SU-E-T-615: Clinical Implementation of Deep Inspiration Breath-Hold for Left Breast Cancers Treatment

Abstract

Purpose: This study presents the development and implementation of the clinical workflow of Deep Inspiration Breath Hold (DIBH) radiation therapytreatment for left breast cancer patients, which includes patient simulation, treatment planning (TP) and treatmentdelivery. Materials: DIBH is used for left chest‐wall or left breast cancer patients where the heart is within the tangential fields. The patient must be able to maintain the breath hold for approximately 30 seconds. The procedure involves monitoring of patients' breathing motion using Varian Real‐time Position Management (RPM) System to ensure that the patients' breathing position matches an established reference position during CT scan. The CT scan of the patient during DIBH and Free breathing (FB) are taken; DIBH scan is used for treatment planning and FB scan for setup. The TP is performed in Eclipse TP system using DIBH scan. Installed camera monitors the patients' free breathing and DIBH inhalation. The displacements between the two are displayed visually and numerically in real time by the graphical user interface. The treatment beam is active only when the displacements are within predetermined tolerances, which is set during DIBH CT scan as the reference. In order to ensure reproducible and stable DIBH level, an installed camera at the treatment room provides visual aid. Visual aid allows the patient to see a graphical display of real time displacements. The patient can then inhale the same volume as the treatment plan reference position at CT. Results: Patients' education to hold their breath and practice before simulation is important. Visual aid is provided to ensure reproducible and stable DIBH level. The procedure has been tested in phantom and volunteers. Conclusions: The workflow for DIBH left breast cancerradiation therapy has been developed and the technique is ready to treat patients. Clinical experience will be discussed as it becomes available.