The Importance of Managing Motion Caused by Breathing.

The Importance of Managing Motion Caused by Breathing.

Managing respiratory motion is crucial. You might be wondering, why is that the case? And how is breathing “Managed”?!

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When it comes to treating cancers located in the thorax (chest) and abdominal areas, managing respiratory motion is crucial. You might be wondering, why is that the case?

Well, the human body is in a constant state of motion, and this is particularly evident when it comes to breathing. With every inhale and exhale, the organs in the chest and abdominal regions move. These movements can be quite substantial, and they pose a significant challenge when it comes to delivering radiation therapy precisely.

Imagine trying to hit a moving target… Difficult, Challenge, Hard!!!

In the case of radiation therapy, the target is the tumour, and the movements are caused by breathing. The lungs, oesophagus, liver, pancreas, breast, prostate, and kidneys are all organs that are known to move with breathing. If we don't account for these movements, there's a risk of the radiation damaging healthy tissue while missing its intended target. To overcome this challenge, motion management techniques like DIBH and Respiratory Gating are employed.

These non-surgical and non-invasive motion management techniques are making a significant difference in ensuring accurate and precise treatment delivery


Deep Inspiration Breath-Hold (DIBH): A Pause for Precision

DIBH is a technique that requires a person to take a deep breath and hold it for a specific duration. Normally between 30-40 seconds. By doing so, the lungs expand and move the heart and other organs away from the targeted area, reducing their exposure to radiation.

The Radiation Therapy team carefully monitors the patient's breath-hold using specialized equipment, ensuring that the radiation is administered when the patient is in the optimal position. DIBH is particularly beneficial for treating breast and left-sided lung cancers, where protecting the heart from radiation is of paramount importance.

What can you expect when treated with the DIBH?

Before the actual treatment, you will undergo a planning session. During this session, you work closely with a radiation therapist who will coach you through holding your breath.

You may have a block placed on your abdomen or you may be required to use a mouthpiece and nose plug depending on the system utilised by the department you are undergoing your treatment.

This equipment can relay the amount of air that is in your lungs to ensure that you are in the exact same position for each of your treatments.

How to practice your DIBH at home

Like most things, practice makes perfect, and it is encourage to practice holding your breath at home prior to your planning appointment.

  1. Lie on your back on your bed or on the floor  

  2. Place your arms above your head - like the radiation treatment position.

  3. When you are ready, take a slow deep breath in. Your back should not lift from your bed when you take a deep breath in 

  4. Try holding your breath for a few seconds and lasting a little longer each time. Work your way up to 20 seconds in total  

  5. When you are ready and confident, take a slow deep breath in and hold your breath for at least 20 seconds 

  6. Slowly breathe out

  7. Return to your normal breathing  

  8. Once you feel you have returned to your normal breathing, it is time to try again  

Do no panic if you cannot hold your breath for the required time

What happens if you cannot hold your breath for the DIBH Technique? That’s not a problem. It is important to understand that if you are unable to perform a breath hold for the DIBH technique you are still receiving a safe and accurate treatment. The Radiation Oncologist and Radiation Therapist use several methods to decrease the radiation dose to the heart and lungs such as:

  • Shaping the treatment fields to avoid the heart.

  • Changing the intensity of the beam around the heart

So if you cannot manage this technique or the treatment team feel that it is not suitable, you will be treated as per standard department protocol and your Radiation oncologist will ensure the dose received by your heart is consistent with that of international best practice standards.

Respiratory Gating: Syncing with Breath

Respiratory Gating is another remarkable motion management technique. It involves synchronizing the delivery of radiation with a person’s natural breathing cycle. To achieve this, a device is used to monitor the patient's breathing, and radiation is only delivered when the tumor is in the desired position during the respiratory cycle. This dynamic approach ensures that the radiation is precisely targeted, sparing healthy tissues and organs from unnecessary exposure.

Respiratory Gating is especially effective for tumors located in areas where breath-holding may not be practical, such as the liver or pancreas.

What can a patient expect when treated with the respiratory-gated system?

The journey for a person undergoing treatment with the respiratory-gated system starts with a planning session on the CT Scanner. During this session, the persons breathing is meticulously tracked using a lightweight chest/abdomen marker and an infrared camera. The images captured during this process are then analyzed using advanced 4D software. This software accurately determines how the tumor moves in relation to the patient's breathing, creating a precise roadmap for treatment.

When the person returns for their actual treatment sessions, the chest/abdomen marker is placed in the exact same location as it was during the imaging session. The infrared camera is once again employed to track the patient's breathing cycle.

It is encouraged to breathe in a relaxed and natural manner. The respiratory gating system operates seamlessly, automatically detecting the ideal moments to administer radiation in perfect synchronization with the patient's specific respiratory cycle. An important feature of the respiratory gating technique is its ability to adapt to disruptions in the breathing cycle, such as coughing or sneezing. In such cases, the system will temporarily pause the radiation beam, ensuring that the treatment remains as precise as possible. This means that the you can be assured of both effective tumor control and minimal complications in surrounding healthy tissues.

Importantly, this enhanced precision does not come at the cost of the patient's comfort, making the treatment experience more tolerable and less stressful.

In summary, a patient undergoing treatment with the respiratory-gated system can expect a carefully tailored and precise approach to their radiation therapy. By synchronizing radiation delivery with their natural breathing cycle and accounting for any interruptions, this system provides not only better tumor control but also increased comfort and reduced risks to normal tissues, ensuring a more positive and effective treatment experience.

Lets wrap this up

In the ever-evolving field of radiation therapy, managing respiratory motion is a critical factor in ensuring the success of cancer treatment. DIBH and Respiratory Gating are two incredible techniques that have revolutionized the way we approach cancer care, offering patients the benefits of both precision and safety.

Stay tuned for our next blog, where we'll explore more cutting-edge developments, hear from industry professionals and trendsetters who have a unique and inspirational insight in the world of cancer treatment.

Thank you for joining us on this journey to discover the remarkable advancements in radiation therapy.