The feasibility, safety and optimization of multiple prolonged breath-holds for radiotherapy

Research output: Contribution to journalArticle


  • Stuart Green
  • Warren Kilby
  • Jason Cashmore
  • Qamar Ghafoor

External organisations

  • Hall Edwards Radiotherapy Group, University Hospitals Birmingham NHS Foundation Trust, United Kingdom.
  • Accuray Incorporated, Sunnyvale, United States.


BACKGROUND & PURPOSE: Multiple, short breath-holds are now used in single radiotherapy treatment sessions. Here we investigated the feasibility and safety of multiple prolonged breath-holds in a single session. We measured how long is a second breath-hold if we prematurely terminate a single, prolonged breath-hold of >5 min either by using a single breath of oxygen (O2), or by reintroducing preoxygenation and hypocapnia. We also investigated the feasibility and safety of undertaking 9 prolonged breath-holds in a row.

MATERIALS & METHODS: 30 healthy volunteers with no previous breath-holding experience were trained to perform single prolonged breath-holds safely.

RESULTS: Their mean single, prolonged breath-hold duration was 6.1 ± 0.3 se minutes (n = 30). In 18/18 subjects, premature termination (at 5.1 ± 0.2 min) with a single breath of 60% O2, enabled a 2nd safe breath-hold lasting 3.3 ± 0.2 min. In 18/18 subjects, premature termination at 5.3 ± 0.2 min) by reintroducing preoxygenation and hypocapnia, enabled a 2nd safe breath-hold lasting 5.8 ± 0.3 min. 17/17 subjects could safely perform 9 successive prolonged breath-holds, each terminated (at 4.3 ± 0.2 min) by reintroducing preoxygenation and hypocapnia for 3.1 ± 0.2 min. The 9th unconstrained breath-hold (mean of 6.0 ± 0.3 min) lasted as long as their single breath-hold.

CONCLUSIONS: Multiple prolonged breath-holds are possible and safe. In a ∼19 min treatment session, it would therefore be possible to have ∼13 min for radiotherapy treatment (3 breath-holds) and ∼6 min for setup and recovery. In a 65 min session, it would be possible to have 41 min for radiotherapy and 25 min for setup and recovery.


Original languageEnglish
Pages (from-to)296-303
Number of pages8
JournalRadiotherapy & Oncology
Early online date18 Sep 2019
Publication statusPublished - Dec 2019


  • Breath-hold, Radiotherapy, Mechanical ventilation, Hypocapnia, Oxygen