VMAT RT and no breath hold?

Hi Dedalus

VMAT can be performed on the newer type of Linear Accelerators. Perhaps those here who have been asked to have rads using the 'Breath Hold' technique were treated on older Linac machines ?

Just thinking aloud - G n' J

Hi Dedalus, I did the breath hold and was definitely on an old machine so sounds like ’s explanation could be spot on. Do ask the team though, to put your minds at rest, horrible to have more uncertainty. HFxx

This is an update to the breath-hold technique or rather 'no breath-hold' in my wife's case.  My wife went back to the radiotherapy unit today because of concern over a disappearing tattoo mark.  She asked again about there being no need for a 'breath-hold' with VMAT RT.  Apparently the 'no breath-hold' was not particularly related to the type of RT ie VMAT but rather down to the results from the CT scan.  The position of her heart was assessed in relation to the planned treatment beam(s).  She was told there would be no interaction with her heart and the planned treatment.

Previously they also said that doing the breath-hold could bring the lung into play.  Having read that this technique is now virtually universal, we worry.  

We also still worry over this explanation because a neighbour who had relatively recent BC requiring triple bypass heart surgery due to RT heart damage.

Has anyone else avoided the breath-hold technique due to the CT scan results? 

Dedalus

As you know I am no expert but the prep CT must give them a great deal of info about position of area to be treated and position of organs. I did do Breath hold  technique and although most of the time I got it right sometimes my breath was too deep and sometimes  too shallow. They always directed me as apparently the radiographers were able to see from their control panel the position of my heart etc and am sure they said the machine will only work if things are in the correct position as planned.

I know you are in Scotland. I got my treatment at the Beatson in Glasgow and I felt confident in all my sessions there. I did ask the radiographers about various things and they always took time to explain. Where are you and hope you and your OH get on ok with treatment.

Jojodot

Hi Jojodot

Thanks for your reply.  

It was not the Beatson, and I have read that the Beatson is considered to be a centre of excellence for cancer treatment.

I must say that the explanation and information were not as good as we would have liked, and at times it was contradictory, which does increase stress levels.  For example, when my wife initially asked about the breath-hold technique, she was told that she could attend an instruction and practice session if she wanted.  She declined in order to minimise hospital attendance.  To us, it was implicit in that offer that the b.h.t would be incorporated into the RT procedure.  However, at the CT prep session, my wife was told it was not, as the beam would be configured to avoid the heart.  Why is this not generally possible?  

Perhaps we are over-stressing but when a neighbour ended up with a triple heart bypass after radiotherapy, it does raise concerns.  When you ask questions you get a response, but not one that totally puts your mind at ease.  Then you worry if you persist that you will be categorised as being overly anxious.

Hi,

This discussion worries me as my BC was on the left and I had RT with no breath hold, I was advised the CT planning is so accurate and the heart would be avoided, my treatment was in Sheffield and I spoke to other ladies in the waiting room having RT to the left side and again no BHT.  Just recently their was another discussion on here regarding BHT and so I raised my concerns with my Consultant who advised the same as the RT Department had done at the planning RT stage that these days it is so accurate due to the CT planning.  I certainly hope they got it right for me.  

You are quite right Dedalus that you worry that if you persist you will be categorised as being over anxious, at times I have persisted and still not been satisfied with the response, it is very difficult, the worry goes on and on. 

Best Wishes. 

I also had LHS radiotherapy at Sheffield and didn’t do the breath hold.

Hi peterawake

I was treated at Sheffield WPH. Left sided BC I had 23 sessions starting in March this year. I was advised breath hold was not required. CT planning helps plan direction of treatment very accurately and I know the expertise at that hospital is second to none and I am glad I was in their hands. 

Xxx

Thanks to everyone for your experiences.  It is kind of you.

Unfortunately, we are the types who need to be fully informed and involved in our health care, and despite the 'participative' rhetoric in the hospital literature, they tend to perceive you as being in the overly anxious category, if you probe too much.  It is just another day at the office for them, but not so for us.

There is so much available on breath-holding technique, you query as to why it is no longer considered so necessary.  Has planning taken a sudden leap forward recently?  We have looked at examples of online coloured ct images where the heart is shown to have greater distancing due to the bht.  Then you are told that this technique could bring the lung into the field.

I really want my wife to be confident and comfortable with the RT.  If they would just take a little time to explain pre and post ct scan that they are taking measurements to determine whether bht is actually necessary, and give you the conclusion, but they don't do this.  You tend to find out by asking questions and teasing things out bit by bit.

Your experiences with no bht has helped to reassure my wife.  Did any of you receive VMAT RT?

Hi Toothtinks, 

It must be the protocol used by Weston Park with LH RT ie no breath hold.