Deep inspirational breath hold to reduce cardiac dose in left-sided breast radiotherapy

2017 ◽  
Vol 16 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Camarie Welgemoed ◽  
Jonathan Rogers ◽  
Patti McNaught ◽  
Susan Cleator ◽  
Pippa Riddle ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Free Breathing ◽  
Good Method ◽  
Breath Hold ◽  
Treatment Area ◽  
Breast Radiotherapy ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose ◽  
Set Up ◽  
Mean Heart Dose

AbstractBackgroundDuring left-sided breast radiotherapy, the heart is often exposed to radiation dose. Shielding can be utilised to reduce heart exposure, but compromises the dose delivered to the breast tissue and, in a proportion of patients, to the tumour bed. Deep inspiration breath hold (DIBH) can be used as a technique to move the heart away from the treatment area and thus reduce heart dose. This study examines the efficacy of the Elekta Active Breathing Coordinator (ABC), a DIBH method, in reducing heart dose.Materials and methodsIn total, 12 patients receiving radiotherapy to the left breast were planned for treatment with both a free-breathing (FB) and an ABC scan. The dose volume histogram data for the plans was analysed with respect to heart V13, V5 Gy, mean heart dose and ipsilateral lung V18 Gy. Tumour bed D98%, threshold lung volume in breath hold (BH) and the maximum BH time for each patient was also measured. Patients then received their radiotherapy treatment using the ABC plan and the systematic error in the craniocaudal, lateral and vertical axes was assessed using orthogonal imaging.ResultsThe median heart V13 Gy for FB and DIBH patients was 3% (range, 0·85–11·28) and 0% (range, 0–1·56), respectively, with a mean heart dose of 2·62 Gy (range, 1·21–4·93) in FB and 1·51 Gy (range, 1·17–2·22) in ABC. The median lung V18 Gy was 8·7% (3·08–14·87) in FB plans and 9% (4·88–12·82) in ABC plans. The mean systematic set-up errors in all three planes were within the departmental set-up tolerance of 5 mm for both techniques. Median FB tumour bed D98% was 97·4% (92·8–99·5) and 97·5% (97·3–98·5) for ABC.ConclusionABC represents a good method of reducing radiation dose to the heart while not compromising on dose to the tumour bed, and it has a clear advantage over FB radiotherapy in reducing the risk of cardiac toxicity. It is tolerated well by patients and does not produce any difficulties in patient positioning.

scholarly journals Comparison of cardiac and lung doses for breast cancer patients with free breathing and deep inspiration breath hold technique in 3 dimensional conformal radiotherapy - a dosimetric study

2017 ◽  
Vol 23 (4) ◽  
pp. 109-114 ◽  
Author(s):  
Karthick Raj Mani ◽  
Suresh Poudel ◽  
K J Maria Das
Keyword(s):  
Left Lung ◽  
Free Breathing ◽  
Breath Hold ◽  
Relative Reduction ◽  
Deep Inspiration ◽  
Breast Irradiation ◽  
Data Set ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose ◽  
Mean Heart Dose

Abstract Purpose: To investigate the cardio-pulmonary doses between Deep Inspiration Breath Hold (DIBH) and Free Breathing (FB) technique in left sided breast irradiation. Materials & Methods: DIBH CT and FB CT were acquired for 10 left sided breast patients who underwent whole breast irradiation with or without nodal irradiation. Three fields single isocenter technique were used for patients with node positive patients along with two tangential conformal fields whereas only two tangential fields were used in node negative patients. All the critical structures like lungs, heart, esophagus, thyroid, etc., were delineated in both DIBH and FB scan. Both DIBH and FB scans were fused with the Dicom origin as they were acquired with the same Dicom coordinates. Plans were created in the DIBH scan for a dose range between 50 Gy in 25 fractions. Critical structures doses were recorded from the Dose Volume Histogram for both the DIBH and FB data set for evaluation. Results: The average mean heart dose in DIBH vs FB was 13.18 Gy vs 6.97 Gy, (p = 0.0063) significantly with DIBH as compared to FB technique. The relative reduction in average mean heart dose was 47.12%. The relative V5 reduced by 14.70% (i.e. 34.42% vs 19.72%, p = 0.0080), V10 reduced by 13.83% (i.e. 27.79 % vs 13.96%, p = 0.0073). V20 reduced by 13.19% (i.e. 24.54 % vs 11.35%, p = 0.0069), V30 reduced by 12.38% (i.e. 22.27 % vs 9.89 %, p = 0.0073) significantly with DIBH as compared to FB. The average mean left lung dose reduced marginally by 1.43 Gy (13.73 Gy vs 12.30 Gy, p = 0.4599) but insignificantly with DIBH as compared to FB. Other left lung parameters (V5, V10, V20 and V30) shows marginal decreases in DIBH plans compare to FB plans. Conclusion: DIBH shows a substantial reduction of cardiac doses but slight and insignificant reduction of pulmonary doses as compared with FB technique. Using the simple DIBH technique, we can effectively reduce the cardiac morbidity and at the same time radiation induced lung pneumonitis is unlikely to increase.

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.

