scholarly journals PO-0700: Significant heart dose reduction by deep inspiration breath hold for RT of esophageal cancer

2017 ◽  
Vol 123 ◽  
pp. S366-S367
Author(s):  
M. Dieters ◽  
J.C. Beukema ◽  
A.C.M. Van den Bergh ◽  
E.W. Korevaar ◽  
N.M. Sijtsema ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Dose Reduction ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose

Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation

2015 ◽  
Vol 114 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Thomas Mulliez ◽  
Liv Veldeman ◽  
Bruno Speleers ◽  
Khalil Mahjoubi ◽  
Vincent Remouchamps ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Irradiation ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose

Dosimetric effects of deep inspiration breath hold for radiation treatment of esophageal cancer based on tumor location.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 173-173
Author(s):  
Kaleigh Doke ◽  
Rajeev Badkul ◽  
Nathan Aguilera ◽  
Melissa Pulfer Mitchell ◽  
Xinglei Shen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Treatment ◽  
Statistical Significance ◽  
Gastroesophageal Junction ◽  
Conformal Radiotherapy ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Dose Volume Histograms ◽  
Heart Dose

173 Background: Deep inspiration breath hold (DIBH) has been shown to reduce heart and lung doses in radiation treatment of breast cancer and lymphoma. We investigated its application for treatment of esophageal cancer. Methods: Five patients who had DIBH simulation for diagnoses with chest scans were studied. Patients were simulated supine with 2 CT scans each: free breathing (FB) and DIBH using surface infrared markers. The patients were contoured using standard volumes as per RTOG 1010, including a 45 Gy planning target volume (PTV). Both a mid-esophagus and distal PTV were created for each of the model patients, by contouring 5 cm tumor volumes at the level of the carina and gastroesophageal junction. Normal structures were contoured as well. For distal tumors, the celiac nodes were covered electively as per RTOG 1010. Uniform three dimensional conformal radiotherapy plans were generated and normalized to provide 100% dose coverage to 95% of the PTV. Dose volume histograms were generated and evaluated. A 2-tailed paired student’s T-test was used to evaluate statistical significance. Results: When comparing the changes in dose to the normal structures with breath hold, a contrasting trend was seen between proximal and distal tumors. The mean heart dose and V40 decreased with breath hold for proximal tumor plans, however the heart dose metrics increased with breath hold for distal tumors. For the proximal tumor plans, the lung mean, V20, V10 and V5 decreased with breath hold in all patients. For distal tumors, mean lung doses trended towards an increase. Conclusions: Dosimetric parameters uniformly improved for proximal tumors with DIBH. By contrast, distal tumors often showed worsening of heart and lung dosimetry with DIBH. This appeared to be related to entry of the lung volume into the celiac nodal field, among other factors. [Table: see text]

scholarly journals Dosimetric evaluation of deep inspiration breath hold for left-sided breast cancer: analysis of patient-specific parameters related to heart dose reduction

2020 ◽  
Vol 61 (3) ◽  
pp. 447-456 ◽  
Author(s):  
Ryohei Yamauchi ◽  
Norifumi Mizuno ◽  
Tomoko Itazawa ◽  
Hidetoshi Saitoh ◽  
Jiro Kawamori
Keyword(s):  
Dose Reduction ◽  
Patient Specific ◽  
Breath Hold ◽  
Relative Reduction ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose ◽  
Dose Volume ◽  
The Mean ◽  
Mean Heart Dose

Abstract Deep inspiration breath hold (DIBH) is a common method used worldwide for reducing the radiation dose to the heart. However, few studies have reported on the relationship between dose reduction and patient-specific parameters. The aim of this study was to compare the reductions of heart dose and volume using DIBH with the dose/volume of free breathing (FB) for patients with left-sided breast cancer and to analyse patient-specific dose reduction parameters. A total of 85 Asian patients who underwent whole-breast radiotherapy after breast-conserving surgery were recruited. Treatment plans for FB and DIBH were retrospectively generated by using an automated breast planning tool with a two-field tangential intensity-modulated radiation therapy technique. The prescribed dose was 50 Gy in 25 fractions. The dosimetric parameters (e.g., mean dose and maximum dose) in heart and lung were extracted from the dose–volume histogram. The relationships between dose–volume data and patient-specific parameters, such as age, body mass index (BMI), and inspiratory volume, were analyzed. The mean heart doses for the FB and DIBH plans were 1.56 Gy and 0.75 Gy, respectively, a relative reduction of 47%. There were significant differences in all heart dosimetric parameters (p < 0.001). For patients with a high heart dose in the FB plan, a relative reduction of the mean heart dose correlated with inspiratory volume (r = 0.646). There was correlation between the relative reduction of mean heart dose and BMI (r = −0.248). We recommend considering the possible feasibility of DIBH in low BMI patients because the degree of benefit from DIBH varied with BMI.

