{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:51:35Z","timestamp":1777351895496,"version":"3.51.4"},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Deep inspiration breath hold (DIBH) is a treatment technique used for patients with left\u2010sided breast cancer to move the heart further from the treatment area and thus reduce cardiac toxicity. Active participation of the patient plays a vital role in the success and efficiency of DIBH. The purpose of this study was to investigate various clinical factors that can influence breath\u2010hold performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Surface\u2010guided radiotherapy (SGRT) data from 72 left\u2010sided DIBH breast cancer patients monitored with AlignRT (VisionRT) were retrospectively analyzed to evaluate breath\u2010hold accuracy (deviation of patient surface at treatment from the CT simulation surface), reproducibility, and the percentage of breath holds within tolerance (%WT). An internal Python\u2010based tool was developed to identify all breath holds from acquired breathing traces during patient setup and treatment. Patients were grouped based on clinical factors such as age, English proficiency, and reported pain or anxiety. Group differences in the breath\u2010hold performance metrics were assessed using the Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Breath\u2010hold accuracy did not show statistically significant differences across any patient groups. However, reproducibility was significantly worse for patients reporting pain (standard deviation\u00a0=\u00a02.54 mm vs. 1.69 mm,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0003), indicating greater difficulty in maintaining consistent breath\u2010hold levels. In terms of %WT, patients with reported anxiety demonstrated lower performance (83.3% vs. 90.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03), as did patients reporting pain (80.6% vs. 86.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02). These findings suggest that both pain and anxiety are factors that may negatively impact a patient's ability to consistently hold their breath during treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the importance of addressing patient\u2010reported pain and anxiety in achieving optimal breath\u2010hold performance during DIBH treatments. While factors such as age and English proficiency did not significantly impact breath\u2010hold metrics, pain and anxiety were associated with impaired reproducibility and reduced time within tolerance. These results suggest that targeted interventions, such as pain management strategies, additional coaching, or supportive devices to increase patient comfort, may improve patient outcomes and clinical efficiency for anxious patients or those in pain. DIBH remains a feasible and effective technique for patients regardless of age or native language in the patient cohort we investigated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70364","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T02:17:54Z","timestamp":1764123474000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical factors affecting breath\u2010hold performance for left\u2010sided breast cancer patients"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7382-7354","authenticated-orcid":false,"given":"Kaelyn","family":"Becker","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine &amp; Applied Sciences UC San Diego Health  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Kisling","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine &amp; Applied Sciences UC San Diego Health  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-6643","authenticated-orcid":false,"given":"Laura","family":"Padilla","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine &amp; Applied Sciences UC San Diego Health  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(05)67887\u20107"},{"issue":"1","key":"e_1_2_9_3_1","first-page":"15","article-title":"Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer","volume":"71","author":"Cuzick J","year":"1987","journal-title":"Cancer Treat Rep"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022152"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.05.065"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.72.0722"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(92)90895\u2010O"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1990.193"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209825"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmir.2020.12.004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.89"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.07.675"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4903511"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tipsro.2022.02.001"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2012.12.016"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.16699"},{"key":"e_1_2_9_17_1","first-page":"545","article-title":"Comparison of three differently shaped ROIs in free breathing breast radiotherapy setup using surface guidance with AlignRT","volume":"26","author":"Laaksomaa M","year":"2021","journal-title":"Rep Pract Oncol Radiother"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110229"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2019.03.025"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.790"},{"key":"e_1_2_9_21_1","unstructured":"Memorial Sloan Kettering Cancer Center.Radiation therapy to your breast or chest wall. 2023. Accessed May 12 2025.https:\/\/www.mskcc.org\/cancer\u2010care\/patient\u2010education\/radiation\u2010therapy\u2010breast\u2010chest\u2010wall"},{"key":"e_1_2_9_22_1","unstructured":"American Cancer Society.Opioids for cancer pain. 2024. Accessed May 12 2025.https:\/\/www.cancer.org\/cancer\/managing\u2010cancer\/side\u2010effects\/pain\/cancer\u2010pain\/opioid\u2010pain\u2010medicines\u2010for\u2010cancer\u2010pain.html"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/RMR.0000000000000241"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2018.04.009"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2019.00290"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70364","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:12:45Z","timestamp":1767179565000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":24,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/acm2.70364"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70364","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"assertion":[{"value":"2025-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70364"}}