Defining short and prolonged breath-holds

Parkes, M. J.; Cashmore, J.; Green, Stuart; Clutton-Brock, T. H.; Dijk, I. Van; Kesteren, Z. van; Tienhoven, Geertjan van; Bel, Arjan; Aardweg, Joost van den; Stevens, Markus F.

doi:10.1259/bjr.20200191

Cited by 3 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 1–10 Here, the dose delivered in each treatment session is divided over multiple (~10) and short (~20 s) breath-holds, each after inhaling room air. 11 This increases accuracy and decreases radiation-induced cardiac morbidity and mortality, proportional to the reduction in radiation dose. 12–17 …”

Section: Introductionmentioning

confidence: 99%

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Parkes

Neve

Vakaet

et al. 2021

The British Journal of Radiology

Self Cite

View full text Add to dashboard Cite

Objective: Breast cancer radiotherapy is increasingly delivered supine with multiple, short breath-holds. There may be heart and lung sparing advantages for locoregional breast cancer of both prone treatment and in a single breath-hold. We test here whether single prolonged breath-holds are possible in the prone, front crawl position. Methods: 19 healthy volunteers were trained to deliver supine, single prolonged breath-holds with pre-oxygenation and hypocapnia. We tested whether all could achieve the same durations in the prone, front crawl position. Results: 19 healthy volunteers achieved supine, single prolonged breath-holds for mean of 6.2 ± 0.3 min. All were able to hold safely for the same duration while prone (6.1 ± 0.2 min ns. by paired ANOVA). With prone, the increased weight on the chest did not impede chest inflation, nor the ability to hold air in the chest. Thus, the rate of chest deflation (mean anteroposterior deflation movement of three craniocaudally arranged surface markers on the spinal cord) was the same (1.2 ± 0.2, 2.0 ± 0.4 and 1.2 ± 0.4 mm/min) as found previously during supine prolonged breath-holds. No leakage of carbon dioxide or air was detectable into the facemask. Conclusion: Single prolonged (>5 min) breath-holds are equally possible in the prone, front crawl position. Advances in knowledge: Prolonged breath-holds in the front crawl position are possible and have the same durations as in the supine position. Such training would therefore be feasible for some patients with breast cancer requiring loco-regional irradiation. It would have obvious advantages for hypofractionation.

show abstract

Section: Introductionmentioning

confidence: 99%

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Parkes

Neve

Vakaet

et al. 2021

The British Journal of Radiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…It would be interesting to generalize our results to DIBH and/or FB, since these are used in clinical practice. During DIBH, the error in estimating abdominal organ motion using RHT is expected to be in the order of sub-millimeters, since the median estimation error during PBH is <1 mm/min (Figure 7), whereas the DIBH duration is less than 60 s. 16 However, it has been shown that an initial (and larger) settlement of the diaphragm occurs during the first 10 s of DIBH. 39 Similarly, to DIBH in clinical practice, PBHs with 5 min duration may be repeated up to 9 times, by re-introducing hypocapnia within 3 min.…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged breath‐holding, for example, breath‐holding for longer than 1 min, 16 is a promising technique to control respiratory motion. This however is not widely applied in radiotherapy.…”

Section: Methodsmentioning

confidence: 99%

“…During all breath‐holds, the diaphragm and all internal organs drift passively in predominantly the cranial direction, 14 due to the difference in gas exchange of oxygen (O 2 ) and carbon dioxide (CO 2 ) between the lungs and the bloodstream 15 . The diaphragm as surrogate during short (typically <60 s) 16 deep‐inspiration breath‐holds (DIBH) has been studied for pancreas tumors, with correlation of >0.8 reported for 41% of DIBHs 14 . The typically short duration of a DIBH limits the ability to accurately quantify the value of the diaphragm as surrogate 14 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of abdominal organ motion estimation in radiotherapy using the right hemidiaphragm top as a surrogate during prolonged breath‐holds quantified with MRI

