Deep Inspiration Breath Hold Technique (DIBH)
What is DIBH?
DIBH is a specialised technique to deliver radiotherapy to the left breast with patients in a breath hold position. DIBH is designed to reduce any incidental radiation dose to the heart. One of the main concerns during the radiotherapy treatment is the closeness of the heart to the treatment area. Heart tissue can potentially receive some of the radiation dose due to an individuals’ internal anatomy and the position of the breast tissue requiring treatment. Evidence has shown that these incidental doses of radiation can cause patients heart related problems years after treatment has finished. In many people, using the DIBH technique is helpful in reducing the dose to the heart whilst ensuring that the breast/chest wall area receives the full prescribed dose.
What type of diagnosis is it used for?
DIBH is only used to treat left-sided breast cancer as it is used to maximise the distance between the heart and the treatment area.
How does DIBH work?
The DIBH technique is simple and extremely effective in its outcome. The technique requires a patient to hold air in their lungs for approximately 20 seconds at a time whilst radiotherapy treatment is being delivered (allowing normal breathing breaks in between treatment beams). The action of holding in a deep breath of air allows the lungs to expand pushing the heart away from the treatment area. It also stabilizes the patients’ positioning. This action can reduce the incidental radiation dose the heart receives during radiotherapy treatment. It is important to note 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 radiotherapy 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 until the treatment position and breath hold is resumed.
Would it work for me?
DIBH may not be suitable or beneficial to all patients with a left-sided breast cancer diagnosis. The need for it is determined by the position of the heart in relation to the radiotherapy treatment site and this can vary between individuals. The physician will decide what technique is best for each patient and tailor the radiotherapy treatment to their individual needs. If DIBH is considered an option, pre-treatment radiographers will assess individuals to see whether they are able to hold their breath in a stable and reproducible position for the required duration. Many patients practice 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 bigger breaths.
What are the risks?
There are no risks associated with DIBH above that for conventional radiotherapy treatment to the breast.
Are there any alternatives?
The alternative to DIBH is to have conventional radiotherapy administered whilst 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.
Where is it available?
This technique is available at the following centres:
- The Clatterbridge Cancer Centre (The Wirral)
- Southend University Hospital NHS Foundation Trust
- Royal Stoke University Hospital
- Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust
- Velindre Cancer Centre, Cardiff
- South West Wales Cancer Centre
- Nottingham University Hospitals NHS Trust
- Bristol Haematology and Oncology Centre
- Royal Devon and Exeter NHS Foundation Trust
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust
- Mount Vernon Cancer Centre (East and North Herts NHS)
- Leeds NHS Teaching Hospital
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust
- Barts Health NHS Trust
- Derby Teaching Hospitals NHS Foundation Trust
- Ipswich Hospital NHS Trust
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust
- Northampton General Hospital
- Royal Berkshire Foundation Trust
- Sheffield Teaching Hospitals
- University Hospitals of North Midlands
- Beacon Centre, Taunton and Somerset NHS Foundation Trust
- Oxford University Hospitals NHS Trust
- St Luke’s Cancer Centre at Royal Surrey County Hospital
- North Middlesex University Hospital NHS Trust
- The Royal Liverpool University Hospital
- Portsmouth Hospitals NHS Trust
- Colchester General Hospital
- The London Radiotherapy Centre, Guy’s and St Thomas’
- The Harley Street Clinic and associated Joint Ventures sites in the HCA group.
- Genesis Cancer Care UK Ltd (Various Centres)
- The London Clinic
- Cancer Centre London
- HCA Healthcare UK (Various Centres)
To find out more about DIBH and a patient’s experience of it, please find below a link to Alison Young, presenting at a ceremony hosted by Vision RT. Vision RT’s optical technology supported Alison’s treatment by tracking her motion and providing a tool for DIBH. Learn more about how the Vision RT technology works for left breast treatment by visiting visionrt.com/alison.
Please also find here a link to an article on DIBH on the Mail online published in October 2016.