title: Voluntary breath-hold technique for reducing heart dose in left breast radiotherapy.
abstract: Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery.
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust; frederick.bartlett@rmh.nhs.uk.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Bartlett
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Colgan
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Donovan
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Karen
authors.initials: K
authors.lastname: Carr
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Steven
authors.initials: S
authors.lastname: Landeg
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Nicola
authors.initials: N
authors.lastname: Clements
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Helen A
authors.initials: HA
authors.lastname: McNair
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Imogen
authors.initials: I
authors.lastname: Locke
authors.affiliation: Centre for Vision, Speech and Signal Processing, Faculty of Engineering and Physical Sciences, University of Surrey.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Evans
authors.affiliation: Clinical Trials and Statistics Unit (ICR-CTSU), Institute of Cancer Research, Sutton, UK.
authors.forename: Joanne S
authors.initials: JS
authors.lastname: Haviland
authors.affiliation: Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Yarnold
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Foundation Trust.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kirby
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D062485:Breath Holding; D005260:Female; D006321:Heart / Q000033:anatomy & histology / Q000528:radiation effects; D006331:Heart Diseases / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011832:Radiation Injuries / Q000517:prevention & control*; D011878:Radiotherapy / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D016032:Randomized Controlled Trials as Topic