Respiratory level tracking with visual biofeedback for consistent breath-hold level with potential application in image-guided interventions

BACKGROUND: To present and evaluate a new respiratory level biofeedback system that aids the patient to return to a consistent breath-hold level with potential application in image-guided interventions. METHODS: The study was approved by the local ethics committee and written informed consent was waived. Respiratory motion was recorded in eight healthy volunteers in the supine and prone positions, using a depth camera that measures the mean distance to thorax, abdomen and back. Volunteers were provided with real-time visual biofeedback on a screen, as a ball moving up and down with respiratory motion. For validation purposes, a conversion factor from mean distance (in mm) to relative lung volume (in mL) was determined using spirometry. Subsequently, without spirometry, volunteers were given breathing instructions and were asked to return to their initial breath-hold level at expiration ten times, in both positions, with and without visual biofeedback. For both positions, the median and interquartile range (IQR) of the absolute error in lung volume from initial breath-hold were determined with and without biofeedback and compared using Wilcoxon signed rank tests. RESULTS: Without visual biofeedback, the median difference from initial breath-hold was 124.6 mL (IQR 55.7–259.7 mL) for the supine position and 156.3 mL (IQR 90.9–334.7 mL) for the prone position. With the biofeedback, the difference was significantly decreased to 32.7 mL (IQR 12.8–59.6 mL) (p < 0.001) and 22.3 mL (IQR 7.7–47.0 mL) (p < 0.001), respectively. CONCLUSIONS: The use of a depth camera to provide visual biofeedback increased the reproducibility of breath-hold expiration level in healthy volunteers, with a potential to eliminate targeting errors caused by respiratory movement during lung image-guided procedures.