Deep Breath Hold Protects the Heart


Breathing deeply isn’t just for yoga class. A specialized method of deep breathing is keeping some breast cancer patients from getting unintended doses of radiation to the heart.

Imagine if the side effects of radiation could be reduced, just by holding the breath.

Alonso N. Gutierrez, Ph.D., a radiation oncology physicist at UT Health Science Center, San Antonio told Ivanhoe, “As you breathe, you have a natural separation between your heart and your left breast.”

It’s that separation that makes a big difference for patients with cancer in their left breast.  

The technique is called deep inspiration breath hold. It uses surface imaging to ensure the breast, lungs, and heart are in the correct position when the radiation is delivered. 

“The patient will have to hold their breath, take a deep breath, and by doing so, they fill their lung volume, and have a separation between the heart and the breast,” detailed Gutierrez.

Special goggles show the patient a window with a bar in it.

“As she breathes, her goal would be to get that bar inside of that window,” said Gutierrez.

Colored images on the patient’s chest help align the organs as cameras focus on any movement.

Gutierrez detailed, “In real time, they’re able to track where the patient is.”

If the patient should move out of the safety range, the radiation automatically cuts off. Patient Christine Castaneda said it’s a bit challenging.

“It’s just the staying still and not moving, that’s what’s hard about it,” said Castaneda.
However, the health benefits are worth it.

Richard Crownover, M.D., Ph.D., a radiation oncologist at UT Health Science Center, San Antonio told Ivanhoe, “It spares doses to the heart that can lead to measurable heart disease in the future.”

“I got six weeks to go, so I think I can handle it,” detailed Castaneda.

Compared to conventional radiation for left-side breast tumors, studies show the deep inspiration breath hold technique could reduce the average dose of radiation to the heart by 50 percent.


TOPIC:  Deep Breath Hold Protects the Heart
REPORT: MB #4096

BACKGROUND: A study showed that women with cancer in the left breast treated with radiation therapy were much more likely to develop heart disease years later than women who received radiation therapy on their right breast. In the study, 59% of women with left-sided breast cancer had stress test abnormalities compared to only 8% of women with right-sided breast cancer. Because the heart is on the left side of the chest, it’s likely the heart unintentionally was exposed to more radiation in women with cancer in the left breast. Women can develop atherosclerosis, hardening of the arteries and the radiation can accelerate that.

NEW TECHNOLOGY: Advances in technology are making it less likely that the heart and the surrounding breast tissue will be unintentionally exposed to radiation. Some radiation therapy equipment effectively blocks those tissues from any radiation exposure by tracking heartbeats and the movement of the lungs. One technique that has been developed to reduce exposure to the heart includes the breath-hold technique also called the deep inspiration breath hold. This technique allows doctors to monitor a patient’s breath for the position that shifts the heart out of the range of the radiation. Alonso N. Gutierrez, Ph.D., a radiation oncology physicist at UT Health Science Center, San Antonio said, “Specifically for left breast cancer patients where the heart is naturally closer to the left breast, a deep inspiration breath hold radiation delivery technique could be beneficial as the left lung will expand during the breath hold and separate the heart away from the left breast.” A study followed 81women for eight years post treatment. They were asked to hold their breath during radiation treatment for breast cancer. The study found that patients capable of holding their breath over the course of treatment had a 96% overall survival rate, with a median reduction in radiation dose to the heart of 62%.


Richard Crownover, M.D., Ph.D.
UT Health Science Center San Antonio
CTRC Hotline: 210-450-1000

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