scholarly journals Application Of The Mean Absolute Dose Deviation To The Dosimetric Gain Analysis Of Left Whole Breast Radiotherapy By Prone-Free Breathing Versus Supine-Deep Inspiration Breath Hold (DiBH)

2020 ◽  
Vol 108 (3) ◽  
pp. e764-e765
Author(s):  
V. Vinh-Hung ◽  
X. Wang ◽  
G. Dipasquale ◽  
O. Fargier-Bochaton ◽  
M. Kountouri ◽  
...  
Keyword(s):  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Radiotherapy ◽  
Deep Inspiration Breath Hold ◽  
Whole Breast Radiotherapy ◽  
The Mean

scholarly journals Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

2021 ◽  
Author(s):  
Xinzhuo Wang ◽  
Odile Fargier-Bochaton ◽  
Giovanna Dipasquale ◽  
Mohamed Laouiti ◽  
Melpomeni Kountouri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Deep Inspiration Breath Hold ◽  
Number Of Patients ◽  
Whole Breast Radiotherapy

Abstract Purpose The advantage of prone setup compared with supine for left-breast radiotherapy is controversial. We evaluate the dosimetric gain of prone setup and aim to identify predictors of the gain. Methods Left-sided breast cancer patients who had dual computed tomography (CT) planning in prone free breathing (FB) and supine deep inspiration breath-hold (DiBH) were retrospectively identified. Radiation doses to heart, lungs, breasts, and tumor bed were evaluated using the recently developed mean absolute dose deviation (MADD). MADD measures how widely the dose delivered to a structure deviates from a reference dose specified for the structure. A penalty score was computed for every treatment plan as a weighted sum of the MADDs normalized to the breast prescribed dose. Changes in penalty scores when switching from supine to prone were assessed by paired t-tests and by the number of patients with a reduction of the penalty score (i.e., gain). Robust linear regression and fractional polynomials were used to correlate patients’ characteristics and their respective penalty scores. Results Among 116 patients identified with dual CT planning, the prone setup, compared with supine, was associated with a dosimetric gain in 72 (62.1%, 95% CI: 52.6–70.9%). The most significant predictors of a gain with the prone setup were the breast depth prone/supine ratio (>1.6), breast depth difference (>31 mm), prone breast depth (>77 mm), and breast volume (>282 mL). Conclusion Prone compared with supine DiBH was associated with a dosimetric gain in 62.1% of our left-sided breast cancer patients. High pendulousness and moderately large breast predicted for the gain.

scholarly journals EP-1316: Prone breast radiotherapy in prone: free breathing, deep inspiration breath hold and inspiration gating

2015 ◽  
Vol 115 ◽  
pp. S710
Author(s):  
M. Swimberge ◽  
V. Remouchamps ◽  
L. Veldeman ◽  
T. Mulliez ◽  
B. Speelers ◽  
...  
Keyword(s):  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Radiotherapy ◽  
Deep Inspiration Breath Hold

EP-1636: Left sided breast radiotherapy with respiratory gating: Deep inspiration breath hold versus free breathing

2014 ◽  
Vol 111 ◽  
pp. S219-S220
Author(s):  
B. Gunhan ◽  
A. Arifoglu ◽  
Z. Ozen ◽  
R. Ibrahimov ◽  
N. Kayalilar ◽  
...  
Keyword(s):  
Respiratory Gating ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Radiotherapy ◽  
Deep Inspiration Breath Hold

scholarly journals Dosimetric comparison of deep inspiration breath hold and free breathing technique in stereotactic body radiotherapy for localized lung tumor using Flattening Filter Free beam

2018 ◽  
Vol 24 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Karthick Raj Mani ◽  
Md. Anisuzzaman Bhuiyan ◽  
Md. Mahbub Alam ◽  
Sharif Ahmed ◽  
Mostafa Aziz Sumon ◽  
...  
Keyword(s):  
Lung Tumor ◽  
Free Breathing ◽  
Target Volume ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Ipsilateral Lung ◽  
Flattening Filter Free ◽  
Flattening Filter ◽  
The Mean

