"Deep-inspiratory breath-hold (DIBH) is a widely adopted cardiac-sparing technique but is associated with longer treatment times than free breathing."
BUFFALO, NY — October 16, 2026 — A new research paper was published in Volume 13 of Oncoscience on September 24, 2026, titled " Investigating the role of 3D goggles in optimising time during deep-inspiratory breath-hold radiotherapy: A randomised study ."
The study found that adding three-dimensional (3D) goggles to deep-inspiratory breath-hold (DIBH) radiotherapy did not significantly reduce overall treatment time compared with standard audio-only guidance. In a randomized trial involving 94 patients with breast cancer or lymphoma, the goggles also increased setup time, suggesting that structured breathing training may be sufficient for efficient DIBH treatment without additional visual feedback.
The research was led by first author Naseera Syeda, affiliated with Tata Memorial Hospital . Corresponding author Tabassum Wadasadawala is affiliated with the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) .
Radiotherapy is an important component of treatment for breast cancer and lymphoma, but radiation delivered near the chest can expose the heart to unintended doses, increasing the risk of cardiovascular complications. DIBH helps reduce this exposure by requiring patients to take a deep breath and hold it briefly, expanding the lungs and increasing the distance between the heart and chest wall. This technique also limits movement during radiation delivery.
However, DIBH requires repeated, consistent breath-holds, which can increase treatment duration and affect scheduling in busy radiotherapy departments. Patients may also struggle to follow breathing instructions because of communication barriers or difficulty maintaining the required breathing pattern.
To improve treatment efficiency, some centers use visual feedback systems that allow patients to monitor their breathing patterns. The researchers investigated whether 3D goggles displaying real-time respiratory waveforms alongside verbal instructions could help patients perform breath-holds more efficiently and shorten treatment sessions.
The non-blinded, randomized trial included 94 patients receiving DIBH radiotherapy, primarily for breast cancer, with a smaller group being treated for lymphoma. Participants received either standard audio-only guidance (51 patients) or combined audio-visual feedback using 3D goggles (43 patients).
All participants underwent dedicated DIBH training one to two weeks before simulation. Patients received breathing instructions, practiced using spirometers and were encouraged to perform daily breathing exercises at home. Trained radiotherapy technologists monitored their progress through practice records and regular follow-up.
The researchers measured overall treatment time as the primary outcome, alongside setup time, imaging duration, radiation beam-on time, breath-hold counts and treatment interruptions.
The results showed no statistically significant difference in overall treatment duration between the two groups. Patients receiving audio-only guidance had an average treatment time of 22.4 minutes, compared with 23.4 minutes among those using 3D goggles (p = 0.205). Treatment times during the first session, the first three sessions and subsequent sessions also showed no significant differences between groups.
Similarly, the goggles did not significantly improve radiation beam-on time, imaging duration, breath-hold counts or treatment interruptions. Patient positioning reproducibility was also comparable between the groups.
However, setup time was significantly longer when goggles were used, increasing from a median of 6.5 minutes with standard guidance to 7.3 minutes with goggles (p = 0.005). The researchers attributed this difference partly to the manual setup and connections required by the equipment.
An important finding was that treatment efficiency improved with repeated sessions, regardless of feedback method. Across the entire study population, average treatment time decreased significantly from 25.6 minutes during the first three sessions to 21.5 minutes thereafter (p = 0.001). This suggests that increasing familiarity with DIBH may help patients complete treatments more efficiently.
The researchers also examined patient characteristics associated with treatment duration. Gender was the only significant factor in the univariate analysis, with shorter treatment times observed among men. However, only eight male patients participated, limiting the interpretation of this finding.
The results differ from some earlier smaller studies reporting improvements with audio-visual guidance. The authors suggest that structured pre-treatment coaching may help explain why goggles provided no measurable additional benefit. The manual setup required by the specific goggle system may also have reduced its potential efficiency.
"The findings from our study suggest that structured pre-treatment coaching alone may be sufficient to achieve efficient DIBH delivery in routine clinical practice, without the need for additional audiovisual augmentation."
These findings could have practical implications for radiotherapy centers with high patient volumes or limited resources. Structured breathing training may support efficient cardiac-sparing treatment without requiring additional visual equipment, potentially simplifying clinical workflows. However, this does not mean that visual feedback offers no benefit to individual patients who experience difficulty performing DIBH.
The study has several limitations. Patients unable to perform DIBH were not evaluated to determine whether goggles could improve their compliance. The equipment required manual setup, so more streamlined or battery-operated systems might produce different results. Patient satisfaction and compliance outcomes were also not included in the present report and are intended for separate publication.
Additionally, the trial focused on treatment efficiency rather than comparing radiation doses to the heart or long-term clinical outcomes. Therefore, it cannot establish whether visual feedback influences cardiac protection or treatment effectiveness. Further studies involving different feedback systems and patient populations may help identify individuals who could benefit from additional visual guidance.
Overall, the findings suggest that 3D goggles do not necessarily improve treatment efficiency when patients receive structured breathing training before DIBH radiotherapy. The study highlights the importance of patient preparation, familiarity and equipment setup in optimizing cardiac-sparing radiotherapy while avoiding unnecessary complexity in treatment delivery.
DOI: https://doi.org/10.18632/oncoscience.672
