot study involving 33 children (18 healthy, 15 with cancer) aged 5-15 years.
- Children underwent a DIBH training session, with voluntary breath-holds monitored by an optical surface system.
- Compliance was defined as performing 3 stable 20-second DIBHs while remaining motionless.
Main Results:
- 85% (28/33) of children were DIBH compliant, with 20 immediately compliant and 8 conditionally compliant.
- Hospitalized children showed high compliance (14/15), and only one child could not grasp the DIBH concept.
- DIBH equipment was suitable for children, and 94% reported satisfaction with training and the procedure.
Conclusions:
- Children aged 5 and older can potentially comply with DIBH, performing stable and reproducible breath-holds for radiation therapy.
- Custom-made immobilization and adequate training may further enhance DIBH compliance in pediatric patients.
- A prospective clinical trial is underway to evaluate the dosimetric benefits of DIBH in pediatric patients.
Purpose:
Radiation therapy delivery during deep inspiration breath-hold (DIBH) reduces the irradiation of the heart and lungs and is therefore recommended for adults with mediastinal lymphoma. However, no studies have addressed the use of DIBH in children. This pilot study investigates the feasibility of and compliance with DIBH in children.
Methods And Materials:
Children from the age of 5 years were recruited to a training session to assess their ability to perform DIBH. No children received radiation therapy. The children were placed in a potential radiation therapy position. The DIBH was voluntary and monitored using an optical surface system providing visual feedback. Children who performed 3 stable DIBHs of 20 seconds each and remained motionless were deemed DIBH compliant. Compliance, equipment suitability, and coaching were further assessed in a semistructured interview.
Results:
We included 33 children (18 healthy and 15 hospitalized children with cancer) with a mean age of 8.5 years (range, 5-15). A total of 28 (85%) children were DIBH compliant. Twenty children were deemed immediately DIBH compliant, and 8 were deemed conditionally DIBH compliant, as DIBH compliance was presumed with custom-made immobilization and/or additional DIBH training. Mean age of the DIBH-compliant and the non-DIBH-compliant children was 8.9 years (range, 5-15) and 6 years (range, 5-9), respectively. Only 1 of 15 hospitalized children was not DIBH compliant and only 1 of all 33 children was unable to grasp the DIBH concept. The available DIBH equipment was suitable for children, and 94% reported that they were happy with training and performing DIBH.
Conclusions:
This pilot study demonstrated that children from the age of 5 years can potentially comply with the DIBH technique and perform stable and reproducible DIBHs suitable for radiation therapy. Custom-made immobilization and adequate training will potentially increase DIBH compliance. A prospective clinical trial (NCT03315546), investigating the dosimetric benefit of radiation therapy delivery in DIBH compared with free breathing with pediatric patients, has been initiated.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...