Respiratory Biofeedback during CT-guided Procedures

Abstract

PURPOSE-Respiratory motion can be a complicating factor during image-guided interventions. The ability to reproduce breath-holds may facilitate safer needle-based procedures. The purpose of this study was to evaluate if respiratory biofeedback decreased variability among breath-holds and if the signals from the respiratory bellows belt can be used to measure target motion. MATERIALS AND METHODS-In phase 1 of the study, a respiratory bellows belt was applied to patients before image-guided interventional procedures. Belt stretch from respiratory motion was converted into voltage readings and displayed on a monitor as biofeedback. Patients were asked to perform inspiratory, expiratory, and midcycle breath-holds with and without the biofeedback. The variability in voltage readings between breath-holds with and without biofeedback was compared. In phase 2, the respiratory bellows belt was used during computed tomography (CT)-guided procedures with the patients blinded to the biofeedback. Voltage readings and CT series numbers were recorded as patients were asked to hold their breath during scans. The variability of CT z-axis targets was compared with the variability of voltage readings.RESULTS-A significant decrease in variability was found during expiratory breath-holds (P = . 0083) with trends toward significance with midcycle and inspiratory breath-holds. A positive correlation (Kendall τ = 0.5; P = .024) was shown between CT z-axis and belt stretch variability in subjects who received smaller doses of moderate sedation compared with those who received larger doses or general anesthesia.CONCLUSIONS-Biofeedback may help the patient to have a more consistent breath-hold. The belt could decrease the error and unpredictability from craniocaudal motion of targets during imageguided interventions.PATIENT respiratory motion can be a complicating factor when targeting a tumor for computed tomography (CT)-guided interventional procedures. Respiration-induced motion during the normal breathing cycle can result in significant shifts in tumor position, especially near the diaphragm, in the lung and abdomen (1). Consistent and reproducible breath-holds could reduce procedure time and the number of needle manipulations, promoting a safer procedure. Without a documented measure of their breath-hold position in the respiratory cycle, the patient cannot be expected to precisely reproduce similar pre-and intraprocedural breathholds. The air bellows belt measures chest wall or abdomen excursion and provides patients with visual biofeedback during their respiratory cycle.Address correspondence to J.K.L., National Institutes of Health, Building 10, Room 1C367A, 9000 Rockville Pike, Bethesda, MD 20892; E-mail: locklinj@cc.nih.gov. NIH Public Access MATERIALS AND METHODSIn the present study, a tool consisting of an air bellows belt (Philips Medical Systems, Cleveland, OH) attached to a visual feedback system shown to patients was evaluated for its ability to assist patients to more precisely reproduce preprocedural breath-hold...

First Non-Contingent Respiratory Biofeedback Placebo versus Contingent Biofeedback in Patients with Chronic Low Back Pain: A Randomized, Controlled, Double-Blind Trial

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