Deep Inspiration Breath Hold Technique Research Articles

Radiotherapy without tattoos: Could this work?

IntroductionAn evaluation to compare the traditional tattoo based set up procedure with a surface guided method to assess the possibility of eliminating permanent tattoos in breast cancer patents who are undergoing radiotherapy to the breast/chest wall. MethodsForty-three patients that were having radiotherapy to the breast or chest wall were included in this evaluation. The patients were divided into two groups and further divided into 2 sub-groups. The first group received standard dark ink tattoos and were positioned by aligning these tattoos with lasers. The second group had no tattoo's and were positioned using the Surface-Guided technology (SGRT). Within each group the patients were split into 2 sub-group; right and left sided treatment areas. The right side were treated using a Free-Breathing (FB) technique and the left sided were treated using a Deep-Inspiration Breath-Hold (DIBH) technique. ResultsFor the patients having right sided breast radiotherapy, the mean shift using the standard tattoos and laser set up was 0.52 cm, compared with using the SGRT method where the mean shift was 0.47 cm. (p-value 0.04)For patients having left sided breast radiotherapy with DIBH the mean shift using the standard tattoo's and laser set up was 0.76 cm, compared with a mean shift of 0.45 cm using SGRT alone (p-value < 0.001). ConclusionThe elimination of tattoos together with SGRT offers a comparable set-up for right sided breast treatments against the traditional tattoo method. A significant set-up improvement was observed for the left sided breast DIBH treatments. Implications for practiceTo set up patients having breast Radiotherapy, with no tattoo's.

Selection of patients with left breast cancer for IMRT with deep inspiration breath-hold technique

The deep inspiration breath-hold (DIBH) technique has been utilized to reduce the cardiac dose in left-sided breast cancer (BC) patients undergoing radiotherapy. Further investigation of the parameters for selecting which patients will benefit most from DIBH is essential. We performed dosimetric comparisons for 21 patients with left-sided BC who had both computed tomography (CT)-based free-breathing (FB) and DIBH plans. The doses to the heart and left anterior descending artery (LAD) and any reduction due to the DIBH technique were analysed. Based on CTFB plans, dosimetric analysis revealed that the irradiation doses to the heart and LAD were significantly correlated with the target volume, the ipsilateral lung volume (ILV) and the total lung volume (TLV). When patients had an ILV ≥ 950 cm3 or a TLV ≥ 2200 cm3, the irradiation doses to the heart and LAD were significantly decreased. Furthermore, the reduction in the mean heart dose (MHD) was correlated to the difference in lung volume between FB and DIBH. The difference in ILV between DIBH and FB of 1.8 indicated that the patients obtained more benefit from the DIBH technique. The data suggest that lung volume (ILV and TLV) measured on a CT-simulation scan and the difference between FB and DIBH could be utilized to help select patients for DIBH.

Application of surface image guided radiotherapy (SIGRT) for deep inspiration breath-hold and free breathing gating technique in Pantai Hospital Kuala Lumpur

Pantai Hospital Kuala Lumpur (PHKL) has integrated Surface Image Guided Radiotherapy (SIGRT), C-RAD Catalyst HD camera in radiotherapy treatment over the 12 months. It eases us in setting up patients before treatment, monitoring intrafraction treatment and allows Deep Inspiration Breath-Hold (DIBH) treatment delivery. Positioning patients using Catalyst gives correctable error in 6-dimension and the shifts were small and acceptable. However, C-RAD is not the gold standard for positioning compared to CBCT but it has the advantage in terms of monitoring patient surface motion during treatment especially DIBH treatments. Target volume coverage for DIBH plan is improved by 0.6% to 1.8% compared to FB plan. This study also compare dose to the heart using DIBH technique over the free breathing (FB) technique for left breast cases. Maximum dose to the heart in DIBH is reduced by 18% compared to FB. Treatment of left breast with DIBH results in significant reductions in doses to the heart, since the distance between the target and the heart is increase compare to FB technique.

