A Rapid Transition to Voluntary Breath Hold From Device-Assisted Moderate Deep Inspiration Breath Hold for Patients Receiving Breast Radiation Therapy During the Coronavirus 2019 Pandemic

Barnett, Erin R.; Comsa, D; Zhang, Beibei; Pestill, Tyler; Bradley, Cari; Proctor, Leslie; Mohamoud, Gulaid; Ryan, Michael P.; Loudon, J. D.; Fenkell, Louis

doi:10.1016/j.adro.2020.04.007

Cited by 4 publications

(5 citation statements)

References 3 publications

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“… - All treatment was done by VMAT technique and image-guidance. USA ( Pannullo et al, 2020 ) SRS with frame-based immobilization SRS with mask-based treatment Breast USA ( Song et al, 2020 ) ABC (DIBH) - Voluntary DIBH - Prone positioning - Supine position with further plan optimization Canada ( Barnett et al, 2020 ) ABC (DIBH) A visually monitored voluntary breath-hold technique USA ( Wright et al, 2020 ) ABC - ABC with a new single-use mouthpiece and filter kit must be used per treatment per patient. (in a case with cardiac mean dose >4 Gy or lung V20 > 40%) - IMRT/VMAT to meet dose objectives Italy ( Youssef et al, 2020 ) CBCT CBCT with a prompt review of the lung windows is recommended France ( Beddok et al, 2020 ) Supine positioning, DIBH, isocentric lateral decubitus irradiation - 4D scanner imaging and daily CBCT-based positioning - Prone position using free-breathing VMAT technique (for COVID + patients) Slovenia ( Orazem and Ratosa, 2020 ) ABC - Prone positioning - Voluntary deep inspiration breath-hold Egypt, Morocco, Saudi Arabia, USA, Jordan ( Elghazawy et al, 2020 ) DIBH -Avoid active breathing control due to the risk of aerosol contamination -Voluntary breath-holding techniques Uveal melanoma PTCOG ( Mishra et al, 2020 ) Bite block Using chin rest or chin strap Gastrointestinal Lymphoma Thoracic Sarcoma Pediatric USA ( Wright et al, 2020 ) …”

Section: Resultsmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.

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Section: Resultsmentioning

confidence: 99%

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Siavashpour

Goharpey²,

Mobasheri

2021

Critical Reviews in Oncology/Hematology

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“…In general, the ABC device is challenging to use for patients, especially those with atypical mouth anatomy or other conditions that make the use of the mouth or nose pieces difficult. The current pandemic poses new and serious problems for the ABC device 20,21,32 . While it is known to be safe in terms of influenza and upper respiratory infections (URIs) due to filtration within the air channel, it is not clear how patient safety may be affected with respect to COVID‐19.…”

Section: Discussionmentioning

confidence: 99%

“…The current pandemic poses new and serious problems for the ABC device. 20,21,32 While it is known to be safe in terms of influenza and upper respiratory infections (URIs) due to filtration within the air channel, it is not clear how patient safety may be affected with respect to COVID-19. Based on current information from the product suppliers, the single-use mouthpiece/tube with the Viromax filter has 99.99% filtration efficiency for viral particles of 0.1 µm in size.…”

