Which patients with breast cancer do you treat with deep inspiration breath hold (DIBH)?

My practice is similar. All left-sided patients -- DIBH and free-breathing scans. All right-sided RNI cases - DIBH and free breathing. The benefits for lung-sparing on the right side can be significant. Few right-sided with whole breast only as target, as there is generally low lung dose in these patients. It is important to highlight how the contours will drive planning and to be very intentional about medial and lateral borders to optimize field design (and not overtreat compared with the non-...

We use it for any left breast cancer and any right-sided patient for whom I will be treating IMNs. I also use in the setting of re-irradiation for any reason. Having said that, the added benefit of DIBH for a woman with a tumor bed in the upper quadrants of her left breast can usually be treated without DIBH and still keep mean heart dose to <1 Gy. So, if a woman has a language barrier or has trouble holding her breath for 20 sec, the loss is pretty minimal.

I simulate all left-sided patients with and without DIBH. You can either review to see if there is a benefit between in sim or do a fusion of scans afterward.

I also routinely have with and without DIBH scans when treating right-sided cases where I am treating im nodes.

I use DIBH only scan for my partial breast cases on both sides to limit motion so I don’t do both scans.

Supine left-sided patients who are smaller and medium breast size. Some medium and most large breast only patients we instead prefer to treat prone to eliminate the inframammary fold to reduce skin toxicity.

All left-sided patients treating regional nodes especially IMN are simulated with breath hold.

VMAT/IMRT regional node breast is simulated with breath hold to 1) reduce PTV margin given deep breath hold and 2) increase separation between heart/LAD and breast/chest wall.

All breath hold pati...