dosimetric study of voluntary deep inspiratory breath-hold (v-dibh) vs free breathing (fb) technique on organ doses for left-sided breast cancer

Introduction: long term cardiac morbidity is a concern with left sided breast/chest wall irradiation. in this present study, we have evaluated the impact of voluntary deep inspiratory breath hold (v-dibh) vs free breathing (fb) technique on heart and lung doses for left-sided breast cancer with audio visual guidance. material and methods: a total of 31 patients diagnosed with left breast cancer were found to be suitable for v-dibh. patients were trained for breath hold technique for 3 to 4 days on ct simulator. seven patients being non-compliant to v-dibh therefore 24 patients were simulated for breath hold. we made tangential imrt plans for all the patients on both v-dibh and free breathing scans for dosimetric comparison. d95% target and organ at risk (oars) like dmean of heart, lad, lung and opposite breast were compared for both plans. results: 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) in v-dibh cases as compared to fb. mean dose to the lad was reduced by 3.9 gy in dibh cases (p<.05). differences between fb and v-dibh mean lung dose was 2.47 gy (p=.106, ns) and ipsilateral lung v20gy was 2.57% (p=.078, ns). conclusion: 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. we should opt for v-dibh over fb for left sided breast cancer cases.