How reliable is deep inspiration breath hold at CT simulation? Clinical impact of surface-guided breathing training in breast cancer radiotherapy
In brief
Breathing-training eliminates bad DIBH CTs and reduces heart dose up to 96%
In 115 left-sided breast cancer patients, adding surface-guided breathing training turned all CT simulations into proper deep-inspiration holds, raising lung volume gain by about 9% and cutting breath-hold variability by roughly a quarter. The more reliable scans lowered cardiac exposure dramatically-by as much as 96% in patients receiving nodal irradiation-while preserving target coverage.
- Journal
- Radiation oncology (London, England) (Q1)
- Published
- 4 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Lou Dietrich, Niklas Lackner, Andre Karius, Johann Brand, Rafael Lobao, Aliheydar Huseynli, et al.
- PMID
- 42698070
- DOI
- 10.1186/s13014-026-02920-y
Why clinicians should know about it
- Picked for Medical Physics (paper of the day, 8 September 2026): Significant reductions in cardiac dose with SGRT training
Abstract
PURPOSE: Deep inspiration breath hold (DIBH) is widely used to reduce cardiac dose in left-sided breast radiotherapy. However, the reliability of DIBH at CT simulation, has not been systematically evaluated despite the importance of CT simulation as the basis for treatment planning. We investigated the clinical impact of surface-guided breathing training on DIBH reliability and cardiac dose sparing. METHODS: In this retrospective cohort study, 115 breast cancer patients undergoing DIBH CT simulation were analyzed before and after implementation of surface-guided breathing training using an SGRT system. DIBH performance was quantified by partial lung volume increase (PLVI) and breath-hold variability. Correlations between external surface motion and internal DIBH depth were assessed. Cardiac dose metrics were compared, with a subgroup analysis for patients receiving lymphatic drainage area (LDA) irradiation. RESULTS: Prior to training, insufficient DIBH CTs-including negative PLVI cases-were observed. After training implementation, all CT scans were acquired in intended breath-hold states, eliminating insufficient DIBH acquisitions. Mean PLVI increased by ~ 9%, and breath-hold variability decreased by ~ 26%. Sternum motion correlated most strongly with PLVI, with multiregion surface monitoring yielding the highest internal correlation. These improvements were reflected in significant reductions in cardiac dose, particularly in the LDA subgroup, with selected heart dose metrics reduced up to 96%, while maintaining target coverage. CONCLUSIONS: DIBH at CT simulation with surface-guided breathing training proves to be reliable. The training prevents planning CTs in wrong breathing states and thus enables clinically meaningful cardiac dose reduction in breast radiotherapy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.