Improving Patient Compliance for More Efficient Deep Inspiration Breath Hold Treatment through Innovation and Education.

Abstract

Visual guidance has been widely proven to improve the reproducibility and stability of Deep Inspiration Breath Hold (DIBH) treatments. Here, we present a quality improvement project by implementing the use of visual guidance in a multi-campus institution to improve clinical efficiency, including the design of a novel mount for the visual aid and the creation of a patient education video to better prepare lung and GI patients for their DIBH treatments. Prior to institution-wide implementation, the clinical feasibility of utilizing visual guidance for DIBH treatments was determined by a pilot study with 10 lung/GI patients. A commercial visual guidance device was used, which consisted of a tablet-like device, attached to a mount affixed to the treatment couch. The device is positioned over the patient's head, displaying the real-time vertical motion of a block with infrared markers on the patient's abdomen. The original mount for the device locks onto the superior end of the treatment couch, which occupies space used for immobilization devices and limits the number of patients eligible for visual guidance when the isocenter is inferior, as for GI patients. A novel in-house mount was designed to overcome this limitation. Also, a patient education video was created to introduce the concept of DIBH and the visual aid device. Visual guidance is offered at the first treatment; its use is optional, and patients may start or stop using it at any time. If the device is not used, the patient relies on audio coaching from the radiation therapists (RTTs), which is the standard practice in our clinic. All 10 patients in the pilot who were offered the visual aid used it, found it helpful and continued to use it throughout their treatment, with no issues reported. The median number of fractions for all 10 patients was 5(3-15). The in-house mount was manufactured from 3D printed and machined components. The treatment couch was 3D scanned, and the mount was designed to clamp laterally on the couch top and align with the indexing indentations. The in-house mount is easy to use and is more versatile than the commercial mount, enabling use for patients with inferior isocenters. Prior to treatment, patients were encouraged to view the <3 min long patient education video that consisted of a combination of animation and real-actor content. Verbal instructions for use were also given by RTTs at the first treatment. Upon successful completion of the pilot study, the use of visual guidance was implemented institution-wide across 5 campuses for all lung and GI DIBH patients, being utilized on an average of 14 patients/week. A quality improvement project was developed and successfully implemented to introduce the use of visual guidance for lung and GI DIBH patients at a large institution, improving the efficiency of DIBH treatment for both the patients and RTTs.