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‘Cancer Goggles’ for Surgery > Remote Seed Implant Guidance for Breast Cancer Surgery > Breast Cancer Incidence > Deep Inspiration Breath Hold (DIBH) for Breast Cancer
Mikaela Dell’Oro
BMedRadSc (RadTherapy) (Hons)
Information for Patients
Radiotherapy
The use of external beam radiotherapy for breast cancer has improved significantly in recent years. The course of radiation therapy is necessary to kill any microscopic disease that may have been left behind following your surgery. The X-ray dose to the surrounding lung and heart structures, should be as low as possible. To do this, the X-ray treatment beams are directed tangentially through the breast to avoid the lung and heart.
Because cure rates using radiotherapy and other forms of treatment have reached over 90%, your medical specialist wants to ensure that long-term (many years later) effects to the heart and lung from radiation therapy, are reduced.
Figure 1. shows the dose distribution the patient has received by treating the breast with a medial and lateral tangential X-ray beam. Depending on individual patient anatomy, some lung may be included in the treatment field in order to cover all breast tissue by the desired radiation dose. Note that the heart is receiving minimal X-ray dose in this illustration.
The patient’s anatomy shown in Figure 1 was obtained from a special CT scan (Figure 2) arranged in the radiation therapy department. This scan simulates how you will lie on the couch belonging to the treatment machine.
The CT scan images are used by the radiation therapist to plan exactly how you will receive your treatment. The position, direction and dose for each small beam is calculated on a specially programmed computer. The ‘treatment plan’ is individually tailored for each patient before your course of treatment can begin.
Your medical specialist prescribes the treatment and approves the final plan before your treatment starts and monitors your medical condition as the treatment progresses.
The radiation therapists will ensure that you lie in the same position for each treatment. But there are unavoidable movements that occur during the treatment. For instance, breathing motion of your lung and heart during the X-ray treatment.
To help reduce this X-ray exposure to the lung and heart regions, a method of controlled breathing by the patient (called ‘deep inspiration breath hold’, DIBH), has been developed.
Deep Inspiration Breath Hold (DIBH) for Breast Cancer
If your breast cancer is left-sided, you may have the DIBH option discussed with you by your medical specialist.
The DIBH technique is now commonly used in most Australian radiation therapy centres for left-sided breast cancer treatment. It involves coaching the patient to take a deep breath in and hold this position for between 10-25 seconds. The radiation therapist will assist you to understand and become comfortable with this breathing routine and will be able to tell you when to hold and release your breath.
The DIBH procedure expands the lungs, pushing the breast/chest wall further away from the heart and reduces respiratory motion during the X-ray treatment. Figure 3 shows the possible reduction in lung and heart doses during the breath-hold sequence. As you can see there is visibly less lung in the field and the heart is pushed further away due to the expansion of the lung.
There are several commercial DIBH devices available on the market and the method may vary slightly between the different devices. For instance, some:
- require the patient to use a snorkel like device; or
- have a tracking block placed on the patient’s chest; or
- have visual aids to help you see the breath hold or be instructed by radiation therapists.
DIBH is a safe procedure. Your radiation therapists assisting you will ensure that you are able to carry out this breathing procedure whilst maintaining a close eye on you during the whole of the treatment.
The Peter MacCallum Hospital, Bendigo, Victoria provides an excellent video describing the procedures for breast cancer patients receiving a course of treatment. To view, click on:
Radiation Therapy for Breast Cancer at Peter Mac Bendigo
It is important to note that each patient is different. Also, radiation therapy has vastly improved in the use of sophisticated technology over the last 20 years so that the radiation dose to healthy tissue is minimised. Each case is individually planned and depends on the patient’s anatomical size, location of the organs and chest shape. Whether you undergo DIBH radiation therapy or the routine radiation therapy technique, your treatment experience will be similar. Your medical specialist will take into account your individual medical circumstances and will advise you if DIBH is suitable.
References
(i) Images from University of South Australia
(iii) Peter MacCallum, Bendigo video
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