The following information has been developed to provide education about End Expiration Breath Hold (EEBH) Radiation Therapy, detailing the equipment used and the breathing routine required for treatment at the Princess Alexandra Hospital, Radiation Oncology Department (Ipswich Road Campus).

Why do we use a breath hold technique?

To understand why a breath hold technique is used (specifically EEBH) , it’s helpful to consider what happens inside our body when we breathe.

If we examine the internal organs in our chest and abdomen as displayed on the MRI scan video clip, you can see that they have a natural range of motion as we breathe. The heart, stomach, liver and bowel all shift up and down several centimetres as the muscles responsible for breathing contract & relax.

However, when we exhale and hold our breath, our lungs shrink in size and our organs tend to stay in a relatively stable position, because our breathing muscles stop moving them about.

This reduction in motion can be very beneficial when it comes to treating certain cancer sites with radiation therapy, because it allows us to pinpoint where a tumour is positioned at any given time.

Therefore, by pausing the breathing cycle during treatment, we can apply radiation therapy in a more targeted manner, that focuses on the cancer and minimises radiation exposure to the healthy parts of the body.

In some cases, the EEBH technique can also be used to move a cancer site away from surrounding anatomy. For example, if you are having a tumour treated in your liver, the E.E.B.H. technique may help separate the treatment area from your bowel. This can significantly reduce radiation exposure to the bowel, which in turn, lessens the risk and severity of treatment side effects.

While there are several advantages in using a breath hold technique, it’s important to realise that it may not be suitable for everyone. If you have difficulty holding your breath or have cancer in a location that is not greatly affected by breathing motion, then the EEBH technique may not be recommended.

A thorough assessment will be made at the time of your radiation planning determine whether this breath hold technique is the best option for you.

The EEBH equipment - managing your breathing.

When you attend our Ipswich Road Campus for your radiation therapy, several steps need to be completed before you can receive treatment using the EEBH technique. One of the first steps after your specialist consultation, is attending an EEBH coaching session at our Radiation Oncology Department. This coaching session is only provided to patients who have been recommended the EEBH technique by their Radiation Oncologist.

At this appointment you will be taken into a CT scanning room and taught how to breathe for treatment using a device called the Active Breathing Coordination (ABC) system. This specialised medical equipment is designed to help manage your breathing routine for EEBH - radiation therapy.

If we look at the ABC system illustration, you can see that it has several components that are designed to make you breathe only through your mouth.

To start with there is a foam peg that is placed on your nose. This peg needs to be placed securely to prevent air flow through your nasal passage during treatment.

Next, we have a snorkel like tube with a mouth piece at one end and a filter at the other. When you breathe through the mouth piece, air flows inside the tube and is filtered through a device called a spirometer. This device measures the amount of air passing in and out of your lungs, which is then traced in real time on a computer screen. The spirometer also has a valve inside it that can be opened and closed to regulate airflow.

The final component of the ABC system shown in the illustration is the is the patient control switch (green button). This button is held in your hand during treatment and connected to the ABC system via a cable.

When you press down on the button, it signals to the radiation therapists that you are ready to start the breathing routine. It also activates one of three interlocks required to close a valve that pauses airflow through the snorkel. (Note: Airflow will only be paused when all 3 interlocks are engaged at the same time).

It’s important to understand that this button gives you full control over when you commence holding your breath and the length of time you hold your breath for. If you need to breathe at any stage while using the ABC system, all you need to do is release the button!

The breathing routine - using the ABC system.

To receive EEBH -Radiation Therapy, you will need to learn a breathing routine using the ABC system. The radiation therapists will explain how to perform this routine at your coaching session and talk you through the process each day for your treatment.

During your coaching session this breath hold routine is repeated several times gradually increasing the time you hold in 5 second increments until you reach 25 seconds.

Once you have reached your maximum breath hold duration, (which will need to be in the range of 22 to 25 seconds), the radiation therapists will perform a series of breath holds using the maximum time you were able to achieve. This is done to ensure that you will be able to comfortable hold your breath for the treatment.

Planning & Treatment Process

After your coaching session is complete you will be required to return in the following days for a planning appointment. This is where the Radiation Therapists will set your treatment position and take a CT scan (X-ray pictures) of your cancer site as outlined by your Radiation Oncologist. Sometimes this scan may require the injection of contrast agent (radiopaque liquid) to help visualise the location of your treatment area. During this scan you will be required to perform the EEBH routine using the ABC system.

Images above: A CT scan being performed for radiation therapy planning.

In some cases an additional MRI scan may also be performed to assist in visualising the extent of a tumour.

Overall the planning process usually takes around 1 to 2 hours to complete, but can vary depending on the area being planned, type of scan and contrast injection required.

The information obtained from planning is then used to develop a computer model that details how your radiation therapy is going to be administered.

You can find out more about this process by reading our “Radiation Therapy - A Guide For New Patients”. The only difference with the EEBH - Radiation Therapy planning procedure is that you are required to perform the EEBH breathing routine during the CT planning scan and for your treatment delivery.

If you have any further questions about the EEBH – Radiation Therapy, please speak to your Specialist Doctor (Radiation Oncologist) or call our Nursing Care Advice line. PH: 3176 1967