The aim of this project is to develop, test, and evaluate a digital tool (the DIBH App) that enables patients to practise the correct breathing technique at home prior to receiving postoperative respiratory-gated radiotherapy (RT) for left-sided breast cancer.

The objective of the project is to improve radiotherapy delivery using the deep inspiration breath hold (DIBH) technique in order to reduce radiation exposure to the coronary arteries and cardiac muscle, thereby decreasing the risk of future cardiovascular disease that may lead to premature death and reduced quality of life. This more person-centred treatment approach requires patients to feel well informed and confident, and to have practised the breathing technique over time so that body position and breathing patterns can be reproduced consistently at each treatment session. This may increase patients’ sense of involvement and self-management while also contributing to shorter treatment preparation times within healthcare services.

The project is led by Maria Brovall in collaboration with Associate Professor Frida Smith (Regional Cancer Centre West), Chief Medical Physicist and PhD Anna Karlsson (Medical Physics and Technology, Therapeutic Radiation Physics, Sahlgrenska University Hospital), MD, PhD Dan Lundstedt (Sahlgrenska University Hospital), radiotherapy staff, patients, and healthy volunteers.

The project has a clear person-centred approach in which the new digital tool is being developed through several stages. An initial mock-up (prototype) was created through co-design involving different professional groups from the radiotherapy department, patients who had previously undergone DIBH radiotherapy, researchers, and industry partners. The next step involved healthy volunteers practising the deep-breathing technique to identify the most effective instructions for maximising the distance between the chest wall and healthy organs such as the heart and lungs. Following this phase, former patients and radiotherapy staff tested the next version of the product and evaluated, through a series of workshops, which types of information, coaching strategies, and breathing instructions were most effective.

Since spring 2024, both a pilot study and a subsequent randomized controlled trial (RCT) have been underway, with data collection expected to be completed in spring 2027. At that point, the effectiveness of the developed product will be evaluated. The study is being conducted at Sahlgrenska University Hospital and includes the radiotherapy departments in both Gothenburg and Borås.

Link to DIBH-App