title: Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer.
abstract: BACKGROUND
  To investigate the potential dosimetric and clinical benefits of Deep Inspiration Breath-Hold (DIBH) technique during radiotherapy of breast cancer compared with Free Breathing (FB).
  
  
  METHODS
  Eight left-sided breast cancer patients underwent a supervised breath hold during treatment. For each patient, two CT scans were acquired with and without breath hold, and virtual simulation was performed for conventional tangential fields, utilizing 6 or 15 MV photon fields. The resulting dose-volume histograms were calculated, and the volumes of heart/lung irradiated to given doses were assessed. The left anterior descending coronary artery (LAD) mean and maximum doses were calculated, together with tumour control probability (TCP) and normal tissue complication probabilities (NTCP) for lung and heart.
  
  
  RESULTS
  For all patients a reduction of at least 16% in lung mean dose and at least 20% in irradiated pulmonary volumes was observed when DIBH was applied. Heart and LAD maximum doses were decreased by more than 78% with DIBH. The NTCP values for pneumonitis and long term cardiac mortality were also reduced by about 11% with DIBH. The NTCP values for pericarditis were zero for both DIBH and FB.
  
  
  CONCLUSIONS
  Delivering radiation in DIBH conditions the dose to the surrounding normal structures could be reduced, in particular heart, LAD and lung, due to increased distance between target and heart, and to reduced lung density.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bruzzaniti
authors.forename: Armando
authors.initials: A
authors.lastname: Abate
authors.forename: Paola
authors.initials: P
authors.lastname: Pinnarò
authors.forename: Marco
authors.initials: M
authors.lastname: D'Andrea
authors.forename: Erminia
authors.initials: E
authors.lastname: Infusino
authors.forename: Valeria
authors.initials: V
authors.lastname: Landoni
authors.forename: Antonella
authors.initials: A
authors.lastname: Soriani
authors.forename: Carolina
authors.initials: C
authors.lastname: Giordano
authors.forename: Anna
authors.initials: A
authors.lastname: Ferraro
authors.forename: Lidia
authors.initials: L
authors.lastname: Strigari
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D062485:Breath Holding; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008875:Middle Aged; D011859:Radiography; D011874:Radiometry / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000379:methods; D061089:Radiotherapy, Image-Guided; D015656:Respiratory Mechanics / Q000502:physiology*; D055425:Respiratory-Gated Imaging Techniques / Q000379:methods*