Session Item

Several studies indicate that deep inspiration breath hold (DIBH) significantly reduces cardiac dose and spares lung tissue during whole left-breast irradiation. Thus there is a strong recommendation for using DIBH for left-breast irradiation. This study aims to provide a broad overview of the implementation, utilization, and planning methods of the DIBH technique in Spain.

A national survey was launched among the Spanish medical physicist community to review different aspects of the DIBH technique in our country. The survey contained objective and subjective questions about using and implementing DIBH for breast treatments. Data were firstly split by their use or not of DIBH. Also, objective questions were classified by centers and subjective questions were analyzed by individual answers.

We collected 104 responses from 78 institutions (57 public and 21 private). Of the 118 centers in Spain, 79% of the public institutions and 46% of the private ones answered this survey. From these 78 institutions, 54% perform breast treatments with DIBH, and 46% do not have this technique. The principal reasons for not adopting DIBH for breast treatments are no equipment available (50%), having the equipment but not implemented (44%), and other reasons in 6% of the cases.
The use of IMRT/VMAT for left or right breast treatment planning varies widely among centers (with or without DIBH): 42% of the centers perform IMRT/VMAT in more than 75% of the cases, and 32% of the centers in less than 10%.

Figure 1 summarizes DIBH equipment, treatment planning technique, and treatment time for those centers that perform DIBH.

Figure 1. Questions grouped by center

Most centers performed one training session (66%), 17% none, and 17% between 2-3 sessions. The main reason for not treating all left breasts with DIBH was patient-related factors (42%), followed by lack of equipment/resources/time (29%), and not considering it necessary (29%). The following questions (Figure 2) regarding complexity were analyzed individually (only those with DIBH in their centers).

Figure 2. Using and implementing DIBH

For left-breast treatments, 60% of the surveyed would use DIBH as a standard of care, but only 11% would use it routinely for right-breast treatments. Patient training is the most decisive factor when using DIBH, and most respondents consider a level 3 of complexity when implementing DIBH.

Although using DIBH is highly recommended, this technique is not accessible to all breast cancer patients in our country due to different factors. Only 54% of the centers surveyed have this technique in place. Lack of equipment and complexity of implementation are the most common drawbacks.
There is no preferred treatment planning procedure in combination with DIBH. Most centers choose between 3D and IMRT/VMAT based on patient characteristics.