Answer Choices –	Responses –
– Verbal coaching	60.61% 20
– Visual coaching with goggles	21.21% 7
– Visual coaching with in room display	15.15% 5
– Responses Other (please specify)	3.03% 1
TOTAL	33

If you use verbal coaching, what are the pros and cons of this method?

Answered: 18
Skipped: 15

Takes longer to teach to the patient

8/19/2017 06:34 AM

Pros: you can personally talk and comfort the patient and provide immediate feedback. It is more personalized and caring approach. Also you will know immediately whether patient is following the instruction or not and will be a eligible candidate for DIBH or not.

8/16/2017 08:03 PM

Patient compliance.

7/24/2017 03:24 PM

none

7/24/2017 02:20 AM

Easy to implement. No extra cost. Effective.

7/22/2017 01:49 PM

Verbal coaching is simple for those who are able to just breath hold consistently. For several patients, using verbal coaching alone would lead to them often over correct.

7/21/2017 08:40 PM

Many patients want (visual) feedback.

7/21/2017 05:35 PM

Simple and effective. Except if the patient is hard of hearing or doesn't speak English.

7/21/2017 05:14 PM

Pro: Patient can relax and just listen, no change in breathing to try to "hit" the line perfectly Con: Limited to patients with good hearing and who speak enough English to understand

7/21/2017 03:30 PM

Q3 w

If you use visual coaching with goggles, what are the pros and cons of this method?

Answered: 11
Skipped: 22

Infection is a problem, and a cable connection is usually needed

8/19/2017 06:34 AM

Some are better than others. We also have tried the "goggles" technique but it really depends on the patient. Our setup is a webcam on the waveform display of the TB. We coach the patient to see if they can keep the waveform above the line.

7/24/2017 03:24 PM

Fairly inexpensive, fairly simple. Occasionally video connections are flaky. Patient is effectively blind folded. Worry about infection and cleanliness of goggles.

7/21/2017 08:40 PM

A breath hold is not reproducible if you are on the intercome and are saying "a little more" or "a little less". The patient should come from expiration into the gating window smoothly and stay there. In my opinion, this requires visual coaching. People avoid visual coaching because it is harder for the staff. This is not a good reason not to do it.

7/21/2017 07:19 PM

Pros: Easy for patient to follow Cons: connectivity issues sometimes

7/21/2017 05:35 PM

The goggles run on batteries, need to keep extra on hand. Otherwise it's great!

7/21/2017 02:35 PM

When I was new to this institution (junior physicist) we were using googles with the RPM system. The leaders decided to abandon them due to their cumbersome nature. The RTTs and the patients did not like the googles. Today, with the Truebeam 2.7 (we are still on 2.5), I want to bring visual coaching back, but without googles.

7/21/2017 01:47 PM

Goggles are not robust enough for routine use, also there is the infection control risk (albeit small). We used them for years, but went through many sets of googles (and they are not cheap!).

7/21/2017 08:21 AM

Pros 1) the visual trace is right in front of the patient 2) arm position has no impact on ability to see a screen 3) no holders are required - goggles sit on head. Cons: 1) infection control concerns 2) Some patients have told us they just close their eyes! 3) Patients who wear glasses or have poor sight may struggle with them. 4) May not be wireless

7/21/2017 06:46 AM

Q4 w

If you use visual coaching with an in room display, what are the pros and cons of this method?

Answered: 7
Skipped: 26

Need a small tablet and a sturdy 80cm goose neck with a screw on clamp for attaching to the couch.

8/19/2017 06:34 AM

We use "glasses" with no lens and the clip-on display to the patient's visual field. Video is fed via a long hdmi cable thru the physics port into a chromebook that has webcam app running.

7/24/2017 03:24 PM

We use an in room monitor in combination with a small mirror. We started with small monitors on a couch mount, but we abandonned this method because of troubles with cabling.

7/24/2017 08:09 AM

I cannot comment since we don't use it. I'd like to hear the pros and cons.

7/21/2017 01:47 PM

In room display is the way to go! Find a way that works for you and your room layout. Be inventive ;-)

7/21/2017 08:21 AM

Pros: 1) reduced infection control concern 2) patients who wear glasses can see screen 3) Therapists can also see screen to simultaneously guide the patient. Cons 1) may be bulky 2) linac vendors not routinely supplying equipment for this, especially a mounting arm.

7/21/2017 06:46 AM

Pros: visual feedback seems to make it easier for the patients to reach the breath hold level because they get the feedback directly and not via someone giving audio instructions; usually more comfortable than goggles Cons: sometimes patients feel that they are pretty close to the screen

7/21/2017 06:10 AM

Q5 w

Please add any comments regarding the topic of coaching DIBH patients.

Answered: 11
Skipped: 22

It really depends on the patient. We try and do an assessment during sim to see if they are a candidate for the webcam method.

7/24/2017 03:24 PM

We found visual coaching is much better than verbal coaching alone. We easily do a +-1.5 mm breath hold window with RPM with visual feedback.

7/21/2017 08:40 PM

I shrink wrap the goggles so they last a bit longer. It is considered acceptable to replace the glasses when they get damaged. We perform about 30 DIBH per day.

7/21/2017 07:19 PM

We use C-RAD semitransparent goggles. Most patients like it.

7/21/2017 05:35 PM

Essential that coaching be done at CT sim, and have this re-iterated at time of treatment. We have a high threshold for compliance. If there's any doubt about ability to follow coaching consistently, we do not use DIBH.

7/21/2017 03:20 PM

We add 3mm for upper limit and -1mm for lower limit base on fused CT sagittal image measurement from free breath and breath hold dataset

7/21/2017 03:01 PM

For voluntary DIBH, good coaching is essential. For active DIBH, the physicists and treatment team have more control, but I don't have any clinical experience with Active breath-hold devices.

7/21/2017 01:47 PM

We are looking to develop our technique and had considered goggles, until we were put off by Infection Control worries - how to clean the goggles between patients. We are looking to get a tablet on an articulated arm instead.

7/21/2017 07:45 AM

Would be interested to see if anyone checks daily reproducibility of lung volumes

7/21/2017 05:50 AM

I would pick a method which you can do on every linac in your centre. DIBH is really important and you want to be able to offer it to as many women as possible

7/21/2017 05:21 AM

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