Abstract Aim: To compare the dosimetric advantage of stereotactic body radiotherapy (SBRT) for localized lung tumor between deep inspiration breath hold technique and free breathing technique. Materials and methods: We retrospectively included ten previously treated lung tumor patients in this dosimetric study. All the ten patients underwent CT simulation using 4D-CT free breathing (FB) and deep inspiration breath hold (DIBH) techniques. Plans were created using three coplanar full modulated arc using 6 MV flattening filter free (FFF) bream with a dose rate of 1400 MU/min. Same dose constraints for the target and the critical structures for a particular patient were used during the plan optimization process in DIBH and FB datasets. We intend to deliver 50 Gy in 5 fractions for all the patients. For standardization, all the plans were normalized at target mean of the planning target volume (PTV). Doses to the critical structures and targets were recorded from the dose volume histogram for evaluation. Results: The mean right and left lung volumes were inflated by 1.55 and 1.60 times in DIBH scans compared to the FB scans. The mean internal target volume (ITV) increased in the FB datasets by 1.45 times compared to the DIBH data sets. The mean dose followed by standard deviation (x̄ ± σx̄) of ipsilateral lung for DIBH-SBRT and FB-SBRT plans were 7.48 ± 3.57 (Gy) and 10.23 ± 4.58 (Gy) respectively, with a mean reduction of 36.84% in DIBH-SBRT plans. Ipsilateral lung were reduced to 36.84% in DIBH plans compared to FB plans. Conclusion: Significant dose reduction in ipsilateral lung due to the lung inflation and target motion restriction in DIBH-SBRT plans were observed compare to FB-SBRT. DIBH-SBRT plans demonstrate superior dose reduction to the normal tissues and other critical structures.

scholarly journals Breath Hold Breast Radiotherapy In The Era of Precision Medicine: Appropriate Selection for Left Descending Artery Sparing

2020 ◽  
Author(s):  
Edy Ippolito ◽  
Carlo Greco ◽  
Maristella Marrocco ◽  
Silvia Gentile ◽  
Serena Palizza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Minimum Distance ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Operating Characteristics ◽  
Breast Radiotherapy ◽  
Heart Volume ◽  
Deep Inspiration Breath Hold ◽  
Whole Breast Radiotherapy

Abstract Background and purpose To identify anatomical and/or preplanning characteristics correlated with left descending artery (LAD) dose and therefore provide guidance in the selection of patients with left-breast cancer that could benefit the most from the use of deep inspiration breath hold radiotherapy (DIBH-RT). Materials and methods We retrospectively identified patients with left-sided breast cancer who underwent whole breast radiotherapy in DIBH and extracted data from treatment plans in free-breathing (FB) and DIBH. The following anatomical parameters were obtained from the planning CTs in FB: lung volume, heart volume, breast separation, minimum distance from LAD to tangent open field. Receiving operating characteristics was also performed to define the cut-off point of parameters to use in LAD dosimetry prediction. Areas under the curve (AUCs) were calculated for all variables. Post-test probability has been calculated to evaluate advantage for parameters combination. Results One hundred ninety-seven patients were identified. The strongest predictor at FB CT scan of LAD maximum dose > 10 Gy and a LAD mean dose > 4 Gy was the minimum distance of LAD from tangent open fields. Adding consecutively other preplanning anatomic parameters, the positive predictive value (PPV) to identify patients at risk of higher dose to LAD was > 90%. Conclusions The dosimetric benefit of DIBH is valid for all patients and DIBH should be preferred for all left sided patients; however we can identify a subgroup of patients who benefit the least from DIBH. This is the group with favorable anatomy: limited breast separation, well expanded lungs, LAD distant from open tangent fields.

scholarly journals Deep inspiration breath hold reduces the mean heart dose in left breast cancer radiotherapy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Michał Falco ◽  
Bartłomiej Masojć ◽  
Agnieszka Macała ◽  
Magdalena Łukowiak ◽  
Piotr Woźniak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Cancer Patients ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose ◽  
The Mean ◽  
Mean Heart Dose

Abstract Background Patients with left breast cancer who undergo radiotherapy have a non-negligible risk of developing radiation-induced cardiovascular disease (CVD). Cardioprotection can be achieved through better treatment planning protocols and through respiratory gating techniques, including deep inspiration breath hold (DIBH). Several dosimetric studies have shown that DIBH reduces the cardiac dose, but clinical data confirming this effect is limited. The aim of the study was to compare the mean heart dose (MHD) in patients with left breast cancer who underwent radiotherapy at our institution as we transitioned from non-gated free-breathing (FB) radiotherapy to gated radiotherapy (FB-GRT), and finally to DIBH. Patients and methods Retrospective study involving 2022 breast cancer patients who underwent radiotherapy at West Pomeranian Oncology Center in Szczecin from January 1, 2014 through December 31, 2017. We compared the MHD in these patients according to year of treatment and technique. Results Overall, the MHD for patients with left breast cancer in our cohort was 3.37 Gy. MHD values in the patients treated with DIBH were significantly lower than in patients treated with non-gated FB (2.1 vs. 3.48 Gy, p < 0.0001) and gated FB (3.28 Gy, p < 0.0001). The lowest MHD values over the four-year period were observed in 2017, when nearly 85% of left breast cancer patients were treated with DIBH. The proportion of patients exposed to high (> 4 Gy) MHD values decreased every year, from 40% in 2014 to 7.9% in 2017, while the percentage of patients receiving DIBH increased. Conclusions Compared to free-breathing techniques (both gated and non-gated), DIBH reduces the mean radiation dose to the heart in patients with left breast cancer. These findings support the use of DIBH in patients with left breast cancer treated with radiotherapy.

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