Journal List > Prog Med Phys > v.24(4) > 1098401

Jung, Kim, Jung, Lee, and Suh: Evaluation of Dose Reduction of Cardiac Exposure Using Deep-inspiration Breath Hold Technique in Left-sided Breast Radiotherapy


Breast cancer is the leading cause of cancer death in women worldwide and the number of women breast cancer patient was increased continuously. Most of breast cancer patient has suffered from unnecessary radiation exposure to heart, lung. Low radiation dose to the heart could lead to the worsening of preexisting cardiovascular lesions caused by radiation induced pneumonitis. Also, several statistical reports demonstrated that left-sided breast cancer patient showed higher mortality than right-sided breast cancer patient because of heart disease. In radiation therapy, Deep Inspiration Breath Hold (DIBH) technique which the patient takes a deep inspiration and holds during treatment and could move the heart away from the chest wall and lung, has showed to lead to reduction in cardiac volume and to minimize the unnecessary radiation exposure to heart during treatment. In this study, we investigated the displacement of heart using DIBH CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Treatment planning was performed on the computed tomography (CT) datasets of 10 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ≥95% of the prescribed dose and that the volume inside the CTV receiving >107% of the prescribed dose should be minimized. Scar boost irradiation was not performed in this study. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. The present study demonstrates that cardiac dose during left-sided breast radiotherapy can be reduced by applying DIBH breathing control technique.


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Fig. 1.
Distance from center of heart to center of left breast.
Fig. 2.
Superimposed free breathing CT images (in light gray) and DIBH technique image (in gray).
Fig. 3.
Dose-volume histogram (DVH) for heart between free-breathing (FB) and deep-inspiration breath-hold (DIBH) technique.
Table 1.
Distances from center of heart to center of lef breast. Unit: mm.
  Free-breathing DIBH
Patient 1 12.86 17.68
Patient 2 8.91 9.04
Patient 3 8.18 9.90
Patient 4 8.51 11.49
Patient 5 8.60 9.48
Patient 6 8.47 9.36
Patient 7 8.01 9.19
Patient 8 8.24 11.65
Patient 9 9.88 10.36
Patient 10 8.46 11.97
Average (Std.) 8.55 (1.37) 9.98 (2.45)
p-value ≤0.0 001
Table 2.
Exposure doses for heart between free-breathing (FB) and deep-inspiration breath-hold (DIBH) technique in each patient. Unit: cGy.
  Free-breathing Deep inspiration breath hold Difference
Min Max Mean Min Max Mean Max
Patient 1 95 4,770 495 95 4,940 580 -170
Patient 2 40 4,845 420 70 3,845 195 1,000
Patient 3 70 4,675 230 85 1,120 220 3,555
Patient 4 75 4,880 210 80 4,725 190 155
Patient 5 75 4,935 315 85 4,925 370 10
Patient 6 80 4,820 445 90 3,725 540 1,095
Patient 7 55 4,640 410 80 1,180 210 3,460
Patient 8 80 4,225 225 85 800 175 3,425
Patient 9 60 4,765 175 80 4,940 240 -175
Patient 10 80 4,135 335 70 810 340 3,325
Average (Std.) 71 (14.8) 4,669 (259) 326 (107) 82 (7.5) 3,101 (1784) 306 (141)  
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