Breathing technique reduces radiation dose to the heart

A patient demonstrates the Deep Inspiration Breath Hold technique
A patient demonstrates the Deep Inspiration Breath Hold technique (Elekta)

Hoping to make radiation treatment safer, the William E. Kahlert Regional Cancer Center at Carroll Hospital has started to encourage patients to use the Deep Inspiration Breath Hold technique, a specialized procedure to deliver radiotherapy to the left breast.

"It's a very promising technique," said Dr. Darlene Gabeau, the hospital's medical director of radiation oncology. "Thanks to all the research that has been done in breast cancer, we have excellent outcomes."


Gabeau said DIBH is designed to reduce any incidental radiation dose to the heart during treatment.

"One of the main concerns during the radiotherapy treatment is the closeness of the heart to the treatment area," Gabeau said. "Evidence has shown that these incidental doses of radiation can cause patients heart-related problems years after treatment has finished. In many patients, using the DIBH technique has been helpful in reducing the dose to the heart while ensuring that the breast/chest wall area receives the full prescribed dose."


The technique requires patients to hold air in their lungs for approximately 20 seconds at a time while radiotherapy treatment is being delivered (allowing normal breathing breaks in between treatment beams), Gabeau said.

Gabeau said it is important to note that patients are in control of their breathing and in turn the delivery of the radiotherapy. The activation of the radiation beam will only be activated when the correct breath-hold position is reached and maintained. If during radiotherapy treatment a patient was unable to hold their breath for the required time, this change in a patient's position will lead to the radiation beam being held until the treatment position and breath hold is resumed.

"Because our outcomes with breast cancer are very good, we would hate to cure patients of their breast cancer and then have complications from the treatment itself. We're doing everything in our power to protect their hearts," Gabeau said.

Darlene Gabeau, M.D., Ph.D.
Darlene Gabeau, M.D., Ph.D. (Jaime Ridgley)

Cheryl Remaly, of Sykesville, completed 33 radiation treatments with the breathing apparatus. She was diagnosed with ductal cancer in March 2017. After she had a lumpectomy in May, doctors recommended radiation treatment.


"You use a mouthpiece like when you go snorkeling," Remaly said. "You are coached the entire time to breathe only through your mouth. After practicing four times, I felt more comfortable doing it and during the procedure, I concentrated on my breathing and had no trouble."

Remaly said she was nervous at first but "it just became normal after a while."

"I would do anything to protect my heart," Remaly said.

Holly Geelhaar, of Eldersburg, received 30 radiation treatments using DIBH. She was diagnosed in August 2016. She had two surgeries and completed 16 chemotherapy treatments.

"A slow deep breath is the secret to success. There's an art to it," Geelhaar said. "It's an incredibly precise science."

Geelhaar said she is "grateful for a cutting-edge technology that protects the rest of my body."

"A lot of treatments are very hard on your organs and anything you can do to protect them is greatly appreciated," Geelhaar said. "Everyone's goal is to grow old and get better and this a great way to ensure you don't have secondary issues after treatment."

Deb Fairall, of Reisterstown, was diagnosed in April. After a lumpectomy and partial lumpectomy, doctors recommended radiation treatments.

"Once you're holding your breath, there's this little bit of suction in your mouth during the procedure," Fairall said. "You're in control because you hold a device that triggers a procedure and that trigger can stop everything."

Fairall said she appreciates that the technique is precise.

"The last thing I want to know is that I've gone through the radiation treatment and done some harm to another part of my body," Fairall said. "I would recommend this treatment to other people. I would love it if there was a pill that just took it away, but in lieu of the fact that it's not, anything I can do proactively to extend my life, I will do it."


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