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Discuss cardiac sparing for left breast patients with SGRT.
By mellat_alemayehu

We are interested in providing DIBH coaching sessions for our patients, prior to their simulation. Mainly looking at patient reproducibility as well as the amount of time they spend on the table. Even though we provide our patients with goggles to monitor their breathing patter we still have a few patient that are not able to reproduce their breathing technique.

We want to run a quality study comparing the patients that have had coaching vs. those that have not. Is there any quantitative way to measure daily fluctuation? We are thinking of reducing our threshold (currently at default) as well as recording how long the patient is on the table, but can anyone recommend any other measuring tool to determine if coaching prior to sim makes a difference.
By savera_boodhun
We allow half an hour for coaching our patients prior to CT and it will be interesting to see the results of your study.

I don't have an answer as to a measuring tool that can determine if this makes a difference however our patients seem to get better as treatment progresses. We allow 30 minutes for first day of treatment and 20 minutes for consequent treatments. We are finding that as the patients become more comfortable with the process it can be done in 15 minutes.

I did attend a presentation where patients where not given as much coaching prior and still managed to comply during treatment. So it would be very interesting to see what your findings are.

Sorry that I haven't answered your question.
By olga_kitsou
We use a different threshold for each patient based on their lung capacity. We set the threshold to 80% of the patient's lung capacity. We coach the patients when the come for their CT planning scan. During coaching we ask the patient to hold their breath for 5sec, then 10sec, and then 20sec.  When they are ready we scan them with a breath-hold of 20sec.
By marko_laaksomaa Finland flag
Hi Mellat

You will easily get plenty of retrospective data out of your SGRT- system and/or offline review system for image evaluation about intra-and interfractional setup/BH- reproducibility for comparison between the groups with your daily practices. It is an advantage, if you have CBCTs available. Here is one good publication: Effects of Preparatory Coaching and Home Practice for Deep Inspiration Breath Hold on Cardiac Dose for Left Breast Radiation Therapy, Kim et al. 2018.

By marko_laaksomaa Finland flag
One way to do an easier study, is to take the patient twice to the room where you have full SGRT- systems installed.  Simply simulate the CT- workflow there and record among other things the FB/BH surfaces or BH-window and repeat the simulation after one/two weeks after patient has home- practiced BHs. On the second round measure with the SGRT for example: is it possible to raise the vertical BH- level from the former with the same BH- technique, does the normal breathing recover back to "baseline" better, does the repeatability of the BHs  give better results than on the first visit (which may lead to decreased needs to correct the systematic posture errors on the first treatment days).

By mellat_alemayehu
Thanks for your response.

We too, have see that as time passes and the patients are more comfortable with the process they tend to do much better.