Deep Inspiration Breath Hold Technique (DIBH) - Using the Goggles

Background
For women with left side breast cancer, a major concern is the dose of radiation delivered to the heart which sits to the left side of the body. The radiation dose to the heart could increase the risk of heart disease. Deep Inspiration Breath Hold, or DIBH, is the most efficient way to minimise this risk however, there are other methods to reduce the radiation dose to the heart.

How DIBH works / What is it?
Deep Inspiration Breath Hold is a radiotherapy technique that requires you to hold your breath during your CT scan (measurement scan) and each daily treatment. You need to be able to hold your breath for a short period ~ 20 seconds, several times during each daily treatment. A small plastic box is taped to your chest and a special camera and equipment monitors your breathing . This equipment will only allow the treatment machine to deliver radiation whilst you are holding your breath.

Why consider DIBH?
When you hold your breath your chest is expanded and your heart is pushed down and away from your chest wall. This process will help minimise the dose to your lungs and heart during your daily treatment.

Comparison between free breathing and DIBH

Deep Inspiration Breath Hold Technique (DIBH)

Figure 1 (Above left): Free breathing treatment - heart receives high dose radiation
Figure 2 (Above right): Deep inspiration breath hold treatment - heart outside radiation field (heart delineated in blue)

What is involved?
Once your doctor has decided you may be suitable for DIBH, there are 3 steps in the process.

  1. Education session
  2. CT scan/ Measurements
  3. Treatment

1. Education session
At this appointment your doctor or Radiation Therapist will introduce you to the DIBH equipment and give you an overview of the DIBH technique for the CT scan and treatment.

You will be taught how to breathe and hold your breath correctly. It is useful to practice holding your breath a few times a day at home prior to the next step to give you more confidence. Practicing also increases your ability to take bigger breaths and will familiarise you with what’s required for radiotherapy treatment.

2. CT Simulation
At this appointment we will perform the measurement scans for your treatment. The scan is performed while you wear a pair of video goggles. You will be able to monitor your breathing and be in control at all times.

Below is an example of what you will see inside the goggles.

deep inspiration 273x253 2The yellow bar represents your breathing and will move up and down as you breathe in and out.

The blue area represents the level of deep breath hold you need to achieve. This level is tailored to each patient and is determined at the CT scan by the Radiation Therapist. When you deep breathe, the yellow bar will move into the blue zone and turn green. It is important you understand the breathing process and attempt to breathe the same way every time. Please ask us any questions that come to mind. If taking a breath is too difficult, let the Radiation Therapist know as they can adjust the blue area height to better suit you.

For DIBH, you take a deep breath in, move the yellow bar into the blue zone to turn the bar green, and keep it there during the scan and while receiving radiation treatment. 

Below is an animated example of what you will see inside the goggles

Brreathold

The yellow bar will move up and down as you breathe in and out. As you breathe deeply the yellow bar moves up toward the level of breath hold you need to achieve.

Deep Inspiration Breath Hold is when the yellow bar has moved into the blue zone. The level of deep inspiration breath hold has turned green. You are now holding your breath at the correct level.

3. Treatment
In the treatment room, you will be provided with the goggles and asked to practice holding your breath. You will be coached so that you can hold your breath at the right depth (achieve the green bar which is the same level you achieved at the CT appointment).

When successful breath hold and positioning is established the Radiation Therapists will leave the room to commence your treatment. Using an intercom system, the Radiation Therapists will confirm you are ready to start and when to hold the breath. They will give you an indication of the length of time you need to hold your breath. The Radiation Therapists can see the same goggle view as you and are monitoring your breathing at all times.

Once you have taken the deep breath, and the bar turns green, the machine will turn on and deliver your treatment. When you breathe out, the green bar will drop out of the blue zone and turn yellow. The machine will turn off automatically when the bar is yellow. For each day of treatment, you will need to hold your breath a few times.

This process will be repeated for each treatment. For some patients, DIBH may not be required in the last week of treatment as radiation is ‘boosted’ to a smaller area of your breast or chest wall that doesn’t require you to hold your breath.

What happens if I can’t hold my breath?
If for a particular reason you cannot maintain holding your breath, you can breathe normally and the radiation treatment is automatically stopped. The camera detector in the room will notify the machine to stop. Treatment will recommence when you are ready to do so.

Patients sometimes feel they may be unable to use the DIBH technique. We find there are very few patients unsuitable for this. Before any patient undergoes DIBH, they have an initial appointment to understand the system and be assessed as described earlier.

If you cannot hold your breath, we have other methods to minimise dose to the heart which your doctor will discuss with you.

How to get more information
Contact any Genesis CancerCare Victoria radiotherapy centre to receive further information.
Berwick / Casey: 03 8794 2700
St Vincent's: 03 9427 6500
Epping: 03 9409 8000
Footscray: 03 9319 3200
Ringwood: 03 8870 3300
Frankston: 03 9781 8200
Albury / Wodonga: 02 6043 7800

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