Section: Max Deviation From Eoi (Mm)mentioning

confidence: 99%

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management

Sohn,

Polizzi,

McDonagh

et al. 2023

J Applied Clin Med Phys

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ObjectivesAs an alternative to conventional compression amidst the COVID‐19 pandemic, we developed a contactless motion management strategy. By increasing the patient's breathing rate to induce shallow breathing with the aid of a metronome, our hypothesis is that the motion magnitude of the target may be minimized without physical contact or compression.MethodsFourteen lung stereotactic body radiation therapy (SBRT) patients treated under fast shallow‐breathing (FSB) were selected for inclusion in this retrospective study. Our proposed method is called shallow kinetics induced by a metronome (SKIM). We induce FSB by setting the beats‐per‐minute (BPM) high (typically in the range of 50–60). This corresponded to a patient breathing rate of 25–30 (breathing) cycles per minute. The magnitude of target motion in 3D under SKIM was evaluated using 4DCT datasets. Comparison with free breathing (FB) 4DCT was also made for a subset for which FB data available.ResultsThe overall effectiveness of SKIM was evaluated with 18 targets (14 patients). Direct comparison with FB was performed with 12 targets (10 patients). The vector norm mean ± SD value of motion magnitude under SKIM for 18 targets was 8.2 ± 4.1 mm. The mean ± SD metronome BPM was 54.9 ± 4.0 in this group. The vector norm means ± SD values of target motion for FB and SKIM in the 12 target sub‐group were 14.6 ± 8.5 mm and 9.3 ± 3.7 mm, respectively. The mean ± SD metronome BPM for this sub‐group was 56.3 ± 2.5.ConclusionCompared with FB, SKIM can significantly reduce respiratory motion magnitude of thoracic targets. The difference in maximum motion reduction in the overall vector norm, S‐I, and A‐P directions was significant (p = 0.033, 0.042, 0.011). Our proposed method can be an excellent practical alternative to conventional compression due to its flexibility and ease of implementation.

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“…In our study, both prone and DIBH techniques resulted in a significantly lower mean heart dose as well as other dosimetric heart parameters. Rather than DIBH utilizing ABC, patients could also attempt voluntary breath-hold to attempt replicating the benefits without requiring sharing a respiratory device and thereby improving infection control [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparisons of Simulation Techniques for Left-Sided Breast Cancer in the COVID-19 Era: Techniques to Reduce Viral Transmission and Respect the Therapeutic Ratio

Taylor¹,

Song²,

Nowak³

et al. 2021

Cureus

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Background The COVID-19 pandemic challenges our ability to safely treat breast cancer patients and requires revisiting current techniques to evaluate optimal strategies. Potential long-term sequelae of breast radiation have been addressed by deep inspiration breath-hold (DIBH), prone positioning, and four-dimensional computed tomography (4DCT) average intensity projection (AveIP)-based planning techniques. Dosimetric comparisons to determine the optimal technique to minimize the normal tissue dose for left-sided breast cancers have not been performed. Methods Ten patients with left-sided, early-stage breast cancer undergoing whole breast radiation were simulated in the prone position, supine with DIBH, and with a free-breathing 4DCT scan. The target and organs at risk (OAR) contours were delineated in all scans. Target volume coverage and OAR doses were assessed. One-way analysis of variance (ANOVA) and Kruskal-Wallis one-way ANOVA were used to detect differences in dosimetric parameters among the different treatment plans. Significance was set as p < 0.05. Results We demonstrate differences in heart and lung dose by the simulation technique. The mean heart doses in the prone, DIBH, and AveIP plans were 129 cGy, 154 cGy, and 262 cGy, respectively (p=0.02). The lung V20 in the prone, DIBH, and AveIP groups was 0.5%, 10.3% and 9.5%, respectively (p <0.001). Regardless of technique, lumpectomy planning target volume (PTV) coverage did not differ between the three plans with 95% of the lumpectomy PTV volume covered by 100.4% in prone plans, 98.5% in AveIP plans, and 99.3% in DIBH plans (p=0.7). Conclusions Prone positioning provides dosimetric advantages as compared to DIBH. When infection risks are considered as in the current coronavirus disease 2019 (COVID-19) pandemic, prone plans have advantages in reducing the risk of disease transmission. In instances where prone positioning is not feasible, obtaining an AveIP simulation may be useful in more accurately assessing heart and lung toxicity and informing a risk/benefit discussion of DIBH vs free breath-hold techniques.

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A Rapid Transition to Voluntary Breath Hold From Device-Assisted Moderate Deep Inspiration Breath Hold for Patients Receiving Breast Radiation Therapy During the Coronavirus 2019 Pandemic

Cited by 4 publications

References 3 publications

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Radiotherapy based management during Covid-19 pandemic – A systematic review of presented consensus and guidelines

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management

Dosimetric Comparisons of Simulation Techniques for Left-Sided Breast Cancer in the COVID-19 Era: Techniques to Reduce Viral Transmission and Respect the Therapeutic Ratio

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