An effective patient training for deep inspiration breath hold technique of left-sided breast on computed tomography simulation procedure at King Chulalongkorn Memorial Hospital

Abstract

PurposeTo observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire.MethodsTwo different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video.ResultsTotal number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively.ConclusionPatient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.

Dosimetric evaluation of photons versus protons in postmastectomy planning for ultrahypofractionated breast radiotherapy

“…Although the high-dose regions of the lungs and heart are spared using these methods [ 7 ], but a higher volume of the adjacent OARs receives a low dose radiation, which can cause long term toxicities and secondary cancer [ 8 ]. A previous study used deep inspiration breath hold to reduce the radiation dose to the heart for left-side breast irradiation; however, a low dose to the remaining organs could not be eliminated [ 9 ].…”

The dosimetric benefit of in‐advance respiratory training for deep inspiration breath holding is realized during daily treatment in left breast radiotherapy: A comparative retrospective study of serial surface motion tracking

“…Physical and cognitive unpreparedness for these strenuous on-demand and stringently timed physical manoeuvres can hamper the smooth and consistent performance of DIBH. 13 Patient performance and the quality of DIBH can be variable and unpredictable among individual breast cancer patients. Similarly, patient instruction and preparation for DIBH has been highly variable, but occurs on the procedure day, shortly before the CT simulation.…”

“…9,[14][15][16] While it has been recognized that a learning curve exists for patients to acquire the complex physical and cognitive skills to perform DIBH manoeuvres well, 17 only very few studies have explored alternative preparatorytraining approaches to boost patients' DIBH performance and tolerance. 13,[18][19][20][21] Logistically the timing of respiratory training can be expanded farther into the pre-radiation therapy phase, enabling earlier, preparatory and thereby more intensified DIBH training regimens that provide longer time for patients to practice and improve their DIBH skills. Results of these very few studies show promise that a strategy of early preparatory DIBH training and practice, implemented well in advance of the first DIBH performance at the simulation procedure, can measurably decrease procedure time spent in CT simulation, 13 lengthen the sustained DIBH 19,20 and broaden the range of breath-hold manoeuvres performed.…”

“…13,[18][19][20][21] Logistically the timing of respiratory training can be expanded farther into the pre-radiation therapy phase, enabling earlier, preparatory and thereby more intensified DIBH training regimens that provide longer time for patients to practice and improve their DIBH skills. Results of these very few studies show promise that a strategy of early preparatory DIBH training and practice, implemented well in advance of the first DIBH performance at the simulation procedure, can measurably decrease procedure time spent in CT simulation, 13 lengthen the sustained DIBH 19,20 and broaden the range of breath-hold manoeuvres performed. 21 Among these investigations, our previous comparison study was the first to demonstrate that cardiac dose can be further reduced by in-advance preparatory DIBH training and practice.…”

“…However, none of the early training studies 13,[18][19][20][21] evaluated whether the training-induced DIBH "stretch performance" was maintained during the entire treatment course. This is an important question to answer because, if DIBH performance erodes after the training regimen concludes, during the simulation-treatment start interval and/or during daily therapy, the gains from the improved DIBH would be reduced or lost.…”