title: A cost-effective technique for cardiac sparing with deep inspiration-breath hold (DIBH).
abstract: Deep inspiration breath hold (DIBH) is an effective technique to reduce cardiac and pulmonary dose during breast radiotherapy (RT). However, as a result of expense and the technical challenges of program implementation, DIBH has not been widely adopted in clinical practice. This report describes a program for DIBH this is relatively inexpensive to implement and has little impact on patient throughput. Multiple redundant mechanisms are incorporated to assure accurate and safe delivery of RT during DIBH. Laser alignment verifies that chest wall excursion is reliably reproduced and maintained during treatment. Chest wall excursion is also monitored independently using an infrared camera trained on a reflective marker on the chest wall. This system automatically triggers "beam off" in the event of movement of the target beyond pre-determined thresholds. Finally, physician review of cine imaging obtained during treatment provides an off-line verification of accurate RT delivery. The approach described herein lowers the investment necessary for implementation of DIBH and may facilitate broader adoption of this valuable technique.
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Radiation Oncology, United States.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Macrie
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Radiation Oncology, United States.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Donnelly
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Radiation Oncology, United States.
authors.forename: John P
authors.initials: JP
authors.lastname: Hayes
authors.affiliation: Northwestern Memorial Hospital, Department of Radiation Oncology, United States.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Gopalakrishnan
authors.affiliation: Northwestern Memorial Hospital, Department of Radiation Oncology, United States.
authors.forename: Rino T
authors.initials: RT
authors.lastname: Philip
authors.affiliation: Northwestern Memorial Hospital, Department of Radiation Oncology, United States.
authors.forename: Jozef
authors.initials: J
authors.lastname: Reczek
authors.affiliation: Northwestern Memorial Hospital, Department of Radiation Oncology, United States.
authors.forename: Adam
authors.initials: A
authors.lastname: Prescott
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Radiation Oncology, United States. Electronic address: jstrauss@nmff.org.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Strauss
mesh_terms: D001943:Breast Neoplasms / Q000503:physiopathology / Q000532:radiotherapy; D062485:Breath Holding; D003362:Cost-Benefit Analysis; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D058958:Organs at Risk / Q000528:radiation effects*; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects* / Q000191:economics*
keywords: Breast cancer; Cardiac sparing; DIBH; Deep inspiratory breath hold; IGRT; Radiotherapy