Deep inspiratory breath hold (DIBH) for breast radiotherapy

Radiotherapy is an essential treatment for many breast cancer patients, often used after surgery to target any remaining cancer cells. For those with left-sided breast cancer, the deep-inspiratory breath hold (DIBH) technique has emerged as an innovate technique to minimise potential risks during radiotherapy.

This article provides an expert insight into DIBH, including why it’s used, how it works, and its impact on treatment outcomes.

Why is DIBH used for breast radiotherapy?

Breast cancer radiotherapy is a medical treatment that uses high-energy radiation to destroy cancer cells in the affected area. In cases where the left breast is treated, there is a particular concern regarding the heart, which lies close to the breast tissue. Radiation exposure to the heart, even at low doses, can inadvertently increase the risk of long-term cardiovascular issues.

DIBH is an innovative treatment approach specifically designed to reduce radiation exposure to the heart (and lungs) during breast cancer radiotherapy. When you take a deep breath and hold it, the lungs expand, and the heart is displaced further away from the chest wall. The increased separation between the heart and the breast (the radiation field) reduces the amount of radiation that reaches the heart, allowing radiotherapy beams to precisely target the breast while sparing the heart and other vital organs.

Will I need to prepare for DIBH?

Yes, some preparation is required for DIBH to ensure you can perform the technique effectively during your radiotherapy sessions. Before treatment begins, you will attend a simulation session, during which your oncologist and medical team will introduce you to the DIBH process.

During this session, you will practise taking a deep breath and holding it for a specific period. Your medical team will use tools like a spirometer to monitor your breath and guide you on maintaining a consistent breath hold.

You don’t need to make significant lifestyle changes to prepare for DIBH, but practising at home before your radiotherapy treatment can help you feel more confident and comfortable with taking deep breaths and holding them for short periods.

How is DIBH performed during breast radiotherapy?

On the day of your treatment, you will lie on a treatment table with your arms raised above your head in a position that aligns your body with the radiotherapy machine. This setup will ensure that radiation is delivered precisely to the targeted area. You will be asked to breathe normally while the radiotherapy machine is positioned.

When the machine is ready, you will be instructed to take a deep breath and hold it for a specific duration, typically around 20 to 30 seconds. Meanwhile, your oncologist will monitor your breath-holding to confirm that the heart is adequately displaced from the radiation field. The radiotherapy machine will then deliver the radiation dose to the affected area.

If you can’t hold your breath long enough, the radiotherapy machine will automatically stop. The treatment session will then be paused, and you will be given time to rest before continuing. The radiotherapy machine will only deliver radiation when you’re in the correct breath-hold position, ensuring your safety and the accuracy of the treatment.

Your oncologist will communicate with you and provide support throughout the radiotherapy session. Advanced monitoring systems will also ensure your safety; these systems will track your breathing patterns and pause the radiation beam if any movement is detected outside the set parameters. This guarantees that radiation is only delivered under optimal conditions.

How does DIBH impact overall treatment outcomes?

Studies have shown that DIBH can reduce radiation exposure to the heart by up to 50% or more, compared to traditional radiotherapy techniques. This reduction translates into a lower likelihood of developing conditions such as heart disease or lung fibrosis in the years following treatment. For many patients, this means a better quality of life after completing therapy.

Importantly, the use of DIBH doesn’t compromise the effectiveness of breast cancer radiotherapy. This technique ensures that the prescribed dose of radiation reaches the cancer cells or treatment area with high precision while safeguarding nearby healthy tissues. The result helps maintain the high success rates of radiotherapy in controlling and preventing the recurrence of breast cancer, with fewer side effects.