5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer

Abstract Background Radiation treatment to the left breast is associated with increased cardiac morbidity as well as mortality. Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) could have dosimetric advantages over the free breathing technique (NB, normal breathing) in cardiac (heart and LAD) and ipsilateral lung sparing in patients with left-sided breast cancer after surgery. Therefore this technique was implemented in 2013 at the institute of radiooncology at the KFJ/SMZ-South – Hospital Vienna. Methods From Oct 2013 – December 2018 548 patients were referred to radiotherapy following conservative operation of left-sided invasive breast cancer. All patients gave their informed consent and underwent training sessions for the DIBH-technique independent of age or breathing activity or respiratory disorders. Patients who turned out to be unfit for DIBH were enrolled for NB. The relative reduction in Dmean heart and left lung dose was compared between the two cohorts. Acute radiation induced side effects were classified according to the Radiation Therapy Oncology Group/The European Organisation for Research (RTOG) 37; late toxicity rates according to the Common Terminology Criteria for Adverse Events (CTCAE Version 4.03) Results The median age of the DIBH-patients was 58 years (27–90), of the NB-patients 65 (30–80) years. Follow-up was obtained until June 2019. The median follow-up was 52 months (range 7–73 m). The average coverage of Dmean left lung was 6.91 Gy (1.44 Gy – 12.4 Gy). The average coverage of Dmean heart was 1.17 Gy (0.12 Gy – 3.19 Gy) in the DIBH-cohort. The NB – plans had a Dmean of 8.92 Gy (5.23–16.9 Gy) at the ipsilateral lung and a Dmean of 2.31 Gy (0.71–4.21 Gy) at the heart. This shows that the DIBH-technique halved the Dmean of the heart. The amount of acute side effects was comparable between the two groups: RTOG 1: 70.8 % vs. 64 %, RTOG 3 6.6 % vs. 5.6 %, no reaction 3.2 % vs. 1.4 %. There were more CTCAE 1-late events in the NB-group (51.6 % vs. 12.67 %). Conclusion Deep inspiration breath-hold (DIBH) technique with Surface Guided Radiation Therapy (SGRT) is a rather simple, reproducable method with a high acceptance of the patients who can actively participate in the whole treatment process. The mean dose at the heart and the left lung can be reduced, at the heart even by as much as 50 %.

A Comparative Study of 3-D Conformal Radiotherapy Treatment Plans with and Without Deep Inspiration Breath-Hold Technique for Left-Sided Breast Cancer

Introduction: The rate of cardiac diseases have increased among patients who underwent radiotherapy for left-sided breast cancer. The study’s aim was evaluate the dose to organs at risk in free-breathing 3-dimensional conformal (FB-3DCRT) against 3-dimensional conformal deep inspiration breath-hold (3DCRT-DIBH) in patients with left-sided breast cancer. Material and Methods: In total, 15th female patients diagnosed with left-sided breast cancer were included in this study from December 2017 to December 2018. All selected patients were subjected to FB and DIBH computed tomography (CT) scans. The 3DCRT plans were created on both DIBH and FB scans for each selected patient. Various doses were obtained from dose-volume histograms and then compared. The data were analyzed in SPSS software (version 20) (IBM; IL). P-value less than 0.05 was considered statistically significant. Results: The results obtained from the DIBH and FB conditions were compared. The average maximum dose and V95% for planning target volume was approximate for both DIBH and FB, and the average mean doses to the heart, left anterior descending artery, and left lung were decreased by 40.50% (P=0.0003), 54.30% (P=0.02),and 18.50% (P=0.0002) in DIBH, respectively. Moreover, the heart V25% and V30% were decreased by 36% (P=0.06) and 35.8 % (P=0.03) in DIBH, respectively. Regarding the left lung, a decrease by 18.10% in V10% (P=0.0006) and 18% in V20% (P=0.0002) was also observed in DIBH. Conclusion: The 3DCRT-DIBH for patients with left-sided breast cancer maintained the benefits of radiotherapy while minimizing cardiac risks. All patients completed their treatment smoothly.

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care.

Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

Abstract P4-12-29: Utility of surface guide radiation therapy (SGRT) in radiation therapy for breast cancer

