title: Clinical results of image-guided deep inspiration breath hold breast irradiation.
abstract: OBJECTIVE
  To evaluate the feasibility, cardiac dose reduction, and the influence of the setup error on the delivered dose for fluoroscopy-guided deep inspiration breath hold (DIBH) irradiation using a cone-beam CT for irradiation of left-sided breast cancer patients.
  
  
  METHODS
  Nineteen patients treated according to the DIBH protocol were evaluated regarding dose to the ipsilateral breast (or thoracic wall), heart, (left ventricle [LV] and left anterior descending artery [LAD]), and lung. The DIBH treatment plan was compared to the free-breathing (FB) treatment planning and to the dose data in which setup error was taken into account (i.e., actual delivered dose).
  
  
  RESULTS
  The largest setup variability was observed in the direction perpendicular to the RT field (μ = -0.8 mm, Σ = 2.9 mm, σ = 2.0 mm). The mean (D(mean)) and maximum (D(max)) doses of the DIBH treatment plan was significantly lower compared with the FB treatment plan for the heart (34% and 25%, p < 0.001), LV (71% and 28%, p < 0.001), and LAD (52% and 39.8%, p < 0.001). For some patients, large differences were observed between the heart D(max) according to the DIBH treatment plan and the actual delivered dose (up to 71%), although D(max) was always smaller than the planned FB dose (mean group reduction = 29%, p < 0.001).
  
  
  CONCLUSIONS
  The image-guided DIBH treatment protocol is a feasible irradiation method with small setup variability that significantly reduces the dose to the heart, LV, and LAD.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Gerben R
authors.initials: GR
authors.lastname: Borst
authors.forename: Jan-Jakob
authors.initials: JJ
authors.lastname: Sonke
authors.forename: Suzanne
authors.initials: S
authors.lastname: den Hollander
authors.forename: Anja
authors.initials: A
authors.lastname: Betgen
authors.forename: Peter
authors.initials: P
authors.lastname: Remeijer
authors.forename: Aline
authors.initials: A
authors.lastname: van Giersbergen
authors.forename: Nicola S
authors.initials: NS
authors.lastname: Russell
authors.forename: Paula H M
authors.initials: PH
authors.lastname: Elkhuizen
authors.forename: Harry
authors.initials: H
authors.lastname: Bartelink
authors.forename: Corine
authors.initials: C
authors.lastname: van Vliet-Vroegindeweij
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002985:Clinical Protocols; D054893:Cone-Beam Computed Tomography; D003331:Coronary Vessels / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects; D058958:Organs at Risk / Q000528:radiation effects; D056888:Patient Positioning; D011832:Radiation Injuries / Q000517:prevention & control*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012119:Respiration; D035501:Uncertainty