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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
Author(s) -
Kalet Alan M,
Kim Aileen,
Hippe Daniel S,
Lo Simon S,
Fang L Christine,
Meyer Juergen,
Lang Elvira V,
Mayr Nina A
Publication year - 2021
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.13181
Subject(s) - medicine , radiation therapy , left breast , medical physics , tracking (education) , motion (physics) , radiology , breast cancer , physical therapy , cancer , artificial intelligence , psychology , pedagogy , computer science
A novel approach of in‐advance preparatory respiratory training and practice for deep inspiration breath holding (DIBH) has been shown to further reduce cardiac dose in breast cancer radiotherapy patients, enabled by deeper (extended) DIBH. Here we investigated the consistency and stability of such training‐induced extended DIBH after training completion and throughout the daily radiotherapy course. Methods Daily chestwall motion from real‐time surface tracking transponder data was analysed in 67 left breast radiotherapy patients treated in DIBH. Twenty‐seven received preparatory DIBH training/practice ( prep Trn) 1–2 weeks prior to CT simulation, resulting in an extended DIBH ( ext DIBH) and reduced cardiac dose at simulation. Forty had only conventional immediate pre‐procedure DIBH instruction without prep Trn and without extended DIBH (non‐Trn group). Day‐to‐day variability in chestwall excursion pattern during radiotherapy was compared among the groups. Results The average of daily maximum chestwall excursions was overall similar, 2.5 ± 0.6 mm for prep Trn/ ext DIBH vs. 2.9 ± 0.8 mm for non‐Trn patients ( P = 0.24). Chestwall excursions beyond the 3‐mm tolerance threshold were less common in the prep Trn/ ext DIBH group (18.8% vs. 37.5% of all fractions within the respective groups, P = 0.038). Among patients with cardiopulmonary disease those with prep Trn/ ext DIBH had fewer chestwall excursions beyond 3 mm (9.4% vs. 46.7%, P = 0.023) and smaller average maximum excursions than non‐Trn patients (2.4 ± 0.3 vs. 3.0 ± 0.6 mm, P = 0.047, respectively). Conclusion Similar stability of daily DIBH among patients with and without preparatory training/practice suggests that the training‐induced extended DIBH and cardiac dose reductions were effectively sustained throughout the radiotherapy course. Training further reduced beyond‐tolerance chestwall excursions, particularly in patients with cardiopulmonary disease.