DIBH (Deep Inspiration Breath Holding)

Hopeful82014

DIBH (Deep Inspiration Breath Holding)

Hopeful82014

I'm interested in the experiences of the women who've had recently had radiation with left sided cancer, with or without using the Deep Inspiration Breath Holding technique that's becoming the standard of care in some facilities for those with left sided cancer.

Were you offered this option? Were any of you not able to use or benefit from this option for any reason?

What, if anything, did your RO or others tell you about the technique.

I know it's too soon to see long-term patterns but would appreciate reading anyone's experiences with it.

Thank you!

TB90

Hi Hopeful:  I had radiation to my left side following a mx.  There are many safeguards now being applied and vary depending upon the equipment being used, techniques followed by your treatment centre, etc.  Regardless of whether or not breathing is utilized or not, your RO should be able to explain what your centre does to ensure minimum exposure to your heart.  Breathing is not the only option.  But it can reduce exposure as the heart pulls back out of the way of the radiation field.  You have to be able to hold your breath for quite some time.  They usually offer practice sessions beforehand.  I studied all of this extensively before opting for radiation as it was optional for me.  But everything I did read that was published recently was quite reassuring that minimal exposure now occurs to the heart and even that left sided radiation does not pose a greater threat than right sided.  They have come very far from years ago when radiation posed a much greater risk.  I am almost one year post radiation and have had absolutely no problems (however, problems often only show up years later).  Hope this helps. 

Hopeful82014

Thanks so much, TB90! I have a fair amount of research to do still. However, I learned yesterday that the RO I'd been referred to doesn't offer it in the location nearest to me (3mi.) Instead, IF they determine that I need it, I will have to go to another facility that is extremely inconvenient for me.

Several other systems in our area describe it as being Standard of Care for their left-breast cancer pts. so I definitely want to have that option unless someone can make a very good case that it would not be of benefit to me.

I'm looking at a fair amt. of radiation to the axilla as well as the entire breast and probably the supraclavicular nodes, including a week-long boost.

As stated, I need to have a long discussion with a couple of my "team" and more reading up on the topic.

Thanks a lot for chiming in. I'm really glad to hear you had no problems and hope you're doing well in all ways.

CassieCat

I don't have details yet of my treatment, but the breathing was brought up by my RO today. So yes, they do do that at my center, and it was my RO who mentioned it. He said they do all they can to protect heart, lungs and anything else that shouldn't be radiated. I'm planning on getting more details at my next appointment.

Hopeful82014

Thanks, Cassie! I'm glad your RO brought it up. I'll be interested to hear more about your experience with it.

Mine made is sound as though it wasn't really that important, that not everyone would benefit from it, etc.( I think that was mostly because they don't offer it at her primary facility.) It really dinged my trust in her.

I hope you're doing o.k. after your mx, Cassie, and starting to get back on your feet. You've had a long haul of it.

mqt64

Hi Hopeful. Deep inspiration breath holding was mentioned at my consult but not at my simulation. First treatment is Monday so will know more after that. I, too have neck disc problems. Found it OK prone if I kept my neck straight, looking down. Pretended I was getting a massage! Games people play!

Morwenna

I had radiation to left chest wall and axilla in 2013 after my mastectomy and chemo.

I did the deep inspiration/breath hold thing, and it was quite doable, (once they gave me a clue as to how long I was holding for as some were longer than others!)

The other thing I wanted to mention was that they laid a sheet of "false tissue" on my chest that helped localize the radiation to the chest wall surface.

So far as I am aware, I did not have any long term ill effects from my treatments.

mqt64

Hi Hopeful. I start radiation on Monday. Deep Breath Holding was mentioned by my ro, but nothing at my sim last Friday. Guess I'll find out on Monday. I too have neck disc problems. I found it easier to keep my neck straight. Pretended I was having a massage. Games people play!

Hopeful82014

Thanks to both of you for your insights. MQT, it sounds as though the DBIH is not as critical when you're radiated in the prone position, which may be why it wasn't included in your sim. session. Love the image of it as a massage - wouldn't that be nice? I hope all your sessions go well and provide great benefit.

Morwenna, those details were helpful and appreciated. I hadn't heard about the 'false tissue' so will have to look that up and see what I can learn about it! I'm glad to hear you're doing well.

TB90

They place a bolus on your chest to imitate your tissue that is no longer there so that the radiation hits at the correct intensity.  Again, not all centres use boluses.  I had one where I received my radiation.  Different techniques are often reflective of different equipment available.  There are massive differences in radiation equipment that is likely more significant to the quality of care you are receiving than of these techniques.  The skill of the RO is also very significant.  Just keep asking questions and then you really have to go with your gut feeling as we just cannot get that educated that quickly.  Check references if you can.  And again, remember that radiation today is so much safer overall than it was earlier.  Try to relax as it was much easier for so many of us than we had anticipated.  (((hugs)))   

Morwenna

That was the word: bolus.

Brain failure.

TB90

Morwenna:  I could not for the life of me remember the word bolus either and I just finished rads not quite a year ago.  Good thing we can forget some of this stuff

snorkeler

Where I had radiation they called it active breathing control. At the first simulation, my RO determined that I would benefit from doing this, so there was another simulation with the breathing apparatus. As it was explained to me, when you take a deep breath, your chest expands, thereby increasing the distance from your heart to the surface getting radiated (your heart is now farther away). During the actual treatments, the techs measured how deeply I breathed, and if I didn't hit a certain level as determined in the simulation, they wouldn't turn on the radiation. It's only been 2+ years since treatment, so I can't really say if it helped, but so far I haven't had any heart issues.

Cowgirl13

I had the breathing thing 5 years ago when I was doing radiation. I really didn't know what it was for--I just did what they showed me. Holding the breath was really easy. Good luck!

windgirl

I am a lefty and they did my sim in the prone position. RO said the beam would not be touching my heart or lung based on the sim.

Hopeful82014

Windgirl, I've read that the prone position works best for breasts of a certain size and mine are smallish (not tiny, but not what anyone would call generous, either). Was that the case for you? Did they limit the rad. to just the breast or did you have axillary rad., etc., as well?

Personally, I'd love it if I could do it in the prone position but I don't think that's going to happen. I'm glad your RO was able to assure you that your heart and lung won't be involved. I hope it goes well for you. It sounds like you'll be starting fairly soon?

lilmouse

I just finished radiation treatment for cancer on the left side about 6 weeks ago and did DIBH. Before starting treatment I agreed participate in a study of DIBH, and as part of that I had a heart scan before starting treatment. I'll have one more sometime this summer, so I guess I'll get some objective evidence as to whether or not there has been any change in my heart function. Obviously it hasn't been long, but so far I'm feeling pretty good.

For the actual treatment, they had me lie on my back with my arms behind my head. I didn't have any trouble with the breath hold. Sometimes they had me hold it for a short time and sometimes longer, but I never figured out a pattern. I was told that the machine would cut off the beam if I moved too far out of position, but I don't know if all treatment machines do this.

CassieCat

Thanks for your kind words, hopeful. I'll post again when I find out more. I have a CT scan on Feb. 4th so that they can get the simulation process started.

Heidela

it wasnt an option for me..yes i held breath ( just now finished )and had a gps becon on my chest and was thrilled tjis tsch was available

Hopeful82014

Congratulations on finishing, Heidela. I hope it was very effective for you. Thank you for sharing your experience. I think the technology behind this is pretty fascinating. Take care!