Deep Inspiration Breath-Hold (DIBH) for Left-Sided Breast Cancer: Clinical Application and Validation: Anatomical Predictors, Dosimetric Gains, and Reproducibility Evaluation | ||||
| Advances in Basic and Applied Sciences | ||||
| Volume 5, Issue 1, August 2025, Page 39-50 PDF (2.26 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/abas.2025.412776.1077 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Nouf Ghwaidi  1; Medhat Shafaa2; Ayman Meselhi Ghobeish3; Mostafa Aletreby4; Dina Abdualaziz5; Maha M. Eltaher6; Shamel Mohamed Soaida7
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| 1Radiation Therapy Dept., Soliman Fakeeh Hospital, Jeddah, Saudi Arabia. | ||||
| 2Professor of medical biophysics, Physics department, Faculty of science, Helwan university, Cairo, Egypt. | ||||
| 3Lecturer of medical biophysics, Physics department, Faculty of science, Helwan university, Cairo, Egypt. | ||||
| 4Kasr al aini center of oncology and nuclear medicine, Faculty of medicine, Cairo university, Cairo, Egypt | ||||
| 5Professor of Radiation Therapy, Radiation Therapy Dept., National Cancer Institute, Cairo University. | ||||
| 6Radiation Oncology Dept., National Cancer institute, Cairo university, Egypt | ||||
| 7Clinical Oncology department, Faculty of Medicine, Cairo univesrsity. | ||||
| Abstract | ||||
| This study presents a new clinical implementation of the Deep Inspiration Breath-Hold (DIBH) technique for left-sided breast cancer radiotherapy. The aim is to assess the technique's effectiveness in reducing cardiac and pulmonary radiation exposure, validate breath-hold reproducibility, and determine predictive anatomical and dosimetric factors for selecting patients most likely to benefit from DIBH. Twenty-five female patients underwent dual CT simulation in FB and DIBH positions and Planning was conducted on Eclipse Treatment Planning System with 3D conformal treatment plans were created using mixed energies (6 MV and 16 MV) photon beams. Anatomical parameters, dose-volume metrics (heart and lung), and target coverage indices were compared. Verification included daily breath-hold level (BHL) imaging, portal dosimetry, and gamma pass-rate assessment. Correlation and predictive modeling were performed using anatomical metrics such as chest rise, depth, and the Haller Index. DIBH significantly increased lung volume by 49.3% (p < 0.001) and reduced heart volume in the high-dose region by 8.3% (p = 0.0032). Mean heart dose decreased by 26.7% and Heart V25 and V20 dropped by 39.5% and 37.6%, respectively. Lung V20 and V16 also declined significantly. Chest rise correlated strongly with heart dose reduction (r = −0.68 for V25). BHL verification showed reproducible setup in 92% of sessions, while gamma index analysis achieved a 95.7% average pass rate. The Haller Index showed no significant predictive value. This new DIBH implementation was successfully applied in all patients. It provided significant dosimetric advantages and demonstrated strong anatomical reproducibility. DIBH offers robust anatomical and dosimetric advantages with high treatment reproducibility, even in emerging oncology settings. Chest rise and depth are practical predictors of DIBH efficacy, supporting its routine use in left-sided breast cancer radiotherapy. | ||||
| Keywords | ||||
| Deep Inspiration Breath-Hold (DIBH); Left-sided breast cancer; Radiotherapy; Cardiac sparing; Gamma index; Breath-hold reproducibility | ||||
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