St. Mary Medical Center introduces new technique to limit radiation exposure to the heart
By Samantha Bambino
The Times
When a woman is diagnosed with breast cancer, the last thing she’s concerned about is her heart health. But when doctors treat the cancerous area, that vital organ is usually trapped in the line of radiation fire because of its close proximity. There are rarely immediate repercussions, but rather heart disease and failure later in life, even from the lowest doses of radiation.
To prevent issues, especially in its younger patients, St. Mary Medical Center in Langhorne has adopted a new method called deep inspiration breath hold, which allows physicians to deliver radiation precisely to the cancerous area, and nowhere else.
DIBH has been available at St. Mary for the past several months, but the hospital’s radiation oncologist, Dr. Hiral Fontanilla, practiced the technique for several years during her previous position at MD Anderson Cancer Center. When she transitioned to Bucks County, she was instrumental in adopting it at St. Mary after seeing so much success.
After going through a rigorous training to learn how to work the technology, several nurses are now qualified to use DIBH on their left-sided breast cancer patients. In a live demonstration earlier this month, radiation specialists Jennifer Moyer, Carrie Strauss and Kris Spadaccino explained the process in detail.
Playing the role of the patient, Moyer placed a special spirometry monitor, which looks very much like a snorkel, into her mouth so Spadaccino could measure her breathing. To be eligible for the DIBH method, the patient must have a lung capacity of 85 percent and be able to hold their breath for at least 25 to 30 seconds. After a brief coaching session, Moyer then put on a pair of goggles through which she could see her breathing levels, which were mirrored on a nearby laptop.
“The patient sees what we see,” Fontanilla said. “We may be delivering the treatments, but the patient is really in charge. We only give her the treatment when she is ready for it. Many of our patients respond well to that.”
During the demonstration, Spadaccino explained the patient’s breathholding must stay within a tiny window called a “green zone,” which is represented by a thin green line on the screen. As long as it remains in the “green zone,” the radiation will continue to be applied. If it goes above or below that line, the treatment is instantly paused. This process is repeated as often as necessary to complete the course of the treatment, though it rarely adds more than a few minutes to a standard 20-minute treatment.
As the patient is taking a deep breath, respiratory movement is reduced, which fixes the cancerous tissue in place, allowing for a more targeted approach to radiation delivery. And though the heart is pushed away only fractions of an inch, it makes all the difference in the long run.
“When we take a deep breath, our lungs inflate and this action pushes our heart away from the left breast and chest wall,” Fontanilla explained. “DIBH moves the heart away from the treatment area so we can target the cancer with better precision and deliver the radiation where it’s needed most.”
This technique can reduce radiation exposure to the heart by up to 75 percent compared to a patient who isn’t consciously controlling their breath during treatment. According to Fontanilla, many women are being diagnosed with breast cancer at a younger age, so this additional safety measure will severely decrease their chances later in life of heart failure due to previous radiation exposure.
In addition to left-sided breast cancer patients, Fontanilla said DIBH can be used when treating areas such as the lungs and pancreas. Previously, locals had to travel more than an hour to receive this sort of advanced treatment. Now it’s available in their own backyards.
“The more we can limit the exposure of healthy tissue to radiation and protect the heart, the better the long-term outcome of the patient will be,” Fontanilla said. “This is another advancement for our patients who are living decades after the initial diagnosis thanks to more effective therapies.” ••
Samantha Bambino can be reached at [email protected]
