Deep Inspiration Breath Hold: Techniques and Advantages for Cardiac Sparing During Breast Cancer Irradiation

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  Figure 1. Deep inspiration breath hold (DIBH) techniques and examples of anatomic and dosimetric advantages. (A,B) Axial CT slices from the same level of the breast in free breathing (A) and DIBH (B) CT scans. The red line indicates the tangential radiation field used for whole breast radiation treatment. Note that the heart is easily excluded in the DIBH scan. (C,D) DIBH respiratory tracings and real-time patient monitoring (RPM) using optical tracking at inspiration (green arrow) and expiration (red arrow) during free breathing. (D) RPM tracings confirm appropriate chest excursion during DIBH, with a stable breath hold tracing. After inspiration (blue arrow) with DIBH, the beam would be on during the sustained breath hold. (E) AlignRT screenshot illustrates a reference surface on the chest wall (CW) used for alignment with a region of interest (left breast), which is matched during surface tracking, and with DIBH, when the left breast is within the preset thresholds, as indicated by the dynamic green bars on the side of the panel, the treatment beam is enabled. (F) With expiration or any movements of the left breast outside of tolerance, the green bars turn red and the radiation beam is…