Abstract Purpose: Radiation therapy has been shown to be a highly effective treatment for breast cancer. Historically, patient setup for daily treatment has required a set of permanent tattoos. However, due to a variety of reasons, it may be hard to align patients to these marks and the marks can also cause distress in many patients. National Comprehensive Cancer Network’s (NCCN) radiation therapy guidelines recommend weekly radiation ports films; however, many centers perform daily image guidance using x-rays for breast treatments prior to radiation delivery, increasing both radiation dose and treatment time. Surface Guided Radiation Therapy (SGRT) is a technique which is being adopted by radiation therapy centers to aid in patient’s setup and treatment delivery accuracy. SGRT is safe and non-invasive, using visible light to compare the patient’s skin surface in the treatment room to the planned treatment position with sub-millimeter accuracy. SGRT can also automatically signal for the treatment delivery system to pause radiation if the patient moves out of the desired position. The aim of this study was to evaluate the AlignRT (Vision RT, Ltd, London, United Kingdom) SGRT system for patient setup accuracy in comparison to a 3-point tattoo setup and daily KV pair imaging. Methods: A total of 20 breast cancer patients (600 radiation fractions) were setup using a 3-point tattoo technique and then positioned using AlignRT. Inter-fraction positions were analyzed between all three techniques, namely tattoo, AlignRT and kV imaging. In addition, the AlignRT system was used to evaluate that patient’s position during breath hold. This deep inspiration breath hold (DIBH) technique is designed to provide cardiac sparing during left breast radiotherapy. Results: Using 3-point tattoo setup, an average magnitude of 5.7±3 mm error from isocenter was measured, compared to 2.4±1 mm using surface guidance. Statistically significant 3d shift vectors were found between patient setup using 3-point tattoo and SGRT techniques, however between SGRT and daily KV imaging 3d shift vectors were not statistically significant. AlignRT based DIBH showed the distance between the heart and chest-wall at the mid tangential beam level, based on weekly port films, to be within 2±1 mm of the planned level. Conclusion: SGRT has been shown to improve the accuracy of patient setup compared to 3-point tattoos and is comparable to daily KV imaging for isocentric setup. SGRT can be used in clinics to reduce the frequency of KV imaging and therefore additional radiation exposure. SGRT can also remove setup tattoo requirements which are placed during simulation which provide a permanent reminder to patients of their cancer and treatment. SGRT has also been demonstrated to ensure adequate and reproducible breath hold for DIBH left sided breast treatments. Citation Format: Snehal Desai. Utility of surface guide radiation therapy (SGRT) in radiation therapy for breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-29.

Hypofractionated Radiotherapy Dose Scheme and Application of New Techniques Are Associated to a Lower Incidence of Radiation Pneumonitis in Breast Cancer Patients.

Purpose: Radiation pneumonitis (RP) is one of the most severe toxicities experienced by patients with breast cancer after radiotherapy (RT). RT fractionation schemes and techniques for breast cancer have undergone numerous changes over the past decades. This study aimed to investigate the incidence of RP as a function of such changes in patients with breast cancer undergoing RT and to identify dosimetric markers that predict the risk of this adverse event.Methods and Materials: We identified 1,847 women with breast cancer who received adjuvant RT at our institution between 2015 and 2017. The RT technique was individually tailored based on each patient's clinicopathological features. Deep inspiration breath hold technique or prone positioning were used for patients who underwent left whole-breast irradiation for cardiac sparing, while those requiring regional lymph node irradiation underwent volumetric-modulated arc therapy (VMAT).Results: Of 1,847 patients who received RT, 21.2% received the conventional dose scheme, while 78.8% received the hypofractionated dose scheme (mostly 40 Gy in 15 fractions). The median follow-up period was 14.5 months, and the overall RP rate was 2.1%. The irradiated organ at risk was corrected concerning biologically equivalent dose. The ipsilateral lung V30 in equivalent dose in 2 Gy (EQD2) was the most significant dosimetric factor associated with RP development. Administering RT using VMAT, and hypofractionated dose scheme significantly reduced ipsilateral lung V30.Conclusions: Application of new RT techniques and hypofractionated scheme significantly reduce the ipsilateral lung dose. Our data demonstrated that ipsilateral lung V30 in EQD2 is the most relevant dosimetric predictor of RP in patients with breast cancer.

Radiation effect on late cardiopulmonary toxicity: An analysis comparing supine DIBH versus prone techniques for breast treatment.

