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Minimizing Heart Dose in Left Breast HDR: A Deep Inhalation Breath Hold Approach

N Adnani*, D. Beyer, Northern Arizona Healthcare, Sedona, AZ


(Sunday, 7/14/2019)  

Room: ePoster Forums

Purpose: To report on the use of a Deep Inhalation Breath Hold (DIBH) technique during an HDR brachytherapy treatment of a left breast.

Methods: Due to the proximity of the heart and pericardium to the SAVI applicator of a left breast patient, a DIBH scan was acquired, in addition to the free breath one, in order to assess the dose to the heart. An optimal treatment plan was first generated in Free Breath (FB) mode. The corresponding dwell times were then transferred to the dwell positions of the SAVI applicator on the DIBH image.

Results: Table 1 summarizes the heart and pericardium dose in the two breathing modes. In the FB, it is as follows: D0.1 cc = 19.16 Gy; D5 cc= 13.93 Gy; D50 cc= 7.97 Gy with the maximum dose at 20.98 Gy or 61.7% of prescribed dose as shown in Figure 1.In DIBH mode, see Figure 2, the same plan delivers the following dose: D0.1 cc = 7.2 Gy; D5 cc= 6.11 Gy; D50 cc= 4.13 Gy with a maximum dose of 7.49 Gy or 22% of prescribed dose. Treatments, in DIBH mode, were delivered using a GammaMedPlus iX afterloader (Varian Medical Systems, Palo Alto, CA). Treatments were delivered in maximum increments of 30 seconds of planned dwell positions

Conclusion: To our knowledge, this is the first report of a DIBH HDR treatment (video recording). As expected, the dose to the heart was significantly reduced. Treatment sessions were comfortably tolerated by the patient with minimal breath hold practice prior to the first treatment. While our GammaMedPlus iX suite is not equipped with an imaging modality that would have allowed us to document the reproducibility of the level of the breath hold, we anticipate that facilities with such capability will be able to do so.


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