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Mechanically-assisted non-invasive deep inspiration breath-hold (MANIV-DIBH): A first clinical application in
N Audag1,2, D Di Perri3,4, A Razavi3
1Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL (airways) & Dermatologie (skin), Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.
Background And Purpose:
Respiratory motion is a major challenge in paediatric thoracic radiotherapy, where minimizing exposure to healthy tissues is essential to reduce long-term toxicity. Mechanically-assisted non-invasive ventilation deep inspiration breath-hold (MANIV-DIBH) allows non-sedated patients to achieve repeated, reproducible breath-holds, potentially reducing safety margins and improving dose conformity. We report the first paediatric application of this technique during whole lung irradiation (WLI).
Material And Methods:
A 10-year-old girl with metastatic Ewing sarcoma was referred for WLI. A preparatory session with a physiotherapist was performed to introduce MANIV-DIBH with child-adapted communication and select the optimal non-vented oronasal mask. Ventilator settings for assisted breath-holds were tailored to the patient's tolerance. The goal was to achieve multiple 20-s breath-holds. The simulation CT was acquired during MANIV-DIBH. WLI (15 Gy in 10 fractions) was planned with IMRT.
Results:
The patient performed stable and reproducible 20-s breath-holds across 10 sessions, with an average fraction time of 32.1 (±7.8) minutes. Treatment was well tolerated, with grade 2 fatigue. Follow-up PET/CT showed complete response and no imaging signs of toxicity.
Conclusion:
This first paediatric clinical application of MANIV-DIBH suggests feasibility, stability, and good tolerability. Its successful use required careful, multidisciplinary implementation and adaptation to the paediatric setting. These preliminary findings support further evaluation in this population.
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