The red line in these images represents the angle of the radiation beam. Notice the position of the heart during free breathing, and then while the patient holds their breath. (Source: Mary Bird Perkins - OLOL Cancer Ctr.)
Try holding your breath for twenty seconds. Can you do it? It's a requirement for some cancer patients as part of an innovative treatment technique now used at Mary Bird Perkins – Our Lady of the Lake Cancer Center.
“They say ‘through thick and thin, for better or worse,'” Roger Davis said to his wife Kimberly. “Yeah, we've been through the worst,” she replied.
In October 2013, Davis was diagnosed with breast cancer – just months after her wedding. Radiation therapy was a big part of her treatment, but doctors had an unusual request.
“When I first did it, they said ‘Hold your breath for 20 seconds.' I was like, ‘Oh I can't do that,' so I had to practice holding my breath, because I couldn't do it the first time,” Davis said.
Cancer in the left breast means the beam of radiation comes dangerously close to the heart, sometimes going right through it.
“What radiation does over time is it causes scarring, and scarring can limit blood flow, so you get risk of heart disease,” said Dr. Renee Levine, a radiation oncologist. “If she has any other risks such as high blood pressure or other risks for heart disease, it's thought the radiation could accelerate or make those heart problems come on at an earlier age.”
But when you take a deep breath, the diaphragm and heart move down. The heart can move so much that the beam of radiation is sometimes able to avoid the vital organ completely.
“If you take a young woman in her 30s or 40s, we can make a tremendous reduction in the risk of any heart-related problems,” Levine said.
Getting the patient's heart in the right spot every time is not as easy as it may seem. A team of medical physicists uses advanced computer simulations.
“We use multiple imaging modalities – both before the treatment starts and as the treatment is being delivered – to make sure that their breath hold is in the exact spot that it needs to be in during each cycle of radiation therapy,” said Dr. Jonas Fontenot, chief of medical physics.
Those precise calculations mean less healthy tissue is affected. It's a good example of technology and traditional medicine working together for better outcomes.
“This is one of those techniques where we're seeing doses to certain parts of the heart that are being reduced by 70, 80, 90 percent, and that's a real advantage,” Fontenot said.
Davis is now back at work with the peace of mind that her heart did not suffer the same fate as her cancer.
“I'm happy to be alive. I'm happy to be free of cancer. I'm just blessed right now,” she said.
The breath hold technique can also be used during radiation of other organs in the chest cavity.
“When you're taking a deep breath in, your lungs expand. Well if you have a tumor in your lung, it will move with you taking a deep breath in,” Levine explained.
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