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New Breath-Hold Treatment for Breast Cancer Patients Uses Video Surveillance to Spare Heart from Radiation

Image of radiation portal
This left medial portal film shows the radiation portal (blue solid line) and anterior heart (outlined in pink). In this deep breath-hold position, the heart is completely out of the primary radiation beam.

UT Southwestern has added high-tech video surveillance to the treatment of breast cancer patients who receive radiation while using the deep inspiration breath-hold technique. The result is a treatment that requires no assisted breathing devices or invasive fiducial implants and that delivers a reduced radiation dose to the heart.

Deep inspiration breath hold is a cardiac- sparing or minimizing technique to treat left-sided breast cancer. Prior studies indicate that patients with left-sided breast cancer are at greater risk for developing heart problems from radiation delivered to the left breast. When the patient takes a deep breath during radiation treatments the chest wall and breast tissue move away from the heart, reducing the radiation dose to the heart and lung.

Occasionally, the deep inspiration breath-hold technique has required an assisted breathing control (ABC) device to maintain inflation of the lungs for the breath hold. This system is not always welltolerated by patients.

As an alternative, UT Southwestern doctors now are using a video surveillance system involving two ceiling-mounted 3-D cameras to beam a patterned light grid on the patient. This video system (Vision RT’s AlignRT system) tracks the external contours of the breast area and matches them to the patient’s initial CT scan, ensuring accurate radiation delivery. It’s a completely noninvasive approach that allows the physician to verify the target location and deliver radiation safely, without assisted breathing devices or additional X-ray exposure. UTSW is the first medical facility in North Texas to use the technology in a clinic setting.

Asal Shoustari Rahimi, M.D.
Assal Shoustari Rahimi, M.D.

An Easy Process

So far it’s working for Jada Jung, 46, the first patient treated with the new Vision RT modality at UT Southwestern.

“I’m amazed at how easy the whole process is,” Mrs. Jung says. “My treatment takes a total of 60 seconds—that’s two deep breath holds for 30 seconds each. It’s a bigger headache driving here than the actual treatment.”

Compared with free breathing, the breathhold technique using the 3-D system resulted in a fourfold decrease in the total mean radiation dose to the heart.”

Assal Shoustari Rahimi, M.D.
Assistant Professor of Radiation Oncology 

The Dallas-based wife and mother of two young children spends less than 10 minutes in the clinic every morning before leaving for her job.

“Compared with free breathing, the breath-hold technique using the 3-D system resulted in a fourfold decrease in the total mean radiation dose to the heart for Mrs. Jung,” says Assal Shoustari Rahimi, M.D., Assistant Professor of Radiation Oncology.

“There was also a 50 percent decrease to the left anterior descending artery in the heart, a common site of atherosclerosis leading to coronary heart disease. As this case demonstrates, deep inspiration breath hold performed with high-tech surveillance can be a very important and useful technique for patients who need to have leftsided whole breast radiation.”