Two commonly used whole breast irradiation (WBI) techniques, deep inspiration breath hold (DIBH) and prone positioning, are compared with regard to dosimetry and estimated late cardiac morbidity and secondary lung cancer mortality using published models. Forty patients with left-sided DCIS or breast cancer who underwent lumpectomy and required adjuvant WBI were enrolled on a prospective trial comparing supine DIBH (S-DIBH) with prone free breathing (P-FB) planning. Patients underwent CT simulation in both positions; two plans were generated for each patient. Comparative dosimetry was available for 34 patients. Mean cardiac and lung doses were calculated. Risk of death from ischemic heart disease (IHD), risk of at least one acute coronary event (ACE), and lung cancer mortality were estimated from published data. Difference between S-DIBH and P-FB plans was compared using paired two-tailed t test. Estimated mean risk of death from IHD by age 80 was 0.1% (range 0.0%-0.2%) for both plans (P=1.0). Mean risk of at least one ACE was 0.3% (range 0.1%-0.6%) for both plans (P=.6). Mean lung cancermortality risk was 1.4% (range 0.5%-15.4%) for S-DIBH and 1.0% (range 0.4%-9.8%) for P-FB (P=.008). Excess lung cancer mortality due to radiation was 0.5% (range 0.1%-6.0%) with S-DIBH and 0.0% (range 0.0%-0.4%) with P-FB (P=.008). Both S-DIBH and P-FB provide excellent cardiac sparing. Prone positioning results in lower lung dose than S-DIBH and leads to an absolute decrease of 0.5% in excess lung cancer mortality for patients receiving WBI.

Dosimetric and clinical advantages of adapting the DIBH technique to hybrid solitary dynamic portal radiotherapy for left-sided chest-wall plus regional nodal irradiation

To evaluate the dosimetric and clinical advantages of using deep-inspiration breath-hold (DIBH) technique in hybrid solitary dynamic portal radiotherapy (hSDPRT) for left-sided chest-wall plus regional nodal irradiation and to demonstrate a simplified strategy for preclinical commissioning and calibration of DIBH-gating technique. Fifteen patients with left-sided breast cancer who underwent postmastectomy radiotherapy using hSDPRT were retrospectively evaluated. Two sets of planning-CT images were acquired for each patient, one with free/normal breathing and the other with DIBH. The hSDPRT plans were computed to deliver about 85% of the prescribed dose using static open fields and 15% of dose using a less complex solitary dynamic field. The dosimetric differences between the paired samples were compared using the Wilcoxon signed-rank test. For clinical commissioning of gated treatments, a respiratory simulator equipped with a microcontroller was programmed to simulate free-breathing and DIBH-patterns using a custom-developed android application. While both the hSDPRT plans displayed identical target coverage on both the image-sets, the DIBH technique resulted in statistically significant differences in various dose-volume metrics of heart, left-anterior-descending artery, and ipsilateral-lung structures. The hSDPRT plan with DIBH entails reduced total monitor unit (354.9 ± 13.6 MU) and breath-hold time ranging from 2.9 ± 0.3 to 13.7 ± 0.8 seconds/field, along with an acceptable impact on overall machine throughput. DIBH is a feasible method to effectively address the delivery uncertainty and produce substantial sparing of heart and lung when combined with hSDPRT. Streamlined procedures for commissioning and calibration of DIBH-gating technique are essential for more efficient clinical practice.

P1355 Short-term cardiac side-effects from radiotherapy in women with breast cancer

Abstract Introduction Breast cancer radiotherapy provides an apparent benefit for long-term survival and local recurrence rate. However, there is still much concern about the early and late radiation-induced cardiac toxicity. Therefore, various radiotherapy techniques have been developed to reduce the cardiopulmonary radiation doses in patients with left-sided breast cancer, who are at particular risk of developing post-radiation cardiac injury. Aim We sought to investigate the early effect of radiotherapy on left (LV) and right ventricular (RV) function in females subjected to this treatment. Methods Fifty left-sided breast cancer patients , who underwent adjuvant radiotherapy between May 2017 and May 2018 were included in the study. Forty-nine enrollees were initially treated with breast conserving surgery, and 1 - with mastectomy and axillary lymph node resection. Adjuvant radiotherapy was carefully planned to minimize the radiation side effects and 37 patient received radiotherapy with deep inspiration breath hold technique and 13 patients with free breathing technique. In most cases (n = 33), 3D conformal tangential field radiation therapy was applied, 13 patients received radiotherapy with dynamic-Rapid-Arc technique with additional 3D fields, and 4 patients underwent radiotherapy only with Rapid-Arc technique. Before surgery and 3 months after radiotherapy, echocardiography with measurement of conventional cardiac function parameters, as well as LV and RV longitudinal deformation analysis by speckle tracking technique was performed, and venous blood for biomarkers - galectin-3 reflecting myocardial fibrosis and NT-proBNP was sampled. Results At a mean follow-up of 97 ± 19 days , there were no significant changes in any of the studied cardiac systolic or diastolic function parameters (Table). There were no relationships between the change in LV longitudinal strain at follow-up and type of radiotherapy, as well as type of radiotherapy gating (both R = 0.02, p = 0.90). Similarly, no analogous associations were demonstrated for RV longitudinal strain (R = 0.02, p = 0.88, and R = 0.04, p = 0.77, respectively). No significant changes were found post radiotherapy in serum galectin-3 (7.2 ± 2.6 ng/ml vs. 6.8 ± 2.5 ng/ml; p = 0.58) and NT-proBNP (83 ± 68 pg/ml vs. 84 ± 54 pg/ml; p = 0.90). Conclusions Breast cancer radiotherapy with the use of contemporary planning techniques shows an excellent early cardiac safety. Abstract P1355 Figure.

