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.

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

2020 ◽  
Vol 61 (3) ◽  
pp. 431-439 ◽  
Author(s):  
Chih-Shen CHANG ◽  
Chia-Hsin CHEN ◽  
Kuo-Chi LIU ◽  
Chia-Sheng HO ◽  
Miao-Fen CHEN
Keyword(s):  
Breast Cancer ◽  
Lung Volume ◽  
Free Breathing ◽  
Target Volume ◽  
Left Breast ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Total Lung Volume ◽  
The Difference

Abstract 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.

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.

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.

Deep inspiration breath-hold for patients with left-sided breast cancer – A one fits all approach? A prospective analysis of patient selection using dosimetrical and practical aspects

2021 ◽  
pp. 20210295
Author(s):  
Christina Schröder ◽  
Sebastian Kirschke ◽  
Eyck Blank ◽  
Sophia Rohrberg ◽  
Robert Förster ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Left Lung ◽  
Free Breathing ◽  
Lymphatic Drainage ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Patient Preparation ◽  
Treatment Plans ◽  
Planning Ct

Objective: To prospectively analyze the feasibility of an algorithm for patient preparation, treatment planning and selection for deep inspiration breath-hold (DIBH) treatment of left-sided breast cancer. Methods: From 02/2017 to 07/2019, 135 patients with left-sided breast cancer were selected and prepared for radiotherapy in DIBH. 99 received radiotherapy for the breast alone and 36 for the breast including the lymphatic drainage (RNI). Treatment plans DIBH and free breathing (FB) were calculated. Dosimetrical analyses were performed and criteria were defined to assess whether a patient would dosimetrically profit from DIBH. Results: Of the 135 patients, 97 received a DIBH planning CT and 72 were selected for treatment in DIBH according to predefined criteria. When using DIBH there was a mean reduction of the DmeanHeart of 2.8 Gy and DmeanLAD of 4.2 Gy. seven patients did not benefit from DIBH regarding DmeanHeart, 23 regarding DmeanLAD. For the left lung the V20Gy was reduced by 4.9%, the V30Gy by 2.7% with 15 and 29 patients not benefitting from DIBH, respectively. In the 25 patients treated in FB, the benefit of DIBH would have been lower than for patients treated with DIBH (ΔDmeanHeart0.7 Gy vs 3.4 Gy). Conclusion: Dosimetrically, DIBH is no “one fits all” approach. However, there is a statistically significant benefit when looking at a larger patient population. DIBH should be used for treatment of left-sided breast cancer in patients fit for DIBH. Advances in knowledge: This analysis offers a well-designed dosimetrical analysis in patients treated with DIBH radiotherapy in an “every day” cohort.

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