How Important Is a Reproducible Breath Hold for Deep Inspiration Breath Hold Breast Radiation Therapy?

Wiant, D; Wentworth, Stacy; Han, Lei; Sintay, B

doi:10.1016/j.ijrobp.2015.06.010

Cited by 29 publications

(17 citation statements)

References 23 publications

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“…used CBCT to study vDIBH reproducibility and found that although patients do not achieve the heart metrics in the treatment plan, their breath‐holds ensure a consistent dosimetric advantage over free‐breathing . Others have reported on this sustained advantage of vDIBH compared to free‐breathing to reduce heart dose in this otherwise healthy patient population …”

Section: Discussionmentioning

confidence: 99%

Single‐institution report of setup margins of voluntary deep‐inspiration breath‐hold (DIBH) whole breast radiotherapy implemented with real‐time surface imaging

Xiao

Crosby

Malin

et al. 2018

J Applied Clin Med Phys

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PurposeWe calculated setup margins for whole breast radiotherapy during voluntary deep‐inspiration breath‐hold (vDIBH) using real‐time surface imaging (SI).Methods and MaterialsPatients (n = 58) with a 27‐to‐31 split between right‐ and left‐sided cancers were analyzed. Treatment beams were gated using AlignRT by registering the whole breast region‐of‐interest to the surface generated from the simulation CT scan. AlignRT recorded (three‐dimensional) 3D displacements and the beam‐on‐state every 0.3 s. Means and standard deviations of the displacements during vDIBH for each fraction were used to calculate setup margins. Intra‐DIBH stability and the intrafraction reproducibility were estimated from the medians of the 5th to 95th percentile range of the translations in each breath‐hold and fraction, respectively.ResultsA total of 7269 breath‐holds were detected over 1305 fractions in which a median dose of 200 cGy was delivered. Each fraction was monitored for 5.95 ± 2.44 min. Calculated setup margins were 4.8 mm (A/P), 4.9 mm (S/I), and 6.4 mm (L/R). The intra‐DIBH stability and the intrafraction reproducibility were ≤0.7 mm and ≤2.2 mm, respectively. The isotropic margin according to SI (9.2 mm) was comparable to other institutions’ calculations that relied on x‐ray imaging and/or spirometry for patients with left‐sided cancer (9.8–11.0 mm). Likewise, intra‐DIBH variability and intrafraction reproducibility of breast surface measured with SI agreed with spirometry‐based positioning to within 1.2 and 0.36 mm, respectively.ConclusionsWe demonstrated that intra‐DIBH variability, intrafraction reproducibility, and setup margins are similar to those reported by peer studies who utilized spirometry‐based positioning.

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Section: Discussionmentioning

confidence: 99%

Single‐institution report of setup margins of voluntary deep‐inspiration breath‐hold (DIBH) whole breast radiotherapy implemented with real‐time surface imaging

Xiao

Crosby

Malin

et al. 2018

J Applied Clin Med Phys

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“…Therefore, there has been much focus in the last years in breast cancer radiotherapy to develop treatment techniques that reduce the dose to normal tissues, such as treatment during deep inspiration, prone patient positioning, intensity modulated radiotherapy, proton radiotherapy, and partial breast radiotherapy . Treatment during deep inspiration has been shown to decrease the cardiopulmonary doses without compromising target coverage, due to increased spatial distance between the organs at risk and the target as well as decreased lung density . Treatment in deep inspiration breath‐hold (DIBH) requires patient compliance and the use of visual guidance has been shown to improve intrafractional reproducibility of the inspiration level .…”

Section: Introductionmentioning

confidence: 99%

Dosimetric effects of intrafractional isocenter variation during deep inspiration breath‐hold for breast cancer patients using surface‐guided radiotherapy

Kügele

Edvardsson

Berg

et al. 2017

J Applied Clin Med Phys

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The aim of this study was to investigate potential dose reductions to the heart, left anterior descending coronary artery (LAD), and ipsilateral lung for left‐sided breast cancer using visually guided deep inspiration breath‐hold (DIBH) with the optical surface scanning system Catalyst™, and how these potential dosimetric benefits are affected by intrafractional motion in between breath holds. For both DIBH and free breathing (FB), treatment plans were created for 20 tangential and 20 locoregional left‐sided breast cancer patients. During DIBH treatment, beam‐on was triggered by a region of interest on the xiphoid process using a 3 mm gating window. Using a novel nonrigid algorithm, the Catalyst™ system allows for simultaneous real‐time tracking of the isocenter position, which was used to calculate the intrafractional DIBH isocenter reproducibility. The 50% and 90% cumulative probabilities and maximum values of the intrafractional DIBH isocenter reproducibility were calculated and to obtain the dosimetric effect isocenter shifts corresponding to these values were performed in the treatment planning system. For both tangential and locoregional treatment, the dose to the heart, LAD and ipsilateral lung was significantly reduced for DIBH compared to FB. The intrafractional DIBH isocenter reproducibility was very good for the majority of the treatment sessions, with median values of approximately 1 mm in all three translational directions. However, for a few treatment sessions, intrafractional DIBH isocenter reproducibility of up to 5 mm was observed, which resulted in large dosimetric effects on the target volume and organs at risk. Hence, it is of importance to set tolerance levels on the intrafractional isocenter motion and not only perform DIBH based on the xiphoid process.

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“…In the DIBH position, the distance between the heart and the breast target area also increases as the heart moves down. Several studies have con rmed that DIBH can reduce the heart dose by displacing the heart from the treatment eld resulted from the expansion of the lung while not compromise the dose to the target [9,10]. In the DIBH position, the lung volume increases signi cantly, so that the proportion of lung volume that actually receives radiation was reduced effectively.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-sided Breast Cancers After Breast-conserving Surgery: a Planning Study

Tang

Ishikawa

Ito

et al. 2021

Preprint

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Background This paper aims to compare dosimetric parameters of the organs at risk (OARs) among three different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath hold (DIBH) position. Three-dimensional radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH position. A 3DCRT plan was also created in the FB position. Dose-volume histogram (DVH) was used to analyze each evaluation index of OARs. The principal outcome was heart dose, left anterior descending coronary artery (LADCA) dose and left lung dose.Results For the 3D-CRT plans, significant dose reductions were demonstrated in all evaluation parameters to heart, LADCA and left lung dose in the DIBH position compared with the FB position (p < 0.05). In DIBH position, significant dose reductions were founded in heart and LADCA in VMAT plan compared to 3DCRT plan (p < 0.05). There were no significant differences between 3DCRT and VMAT plan for the left lung dose in DIBH position.Conclusion DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity

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How Important Is a Reproducible Breath Hold for Deep Inspiration Breath Hold Breast Radiation Therapy?

Cited by 29 publications

References 23 publications

Single‐institution report of setup margins of voluntary deep‐inspiration breath‐hold (DIBH) whole breast radiotherapy implemented with real‐time surface imaging

Single‐institution report of setup margins of voluntary deep‐inspiration breath‐hold (DIBH) whole breast radiotherapy implemented with real‐time surface imaging

Dosimetric effects of intrafractional isocenter variation during deep inspiration breath‐hold for breast cancer patients using surface‐guided radiotherapy

Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-sided Breast Cancers After Breast-conserving Surgery: a Planning Study

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