To obtain insurance approval for DIBH when treating left breast cancers, are there particular dose constraints to sites that you employ?

I am surprised insurance companies are still restricting the use of DIBH for left side breast cancer and need some metrics to support it.

Mean dose to heart is low with DIBH as it helps to restrict scatter and transmission from conformal heart block and knowing each Gy to the heart matters, DIBH is ...

Are folks being denied for IMRT on the L side, unless providing proof of reduced MHD (with or without DIBH)?

I’m in prior auth part time.

Left-sided + nodes treated with IMRT are auto-approved by us.

I strongly recommend DIBH, regardless of technique and this would never be denied.