SoutheastHEALTH Catalyst technology allows breast cancer patients to control treatment with breath

While a woman using goggles to control the radiation beams going into her body might seem like something out of a science-fiction movie, this real-life technology is used every day to help treat women fighting breast cancer.

The technology, called Catalyst, is used at SoutheastHEALTH Cancer Center (SHCC).

"This is amazing technology because it's very cutting edge," says Jeannie Landewee, lead radiation therapist at SHCC.

When a woman is diagnosed with breast cancer, she has a CT scan, during which levels are set for her upcoming treatments.

The treatment plan will vary depending on the stage of cancer and on which breast is affected.

All patients use the Catalyst treatment, but the method is different for those with right-breast and those with left-breast cancer.

Radiation therapists use paddles to monitor the patient's movement in right-breast cancer patients. The radiation therapists determine the proper time to dispense radiation beams.

For a woman with cancer in her left breast, however, the process is different, due to the chance that some radiation may reach sensitive heart tissue.

"When you're on that left side you're worried about the heart," Landewee says.

To set the standards for treatment in a left-breast cancer patient, it is necessary to measure lung capacity and natural breathing cycles to establish a breath-hold. The breath-hold volume is used in tailoring the radiologic treatment plan.

"Using Catalyst to monitor the patient's breath-hold allows us to duplicate the same breath volume the patient had during their initial planning CT/Simulation," says Dr. Joseph Miller, a radiation oncologist at SHCC.

There's a reason a woman receiving treatment on her left breast must hold her breath when the radiation is dispensed.

"When you hold your breath, your diaphragm relaxes down, which allows your heart to relax, so those patients get less, if any, heart dose," Landewee explains.

It's important to doctors and patients to do everything possible to keep the radiation away from sensitive heart tissue, because exposing it to radiation can increase the risk of a cardiac event.

"Our goal is to minimize radiation dose to surrounding tissue," Miller says. "Decreasing radiation dose to the heart reduces the risk of developing a cardiac issue in the future. Even small radiation dose reductions to a patient's heart can make a big difference."

This is where the goggles come into play. Women with left-breast cancer use the goggles to see their breath-hold levels, and control when the radiation is dispensed during their treatments.

"The goggles are hooked to the computer system, and technicians watch the computer to monitor the patient's breath waves," Landewee says. "So, in the goggles, the patients are actually seeing their breath wave as a bar going up and down and then they see a box at the top of their screen. What they do is hold their breath until the breath bar is in the middle of this box."

When the breath bar reaches the middle of the box displayed on the goggles, the radiation emission begins.

"The patient can actively visualize and control her breath volume using the specially-designed goggles," Miller says. "A variance outside the patient's breath-hold tolerances will result in interrupting the radiation beam, until the patient is again within tolerance," Miller says.

The average course of radiation treatment depends on the stage of the patient's breast cancer. "A hypo-fractionated course of breast irradiation is 16 treatments and a traditional course is 30 Catalyst technology radiation treatments, Miller says. "Patients receive radiation treatments every weekday."

The ability to reproduce exactly the same treatment day after day is very important.

"They hold their breath to the same depth every day," Landewee says. "If for some reason they are not in that area, the radiation will not turn on, so they are in complete control of their treatment."

Feeling in control of the treatment is especially important for a woman with breast cancer.

"When patients get the diagnosis of cancer, one thing they feel is the loss of control," Landewee says. "This helps them to know that they are doing a good job and that they are getting the right treatment, so it really gives them a little bit of empowerment to know that they have control of that and their radiation treatment is going as it should."

The treatment takes about 10 to 15 minutes, including setup and treatment. The actual treatment time is only a couple of minutes.

"They only hold their breath for a couple of minutes, and they do that in increments of time," Landewee says. "We normally let them hold their breath for around 20 seconds. Just whatever they are comfortable with, but it ends up being just a couple of minutes of treatment time."