scholarly journals Planning strategies and practical implementation of the cardiac dose reduction in the left-side breast irradiation with the deep inspiration breath-hold (DIBH) method

2017 ◽  
Vol 3 (2) ◽  
pp. 347-350
Author(s):  
Linda Wagner ◽  
Thomas Koch ◽  
Antje Fahrig
Keyword(s):  
Dose Reduction ◽  
Maximum Dose ◽  
Heart Diseases ◽  
Thoracic Wall ◽  
Breath Hold ◽  
Practical Implementation ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Increased Risk ◽  
The Mean

AbstractBackground: Despite of the use of tangential beam directions during the irradiation of mammary carcinomas, a dose reduction of the heart cannot always be achieved. This is decivise for the increased risk of heart diseases and the associated mortality. Especially affected is the cardiac apex. However, by using respiratory gated treatment techniques, like the deep inspiration breath-hold (DIBH), a dose sparing of this area can be reached.Material and Methods: The Elekta ABC system was used to control the respiratory stop of early staged breast cancer patients. The treatment planning was implemented by a 3D and VMAT technique. The focus was the optimization of irradiation plans and the evaluation of the respective dose exposure to the heart, the left ventricle and the left anterior descending coronary artery (LAD artery). A planning concept of 28 x 2,25 Gy in the SIB and 28 x 1,8 Gy in the left breast was used.Results: The results showed that a dose reduction of 30-40% in mean and maximal in all structures is possible by using the VMAT technique in combination with the ABC system. In the case of 3D irradiation planning, a substantial relief can only be seen at the mean dose exposure of approximately 50%. Also, only a maximum dose reduction of 13% could be achieved.Conclusion: The mean dose reduction was mainly achieved by the increased distance between the heart and the thorax wall. The maximum dose was reduced by the volumentric optimization algortihm of the VMAT and the resulting steeper dose fall-off at the inner thoracic wall. Due to the lack of this optimization and thus the greater dose drop, the maximum dose of the 3D plans could only reduced by 13%.

scholarly journals Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation

2016 ◽  
Vol 16 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Steve Walston ◽  
Allison M. Quick ◽  
Karla Kuhn ◽  
Yi Rong
Keyword(s):  
Chest Wall ◽  
Lung Volume ◽  
Left Lung ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Lung Dose ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose

Purpose: To present our clinical workflow of incorporating AlignRT for left breast deep inspiration breath-hold treatments and the dosimetric considerations with the deep inspiration breath-hold protocol. Material and Methods: Patients with stage I to III left-sided breast cancer who underwent lumpectomy or mastectomy were considered candidates for deep inspiration breath-hold technique for their external beam radiation therapy. Treatment plans were created on both free-breathing and deep inspiration breath-hold computed tomography for each patient to determine whether deep inspiration breath-hold was beneficial based on dosimetric comparison. The AlignRT system was used for patient setup and monitoring. Dosimetric measurements and their correlation with chest wall excursion and increase in left lung volume were studied for free-breathing and deep inspiration breath-hold plans. Results: Deep inspiration breath-hold plans had significantly increased chest wall excursion when compared with free breathing. This change in geometry resulted in reduced mean and maximum heart dose but did not impact lung V20 or mean dose. The correlation between chest wall excursion and absolute reduction in heart or lung dose was found to be nonsignificant, but correlation between left lung volume and heart dose showed a linear association. It was also identified that higher levels of chest wall excursion may paradoxically increase heart or lung dose. Conclusion: Reduction in heart dose can be achieved for many left-sided breast and chest wall patients using deep inspiration breath-hold. Chest wall excursion as well as left lung volume did not correlate with reduction in heart dose, and it remains to be determined what metric will provide the most optimal and reliable dosimetric advantage.

Evaluation of an in-house self-held respiration monitoring device for deep inspiration breath hold techniques for radiotherapy of patients with cancer of the left breast

2019 ◽  
Vol 19 (2) ◽  
pp. 122-126
Author(s):  
Yuen Yan Chan ◽  
Ki Man Ku ◽  
Yin Ping Ng ◽  
Siu Ki Ben Yu ◽  
Chi Wah Tony Kong ◽  
...  
Keyword(s):  
Maximum Dose ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Monitoring Device ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Respiration Monitoring ◽  
Heart Dose ◽  
Mean Error

AbstractBackground:An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.Methods and materials:Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.Results:Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.Conclusion:This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.

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