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background: Respiratory motion presents a challenge in radiotherapy of thoracic and upper abdominal tumors. Techniques to account for respiratory motion include tracking. Using magnetic resonance imaging (MRI) guided radiotherapy systems, tumors can be tracked continuously. Using conventional linear accelerators, tracking of lung tumors is possible by determining tumor motion on kilo voltage (kV) imaging. But tracking of abdominal tumors with kV imaging is hampered by limited contrast. Therefore, surrogates for the tumor are used. One of the possible surrogates is the diaphragm. However, there is no universal method for establishing the error when using a surrogate and there are particular challenges in establishing such errors during free breathing (FB). Prolonged breath-holding might address these challenges. Purpose: The aim of this study was to quantify the error when using the right hemidiaphragm top (RHT) as surrogate for abdominal organ motion during prolonged breath-holds (PBH) for possible application in radiation treatments. Methods: Fifteen healthy volunteers were trained to perform PBHs in two subsequent MRI sessions (PBH-MRI1 and PBH-MRI2). From each MRI acquisition, we selected seven images (dynamics) to determine organ displacement during PBH by using deformable image registration (DIR). On the first dynamic, the RHT, right and left hemidiaphragm, liver, spleen and right and left kidney were segmented. We used the deformation vector fields (DVF), generated by DIR, to determine the displacement of each organ between two dynamics in inferior-superior (IS), anterior-posterior (AP), left-right (LR) direction and we calculated the 3D vector magnitude (|d|). The displacements of the RHT, both hemidiaphragms and the abdominal organs were compared using a linear fit to determine the correlation (R 2 of the fit) and the displacement ratio (DR, slope of the fit) between displacements of the RHT and each organ. We

show abstract

“…This improves the accuracy of shear wave quantification in regions of low wave amplitude due to an increased sensitivity to motion. However, it prolongs breath‐hold duration, which should be below a clinically feasible breath‐hold time (15–20 seconds 24 ).…”

Section: Methodsmentioning

confidence: 99%

Single Breath‐Hold MR Elastography for Fast Biomechanical Probing of Pancreatic Stiffness

van Schelt,

Gottwald,

Wassenaar

et al. 2023

Magnetic Resonance Imaging

View full text Add to dashboard Cite

BackgroundPancreatic ductal adenocarcinoma (PDAC) stromal disposition is thought to influence chemotherapy efficacy and increase tissue stiffness, which could be quantified noninvasively via MR elastography (MRE). Current methods cause position‐based errors in pancreas location over time, hampering accuracy. It would be beneficial to have a single breath‐hold acquisition.PurposeTo develop and test a single breath‐hold three‐dimensional MRE technique utilizing prospective undersampling and a compressed sensing reconstruction (CS‐MRE).Study TypeProspective.PopulationA total of 30 healthy volunteers (HV) (31 ± 9 years; 33% male) and five patients with PDAC (69 ± 5 years; 80% male).Field Strength/Sequence3‐T, GRE Ristretto MRE.AssessmentFirst, optimization of multi breath‐hold MRE was done in 10 HV using four combinations of vibration frequency, number of measured wave‐phase offsets, and TE and looking at MRE quality measures in the pancreas head. Second, viscoelastic parameters delineated in the pancreas head or tumor of CS‐MRE were compared against (I) 2D and (II) 3D four breath‐hold acquisitions in HV (N = 20) and PDAC patients. Intrasession repeatability was assessed for CS‐MRE in a subgroup of healthy volunteers (N = 15).Statistical TestsTests include repeated measures analysis of variance (ANOVA), Bland–Altman analysis, and coefficients of variation (CoVs). A P‐value <.05 was considered statistically significant.ResultsOptimization of the four breath‐hold acquisitions resulted in 40 Hz vibration frequency, five wave‐phases, and echo time (TE) = 6.9 msec as the preferred method (4BH‐MRE). CS‐MRE quantitative results did not differ from 4BH‐MRE. Shear wave speed (SWS) and phase angle differed significantly between HV and PDAC patients using 4BH‐MRE or CS‐MRE. The limits of agreement for SWS were [−0.09, 0.10] m/second and the within‐subject CoV was 4.8% for CS‐MRE.Data ConclusionCS‐MRE might allow a single breath‐hold MRE acquisition with comparable SWS and phase angle as 4BH‐MRE, and it may still enable to differentiate between HV and PDAC.Level of Evidence: 2Technical Efficacy Stage: 2

show abstract

Defining short and prolonged breath-holds

Cited by 3 publications

References 5 publications

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Accuracy of abdominal organ motion estimation in radiotherapy using the right hemidiaphragm top as a surrogate during prolonged breath‐holds quantified with MRI

Single Breath‐Hold MR Elastography for Fast Biomechanical Probing of Pancreatic Stiffness

Contact Info

Product

Resources

About

Defining short and prolonged breath-holds

Cited by 3 publications

References 5 publications

Safely achieving single prolonged breath-holds of &gt; 5 minutes for radiotherapy in the prone, front crawl position

Safely achieving single prolonged breath-holds of &gt; 5 minutes for radiotherapy in the prone, front crawl position

Accuracy of abdominal organ motion estimation in radiotherapy using the right hemidiaphragm top as a surrogate during prolonged breath‐holds quantified with MRI

Single Breath‐Hold MR Elastography for Fast Biomechanical Probing of Pancreatic Stiffness

Contact Info

Product

Resources

About

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position

Safely achieving single prolonged breath-holds of > 5 minutes for radiotherapy in the prone, front crawl position