Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer Journal Article


Authors: Mah, D.; Hanley, J.; Rosenzweig, K. E.; Yorke, E.; Braban, L.; Ling, C. C.; Leibel, S. A.; Mageras, G.
Article Title: Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer
Abstract: Purpose: The goal of this paper is to describe our initial experience with the deep inspiration breath-hold (DIBH) technique in conformal treatment of non-small-cell lung cancer with particular emphasis on the technical aspects required for implementation. Methods and Materials: In the DIBH technique, the patient is verbally coached through a modified slow vital capacity maneuver and brought to a reproducible deep inspiration breath-hold level. The goal is to immobilize the tumor and to expand normal lung out of the high-dose region. A physicist or therapist monitors and records patient breathing during simulation, verification, and treatment using a spirometer with a custom computer interface. Examination of internal anatomy during fluoroscopy over multiple breath holds establishes the reproducibility of the DIBH maneuver for each patient. A reference free-breathing CT scan and DIBH planning scan are obtained. To provide an estimate of tumor motion during normal tidal breathing, additional scan sets are obtained at end inspiration and end expiration. These are also used to set the spirometer action levels for treatment. Patient lung inflation is independently verified over the course of treatment by comparing the distance from the isocenter to the diaphragm measured from the DIBH digitally reconstructed radiographs to the distance measured on the portal films. Patient breathing traces obtained during treatment were examined retrospectively to assess the reproducibility of the technique. Results: Data from the first 7 patients, encompassing over 250 treatments, were analyzed. The inferred displacement of the centroid of gross tumor volume from its position in the planning scan, as calculated from the spirometer records in over 350 breath holds was 0.02 ± 0.14 cm (mean and standard deviation). These data are consistent with the displacements of the diaphragm (-0.1 ± 0.4 cm; range, from -1.2 to 1.1 cm) relative to the isocenter, as measured on the (92) portal films. The latter measurements include the patient setup error. The patient averaged displacement of the tumor during free breathing, determined from the tumor displacement between end inspiration and end expiration, was 0.8 ± 0.5 cm in both the superior-inferior and anterior-posterior directions and 0.1 cm (± 0.1 cm) medial-laterally. Conclusion: Treatment of patients with the DIBH technique is feasible in a clinical setting. With this technique, consistent lung inflation levels are achieved in patients, as judged by both spirometry and verification films. Breathing-induced tumor motion is significantly reduced using DIBH compared to free breathing, enabling better target coverage. Copyright (C) 2000 Elsevier Science Inc.
Keywords: clinical article; reproducibility; quality control; reproducibility of results; computer assisted tomography; lung non small cell cancer; carcinoma, non-small-cell lung; lung neoplasms; lung cancer; instrumentation; feasibility studies; radiotherapy planning, computer-assisted; radiotherapy, conformal; breath holding; technique; physics; inhalation; fluoroscopy; computer analysis; spirometry; lung volume; vital capacity; spirometer; gating; humans; human; female; priority journal; article; breath hold; conformal therapy; lung inflation
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 48
Issue: 4
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2000-11-01
Start Page: 1175
End Page: 1185
Language: English
DOI: 10.1016/s0360-3016(00)00747-1
PUBMED: 11072177
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 18 November 2015 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Louise E Braban
    10 Braban
  2. Steven A Leibel
    252 Leibel
  3. Gikas S Mageras
    271 Mageras
  4. Ellen D Yorke
    380 Yorke
  5. C Clifton Ling
    331 Ling
  6. Joseph   Hanley
    13 Hanley
  7. Dennis W Mah
    4 Mah