Deep inspiration breath-hold radiotherapy for left-sided breast cancer after conserving surgery: A dose reduction for organs at risk

Background/Aim. For patients with left-sided breast cancer, a major concern is the dose of radiation delivered to the heart, because of increased risk of exposure and consequently increased risk of major coronary events and side effects. In order to reduce the dose to the heart during breast irradiation, deep inspiration breath-hold (DIBH) technique was implemented in our institution. The aim of this retrospective study was to compare dosimetric parameters of DIBH on the heart, left anterior descending artery (LAD) and ipsilateral lung (IL), compared with free breathing (FB) technique. Methods. Twenty patients who underwent radiotherapy with DIBH at our institution were retrospectively analyzed. Two computed tomography (CT) scans were acquired for each patient, FB-CT and DIBH-CT. Plans consisted of two opposed tangential segmented beams and one direct beam with small dose contribution. Doses to the heart, LAD, and IL were assessed. Results. Dosimetric comparison between FB and DIBH for mean dose to the heart was 5.17 Gy vs. 3.68 Gy, respectively (p &lt; 0.0001), and the mean percentage of the volume receiving 25 Gy was 4.63% vs. 0.85%, respectively (p &lt; 0.0001). Mean dose for LAD was 26.09 Gy vs. 11.89 Gy, respectively (p = 0.00014). Mean percentage of the volume receiving 20 Gy for the IL was 15.16% vs. 13.26% (p = 0.0007) for FB and DIBH, respectively. Conclusion. Implementation of DIBH technique in radiotherapy treatment of patients with left-sided breast cancer statistically significantly reduces the dose delivered to the surrounding organs at risk, particularly to the heart and LAD, with optimal target coverage.

Resource to prepare patients for deep inspiration breath hold: the RESPIRE project

Introduction: Incidental irradiation of the heart during radiotherapy can have long-term consequences(1). Deep Inspiration Breath Hold (DIBH) is used for patients receiving radiotherapy for breast cancer to reduce heart doses(2). DIBH can reduce mean heart dose by between 29-67% compared with free breathing(3); differences in dose reduction may be due to patient anatomy or variability in chest expansion achieved at an individual level(4). A survey of a breast cancer special interest group (BRIG) identified patient compliance, ability to hold their breath for the required time, and reproducibility of breath hold as major challenges to implementing DIBH. Between 12-21% of patients are reported to find the technique challenging(5, 6). While coaching has been shown to reduce maximum heart dose compared with non-coached patients(7), formal coaching is not typical in most radiotherapy centres and no standard patient resource exists to support practice prior to radiotherapy planning. Aim: To develop a series of instructional videos to enhance the number of patients that can achieve breath hold, improve patient self-efficacy and patient satisfaction with care. Method: The Medical Research Council (MRC)(8) framework for complex interventions was adopted. A co-design methodology(9) involving patient representatives and health practitioners (HCP) was used to develop a series of instructional videos and podcasts. Co-design workshops were audio recorded and transcribed verbatim. Video scripts were based upon themes identified through framework analysis. To minimise bias member checking was adopted and patient representatives participated in video scripting; to maintain the outputs' authenticity they also appeared as patients in the videos. Results: Key themes from the PPI workshop included: information needs; positioning during radiotherapy; and pre-treatment readiness. Additional themes from the HCP workshop included DIBH service challenges and teaching the DIBH technique. Five videos and two podcasts were developed. Conclusion: This presentation will highlight how participatory co-design facilitated video development to support a more effective DIBH experience. Resource examples will be presented alongside initial feedback from patient representatives and HCPs on suitability and usability. The next stage will assess the resources' effectiveness in supporting breath hold capability.

