Dosimetric analysis of Voluntary deep inspiratory breath-hold (V-DIBH) Vs Free Breathing (FB) technique on organ doses for left-sided breast cancer

Document Type : Original Paper


1 Dept of Radiation Oncology, ILBS, New Delhi

2 Dept of Radiation Oncology Max Superspeciality Hospital, Shalimar Bagh ,Delhi

3 Department of Radiation Oncology, Fortis Superspeciality Hospital, Shalimar Bagh Delhi

4 Department of Radiation Oncology Max Superspeciality Hospital, Shalimar Bagh ,Delhi



Adjuvant radiation therapy to the whole breast or the chest wall is an integral part of the treatment of breast cancer with a long term cardiac morbidity as a concern. In this present study, we have evaluated the Impact of Voluntary deep inspiratory breathhold (V-DIBH) Vs Free Breathing (FB) technique on heart and lung doses for left-sided breast cancer with audio visual guidance.


Total 31 patients with left sided breast cancer were considered suitable for V-DIBH from June 2018 – Dec 2019. After breath hold coaching, 24 patients underwent CT simulation. 2 set of CT images were obtained in both breath hold and free breathing phases. All 24 patients were treated with tangential IMRT techniques with V-DIBH. For dosimetric purposes ,radiation plans were also generated on FB scans. Target coverage and mean dose to organs at risk -heart, left anterior descending coronary artery (LAD), ipsilateral Lung and right breast were compared between the FB and DIBH plans .


Target Coverage was comparable in both FB and DIBH plans. When compared with FB, DIBH resulted in a significant reduction of mean cardiac dose from 5.7 ± 1.58 Gy to 3.45 ± 0.68 Gy (p<.05) and cardiac V25Gy from 7.28 ±3.97 % to 1.64 ± 1.35% (p<.05).

Heart volumes receiving low doses, V5 was 25.35±7.85% in FB group as compared to 16.4± 5.1% in DIBH group (p<.05).Mean dose to the LAD was 20.7Gy and 16.8Gy on FB and V-DIBH, respectively (p<.05). LAD D50 was 22.05Gy in FB group as compared to 15.32Gy in DIBH group(p<.05).Differences between FB and DIBH mean lung dose was 2.47 Gy (p=.106, ns) and ipsilateral lung V20Gy was 2.57% (p=.078,ns).


This study demonstrates dosimetric benefits of V-DIBH over FB in reducing dose to heart, LAD and ipsilateral lung without compromising the target volume coverage


Main Subjects

Articles in Press, Accepted Manuscript
Available Online from 10 April 2022
  • Receive Date: 01 February 2022
  • Revise Date: 06 April 2022
  • Accept Date: 10 April 2022
  • First Publish Date: 10 April 2022