We describe how to implement a simple and low cost method for DIBH using equipment found in most radiation oncology clinics or easily purchased.

Purpose/Objectives: Deep Inspiration Breath Hold (DIBH) Radiation therapy for left sided breast can reduce dose to critical structures such as the lungs and heart. The purpose of this work is to (1) illustrate how to implement a simple and low cost method of DIBH for simulation and treatment using equipment readily available in most radiation oncology clinics; and (2) provide an option for clinics wishing to do DIBH procedures, but lacking access to the capital funds required to purchase a commercial system.

Methods/Materials: For simulation and treatment, a foam block is placed on the patient’s abdomen and a horizontal laser mounted on a movable slide is aimed at the center of the foam block. After a coaching and practice session the block is marked at the average free breathing position and average DIBH position. The position of block relative to laser can be seen by the patient via prism glasses as well as radiation therapists via a video camera system. Simulation CT scans and treatment delivery are performed under DIBH conditions. It was not necessary for the CT scanner or LINAC to have gating capabilities. However, the patient must be able to hold their breath long enough for a CT scan. Treatment is performed by manually turning the beam on once the patient has achieved DIBH.

Results: Manually triggered imaging was used daily to verify DIBH reproducibility for all patients treated using this system. Sets of before and during port images were used to ensure patient position was appropriate for treatment. Results of the laser on block method were compared to a sister facility using surface mapping techniques for DIBH, and the level of reproducibility between the systems was found to be equivalent between methods.
Conclusions: The laser and block system was found to be simple to implement and robust during patient treatment. This system can be created from readily available materials at low cost and provides adequate feedback to patient and therapists to ensure reproducible treatment setup. The during treatment images successfully verified the treatment position on a daily and per field basis.