Key result
Abdominal deep inspiration breath hold displaced the heart more caudally than thoracic breath hold, but resulted in no significant differences in mean heart dose between the techniques.
Why the study?
Abdominal breathing potentially increases heart-breast distance more than thoracic breathing, but their relative impact on mean heart dose during DIBH was unclear.
Does abdominal deep inspiration breath hold reduce simulated heart radiation dose compared to thoracic deep inspiration breath hold in healthy female volunteers?
Observational (n=10)
No
Does abdominal deep inspiration breath hold reduce simulated heart radiation dose compared to thoracic deep inspiration breath hold in healthy female volunteers?
The type of deep inspiration breath hold (abdominal vs. thoracic) does not significantly impact cardiac radiation dose, suggesting that treatment position and the use of breath hold itself are more critical for heart sparing.
Answers are grounded in this paper and cite their sources.
Breath-hold type may matter less than position for cardiac sparing; hypothesis-generating and requires validation in breast cancer patients.
Deep inspiration breath hold (DIBH) significantly reduces radiation dose to the heart during left-sided whole-breast irradiation (WBI). Abdominal (A) breathing causes the diaphragm and the connected heart to move caudally, potentially increasing heart-breast distance more than thoracic (T) breathing. This exploratory study compares anatomical shifts between A- and T-DIBH in prone and supine positions to assess their impact on mean heart dose. Magnetic resonance imaging datasets were captured from ten female healthy volunteers during free-breathing (FB), A- and T-DIBH in prone and supine positions. Target volume (left breast) and organs at risk (OAR) centroid displacements were analyzed. Distance volume histograms (DiVHs) were used to evaluate spatial relationships between the OAR and the irradiated breast. Additionally, radiotherapy plans were generated to compare dose differences across breathing techniques. The heart moves more caudally during A-DIBH than T-DIBH. DiVHs indicate a greater heart-breast distance with T-DIBH compared to A-DIBH. Despite anatomical differences, no significant differences in heart dose were observed between the breathing techniques. Prone positioning consistently reduced radiation exposure to the ipsilateral lung and contralateral breast, while DIBH improved heart sparing. The type of DIBH maneuver is less critical for cardiac protection than the treatment position and the use of DIBH itself.
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Noyette et al. (2026) conducted an observational in Healthy volunteers (simulating left-sided whole-breast irradiation) (n=10). Abdominal deep inspiration breath hold (A-DIBH) vs. Thoracic deep inspiration breath hold (T-DIBH) was evaluated on Inferior heart displacement in prone position (A-DIBH vs T-DIBH) (MD 2.68 mm, 95% CI 0.47 to 4.89, p=0.02). Abdominal deep inspiration breath hold displaced the heart more caudally than thoracic breath hold, but resulted in no significant differences in mean heart dose between the techniques.
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