Prolonging deep inspiration breath-hold time to 3 min during radiotherapy, a simple solution

Abstract

Highlights A new protocol was developped to prolong deep inspiration breath-holds. Multiple prolonged breath-holds are achievable with minimal side effects. DIBH was prolonged to 3 min using HFNO and hyperventilation in breast cancer patients.

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

“… 18,23 For hypofractionation, it is also important to note that even just by training and spontaneously breathing 60% O 2 , we attained here a mean breath-hold duration of 2.5 min while supine and 3 min has been attained in the prone position. 36 …”

A survey of practice patterns for real-time intrafractional motion-management in particle therapy

“…breath hold [22] , [48] , abdomen compression [49] , [50] or patient selection [51] ) can reduce the complexity of 4D PT delivery. The survey did not cover patient selection or abdominal compression, but 25–35% active RRMM users implemented various breath-hold techniques for different indications, which depend on the intra- and interfractional BH reproducibility [52] , duration [53] , and patient capability [48] . Reducing treatment time can be achieved by decreasing energy switching time (particularly for synchrotron-based machine) [54] , and by increasing the beam current [55] with special plan optimization [56] .…”

Efficacy of preoxygenation administration in volunteers, in extending the end-expiration breath-hold duration for application to abdominal radiotherapy

“…This study was designed to determine if preoxygenation with hyperventilation is feasible to increase the EEBH duration to minimise the number of BH cycles required for an abdominal SABR treatment. It has been well established that inspiration BH durations can be significantly increased with the use of preoxygenation [8] , [10] , [11] , [12] , [13] , [15] , [19] . We demonstrated that there was a substantial increase in duration in EEBH time between breathing oxygen and hyperventilating compared with breathing room air which is consistent with Roth et al .…”

“…It has been demonstrated that by administering oxygen at a rate of 10 l/min as well as hyperventilating with oxygen prior to an inspired BH, an increase in BH duration of up to 700% can be achieved [8] . There are several other studies demonstrating that the administration of oxygen prior to treatment using DIBH, can at least double the BH duration [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] . In contrast, there are very few studies showing similar results for EEBH [16] .…”