The use of magnetic sensors to monitor moderate deep inspiration breath hold during breast irradiation with dynamic MLC compensators

Background and purposeTo reduce the dose to the heart during left breast irradiation, a moderate deep breath hold technique (MDIBH) was introduced. Originally, verification of the MDIBH was performed with portal images acquired in movie loop during the treatment delivery. However, this verification method is not compatible with the use of dynamic MLC compensation, recently introduced because of its often superior dose distribution. Magnetic sensors were evaluated as an additional/alternative method to monitor the breath hold.Material and methodsIn a first phase, the reproducibility of MDIBH for breast patients was evaluated by investigating for 19 patients the set-up errors derived from portal images in cine loop acquisition during MDIBH. In a second phase, for 10 patients, the breathing curves recorded by magnetic sensors were used to monitor beam-on and beam-off while portal images were simultaneously recorded in movie loop. In a third phase, breast patients treated with dynamic MLC compensation were trained for MDIBH and monitored with magnetic sensors.ResultsThe interfraction reproducibility of MDIBH for the initial 19 patients was recorded: the mean set-up error, the systematic and the random deviations are all smaller than 4 mm in the anterior–posterior direction and in the cranio-caudal direction and smaller than 2° along the rotation axis. Magnetic sensors provided a reproducible breathing curve: while the mean amplitude recorded for 10 patients varied substantially between patients, the individual standard deviation of the amplitude for each session was smaller than 3 mm. For these 10 patients, the intrafraction set-up variation between the first portal image of two consecutive breath holds and the intra-breath hold set-up variation between the first and last portal image of each breath hold is smaller than 2 mm in the anterior–posterior direction, smaller than 3 mm in the cranio-caudal direction and smaller than 1.5° along the rotation axis.ConclusionUsing magnetic sensors to record the breathing curve of left breast patients in MDIBH, a verification method was developed, suitable for combining MDIBH with dynamic MLC compensation.