Deep Inspiration Breath Hold technique

What is it?

Deep Inspiration Breath Hold (DIBH) is a technique used to deliver radiotherapy to the left breast while the patient holds their breath.

Why is it used?

One of the main concerns during treatment is the closeness of the heart to the breast tissue, and the possibility that the heart tissue will receive some of the radiation dose. Evidence has shown this can sometimes cause patients heart-related problems years after finishing treatment. In some patients, using the DIBH technique is a helpful way to reduce the dose to the heart, while ensuring the breast and chest wall area receives the full prescribed dose of radiation.

The video here shows one method using computer software of applying DIBH but there are many alternatives that can be used.

How does DIBH work?

The Deep Inspiration Breath Hold technique is simple and extremely effective. The patient holds air in their lungs for approximately 20 seconds at a time while radiotherapy treatment is being delivered, with breaks for normal breathing between treatment beams. Holding a deep breath allows the lungs to expand, pushing the heart away from the treatment area, and stabilising the patients’ position. This breath-hold action can reduce the incidental radiation received by the heart during radiotherapy.

It’s important to understand that patients are in control of their breathing, and in turn the delivery of the radiotherapy. The monitoring of the breathing will determine the activation of the radiation beam. This will only be activated when the correct breath-hold position is reached and maintained. Additionally, if during treatment a patient was unable to hold their breath for the required time, this change in a patient’s position will lead to the radiation beam being held or turned off until the correct treatment position and breath hold is resumed.

Would it work for me?

The Deep Inspiration Breath Hold technique may not be suitable or beneficial for everyone with a breast cancer diagnosis. The need is determined by the position of the heart in relation to the radiotherapy treatment site, which can vary between individuals. The physician will decide upon the best technique for each patient and tailor treatment to their needs. If DIBH is considered an option, pre-treatment radiographers will assess individuals to see whether they can hold their breath in a stable and reproducible position for the required duration. Many patients practise holding their breath a few times a day at home for several days before the treatment. Practice helps improve confidence and the ability of the lungs to take in and hold air effectively.

What are the risks?

There are no risks associated with Deep Inspiration Breath Hold above that for conventional radiotherapy treatment to the breast.

Are there any alternatives?

The alternative to DIBH is to have conventional radiotherapy administered while breathing normally. There are many different techniques used to ensure minimum radiation exposure to the heart, such as shielding with lead. The specialist team taking care of the patient will decide which method to apply for the best outcome.