Contribution of Deep Inspiration Breath-Hold Technique for Regional Nodal Irradiation Including Mammaria Interna in Mastectomized Left-Sided Breast Cancer Patients

Contribution of Deep Inspiration Breath-Hold Technique for Regional Nodal Irradiation Including Mammaria Interna in Mastectomized Left-Sided Breast Cancer Patients

Liver dose reduction by deep inspiration breath hold technique in right-sided breast irradiation

PurposeDeep inspiration breath hold (DIBH) is a well-established technique that enables efficient cardiac sparing in patients with left-sided breast cancer. The aim of the current study was to determine if DIBH is effective for reducing radiation exposure of of liver and other organs at risk in right breast radiotherapy (RT).Materials and MethodsTwenty patients with right-sided breast cancer were enrolled in this study. Three-dimensional conformal RT plans were generated for each patient, with two different computed tomography scans of free breathing (FB) and DIBH. Nodes were contoured according to the Radiation Therapy Oncology Group contouring guidelines. Dose-volume histograms for the target volume coverage and organs at risk were evaluated and analyzed.ResultsDIBH plans showed significant reduction in mean liver dose (5.59 ± 2.07 Gy vs. 2.54 ± 1.40 Gy; p = 0.0003), V20Gy (148.38 ± 73.05 vs. 64.19 ± 51.07 mL; p = 0.0003) and V10Gy (195.34 ± 93.57 vs. 89.81 ± 57.28 mL; p = 0.0003) volumes compared with FB plans. Right lung doses were also significantly reduced in DIBH plans. Heart and left lung doses showed small but statistically significant improvement with application of the DIBH technique.ConclusionWe report that the use of DIBH for right-sided breast cancer significantly reduces the radiation doses to the liver, lungs, and heart.

Pencil beam scanning proton therapy of Hodgkin's lymphoma in deep inspiration breath-hold: A case series report.

Most patients with Hodgkin's lymphoma are young and have a favourable prognosis, therefore it is of high importance to decrease the radiation doses to normal tissues received during radiotherapy. A combination of proton therapy and deep inspiration breath-hold technique (DIBH) can improve the sparing effect and thereby reduce the risk of late effects. The two first patient cases treated with proton therapy in DIBH at the Skandion Clinic, Uppsala, Sweden, are presented here. Proton treatment plans were compared to photon plans based on doses to target and organs at risk. Several CT scans were acquired during the treatment course and inter breath-hold variations were evaluated based on anatomical distances and dosimetric comparisons. The results from our first patients treated with proton therapy in DIBH imply that the treatment strategy is robust and has the potential to reduce dose to normal tissue.

6 Evaluation of a surface imaging system to perform deep inspiration breath-hold technique for external beam radiation therapy of left-sided breast cancer

Introduction. Deep inspiration breath-hold (DIBH) technique is used to reduce cardiac doses of left-sided breast radiation therapy. We studied the accuracy and time saving of using a 3-dimensional surface imaging technique with the AlignRT system (VisionRT) to perform DIBH instead of our usually used spirometry-based system.

Application of deep inspiration breath-hold technique in radiotherapy

In radiotherapy for thoracic and abdominal tumors, the negative effect of respiratory movement on radiotherapy persist throughout the whole process of radiotherapy. Deep inspiration breath-hold technique (DIBH) is a method of respiratory movement management in radiotherapy, which can reduce the negative effect of respiratory movement upon radiotherapy in the whole process of radiotherapy. Meantime, DIBH technique has its own characteristics and operation requirements compared with other respiratory movement management measures (such as 4D CT, gated technology and tracking, etc.). The aim of this review was to introduce the advantages, disadvantages and the application status of DIBH technique. Key words: Deep inspiration breath-hold; Neoplasm/radiotherapy

118 Dose-Sparing Effect of Deep Inspiration Breath Hold Technique on Coronary Artery and Left Ventricle Segments

118 Dose-Sparing Effect of Deep Inspiration Breath Hold Technique on Coronary Artery and Left Ventricle Segments

224 Radiation Doses to the Left Anterior Descending Artery and Heart in Left-Sided Breast Cancer Patients Treated with Deep Inspiration Breath Hold and Free Breathing Techniques

224 Radiation Doses to the Left Anterior Descending Artery and Heart in Left-Sided Breast Cancer Patients Treated with Deep Inspiration Breath Hold and Free Breathing Techniques