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Perspectives in deep inspiration breath-hold: Identifying challenges and strategies for improvement from patients and
Aarti Jamwal1, Rakesh Kapoor, Keshav K Verma
1Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Background:
Deep inspiration breath-hold (DIBH) is widely used in left-sided breast cancer radiotherapy to reduce cardiac exposure. While its dosimetric benefits are well established, patient experience and radiotherapy technologist (RTT) perspectives remain less explored. This study aimed to evaluate patient-reported experiences and RTT perceptions of DIBH implementation in routine clinical practice.
Methods:
A prospective observational study was conducted involving 20 female patients with left-sided breast cancer treated using DIBH and six RTTs with 6-8 years of experience. Patient experience was assessed using a structured 15-item questionnaire covering understanding, comfort, breath-hold performance, and overall satisfaction. RTT perspectives were evaluated using a 12-item questionnaire addressing patient coaching, technical challenges, and satisfaction with DIBH implementation. Responses were recorded on a 5-point Likert scale and analyzed using descriptive statistics.
Results:
All patients reported a clear understanding of DIBH instructions and adequate staff guidance, with 100% agreement for both. Overall satisfaction was high (mean score 4.5 ± 0.5), and most patients reported that DIBH became easier with successive treatment sessions. However, variability was observed in physical comfort and breath-hold tolerance, with only 40% reporting complete comfort during breath-hold. Psychological stress prior to breath-hold was reported by 60% of patients. RTTs unanimously agreed that DIBH improved setup reproducibility and cone-beam computed tomography matching accuracy, though additional coaching requirements and occasional technical interruptions were reported.
Conclusion:
DIBH is well accepted by patients and perceived by RTTs as beneficial for treatment accuracy. Its routine implementation requires ongoing patient coaching and workflow optimization to balance clinical benefit with operational efficiency.
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