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

Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy

2021 ◽  
Vol 100 (4) ◽  
Keyword(s):  
Breast Cancer ◽  
Radiation Dose ◽  
Organs At Risk ◽  
Left Lung ◽  
Free Breathing ◽  
Partial Mastectomy ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Dose Volume Histograms

Introduction: The purpose of this study was to compare the radiation dose to organs at risk for deep-inspiration breath hold (DIBH) and free-breathing (FB) radiotherapy in patients with lef-sided breast cancer undergoing adjuvant radiotherapy after partial mastectomy. Methods: One hundred patients with left-sided breast cancer underwent DIBH and FB planning computed tomography scans, and the 2 techniques were compared. Dose-volume histograms were analyzed for heart, left anterior descending coronary artery (LAD), and left lung. Results: Radiation dose to heart, LAD, and left lung was significantly lower for DIBH than for free breathing plans. The median mean heart dose for DIBH technique in comparison with FB was 1.21 Gy, and 3.22 Gy respectively; for LAD, 4.67 versus 24.71 Gy; and for left lung 8.32 Gy versus 9.99 Gy. Conclusion: DIBH is an effective technique to reduce cardiac and lung radiation exposure.

Mono versus dual isocentric technique for breast cancer radiotherapy: evaluation of planning, dosimetry and treatment delivery

2020 ◽  
pp. 1-6
Author(s):  
Tabassum Wadasadawala ◽  
Shirley Lewis ◽  
Utpal Gaikwad ◽  
Umesh Gayake ◽  
Reena Phurailatpam ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Total Error ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Imaging Device ◽  
Heart Dose ◽  
Breast Cancer Radiotherapy ◽  
Field Junction ◽  
Set Up ◽  
Mean Heart Dose

Abstract Aim: To compare the dosimetry and reproducibility of set-up with monoisocentric technique (MIT) and dual isocentric technique (DIT) in adjuvant breast radiotherapy (RT). Material and methods: Breast cancer patients treated with MIT or DIT were retrospectively studied. The organ-at-risk dose was compared between two groups. All patients underwent set-up verification with an electronic portal imaging device, and set-up time was recorded for each fraction. Treatment reproducibility was assessed in terms of systematic and random error. Results: Twenty patients were included (11 right and 9 left-sided tumours) and ten received whole breast RT, while the rest received chest wall RT. Overall, the mean heart dose was less with MIT (0.40 versus 0.79, p = <0.001) as well as in left-sided tumours (0.37 versus 0.98, p = 0.003). The maximum dose at the field junction was significantly higher with DIT (43 Gy, 107%, p = 0.003). The maximum total error was 1 cm in lateral for supraclavicular field and 8 mm in superior–inferior in tangents for both techniques. There was no difference in set-up errors between the two techniques. Findings: MIT resulted in better dose homogeneity at the field junctions and reduced mean heart dose as compared to DIT. MIT is safe for implementation in clinical practice for breast cancer treatment. Conclusion: This study is one of the few studies comparing MIT with DIT in terms of the dosimetry and the first one to compare set-up errors between the two techniques. The ease of set-up and better dosimetry with MIT was achieved.

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.

Deep inspiration breath hold (DIBH) with electromagnetic surface transponder confirmation of chest wall (CW) position during radiation for left breast cancer.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 126-126
Author(s):  
Madeera Kathpal ◽  
Kelly Sun ◽  
Cynthia Malmer ◽  
Stephanie Ninneman ◽  
Stacie Wendt ◽  
...  
Keyword(s):  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Breast Cancers ◽  
Deep Inspiration Breath Hold ◽  
Heart Dose ◽  
Real Time Tracking ◽  
The Mean ◽  
The Difference ◽  
Ischemic Events

126 Background: DIBH during radiation of left breast cancers reduces heart dose, potentially reducing late cardiac ischemic events, but requires a treatment CW position significantly different from a free-breathing (FB) position. We sought to improve the accuracy of radiation therapy during DIBH by using electromagnetic surface transponders to track the position of the CW during treatment. We examined the benefit of this technique in reducing dose to the heart and consistently reproducing the DIBH position. We also evaluated the difference between FB and DIBH CW position and compared CW movement within the plateau of each DIBH to within beam-on time. Methods: 15 patients participated in this IRB-approved study. Patients were planned and treated using DIBH. We fused treatment-position FB CT scans to DIBH scans to compare mean heart (MH) and left anterior descending coronary artery (LAD) dose. We used surface transponder tracking reports to determine CW motion at the time of daily port films, during FB, the plateau of each DIBH, and beam-on time. We summed anterior and superior motion using the Pythagorean Theorem and report our results in this combined axis. Paired t-test was used to compare heart dose with vs. without DIBH and CW motion during plateau DIBH vs. beam-on. Results: DIBH significantly reduced MH and LAD dose vs. FB plans (MH 1.26 ± 0.51 Gy v 2.84 ± 1.55 Gy, p < 0.01), (LAD 5.49 ± 4.02 Gy v 18.15 ± 8.78 Gy, p < 0.01). DIBH CW position was a mean of 13.9 ± 5.3 mm anterior and superior to FB position. The mean difference in CW position at the time of daily port film vs. beam-on was -1.0 ± 2.5 mm. Plateau DIBH CW motion was 2.8 ± 2.3 mm, significantly increased from CW motion during beam-on (1.1 ± 1.2 mm, p < 0.01). Treatment was paused in 23% of fractions to adjust for suboptimal breath hold or CW position. Conclusions: DIBH reduced the MH and LAD dose by at least 50%. Real-time tracking with electromagnetic transponders allowed us to limit treatment to the most stable portion of the DIBH plateau, significantly reducing intra-fraction motion. Electromagnetic confirmation of CW position allowed verification of breath-hold reproducibility.

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