Deep Inspiration Breath-Hold (DIBH)

  • Reference Number: HEY-719-2015
  • Departments: Radiotherapy

Introduction

This leaflet explains more about using the deep inspiration breath-hold technique (DIBH) when patients are having radiotherapy to the breast or chest wall as part of their treatment for breast cancer.  This leaflet is designed to be read alongside our ‘Radiotherapy to the Breast’ leaflet.

What is the Deep Inspiration Breath-Hold Technique?

The deep inspiration breath hold (DIBH) technique is a method of delivering radiotherapy (under set conditions as described later) during breath-hold rather than free-breathing.

This treatment technique is relatively new but the research has shown that in some people it is better than the current standard method.

You will need to be able to take in a deep breath (for approximately 20 seconds at a time) as described to undergo this technique.

It is important to take in as big a breath as you can manage, to hold for a prolonged period (see later), when asked to hold your breath. It is a good idea to practice at home for several days before coming to your planning CT scan and treatment appointments. Practice will also help to improve your confidence and the ability of your lungs to take in and hold bigger breaths.

Why use the Deep Inspiration Breath-Hold Technique?

You may decide that you do not want to be treated using DIBH technique. This is an option you can choose and you will be able to discuss this with your clinical oncologist.

By holding your breath, your chest stays still and your lungs become expanded, moving your breast / chest wall away from the heart. In many people this is helpful in reducing the dose to the heart and the lung, whilst ensuring the breast / chest wall area receives the full dose as prescribed. There are no risks associated with DIBH.

What to expect at your Computed Tomography (CT) scan appointment

We will ask you to lay on the CT scanner bed in the preferred position (explained in the leaflet Radiotherapy to the Breast) and help you to practice your breathing as required before going ahead with the scan. A special camera and equipment monitors your breathing, with the help of a sensor (a small plastic box) placed on your chest.

During this planning CT scan, the radiographers will look at your breathing pattern and set the height of the area that relates to your breath-hold position. This is why it is important that you take in a big breath to expand your lungs as much as possible but also that you can easily reproduce this breath.

The CT scan takes about 15-20 minutes and we will ask you to hold your breath a few times for approximately 20 seconds.

What to expect at your treatment appointments

For your radiotherapy treatments the sensor used for the planning scan is used again. We will also provide you with a small screen, which shows you a picture representation of your breathing. The display will help you to see if you are taking enough air into your lungs. The pictures on the following page show what you will see.

A yellow bar in the picture represents your breathing and will move up and down as you breathe in and out. When holding your breath the yellow bar will move up into the blue area and turn green. While the bar is green, the machine will turn on. When you let your breath go, the bar will drop back out of the blue area and turn yellow again. The machine will turn off once the bar is yellow. This is how the treatment machine stops and starts the radiation and is controlled by computer.

Once we have positioned you for your treatment we will ask you to hold your breath several times. When the radiographers are happy with your breathing pattern and have finished their checks, the screen will be switched on and they will inform you when they are ready to leave the room. Before the radiotherapy is given, the treatment machine will move around you and you will hear noises from the treatment machine. Please lie still and breathe normally. Through an intercom system, the radiographers will let you know when they are ready to begin the treatment and will ask you to take in a deep breath and to hold it, which will move the bar into the blue box.

Once you hold your breath, you will see that the yellow bar on the screen has turned green and the treatment machine will turn on and deliver the treatment.

This image shows the screen view of someone taking a breath to hold:

If you breathe out during the delivery of the radiotherapy, the machine will automatically turn off. Usually, it is possible to give the radiotherapy in only a couple of ‘breath-holds’.  The radiographers will instruct you to breathe normally in between sections of the treatment.

If your breath has not raised the bar high enough, the treatment machine will not turn on. The radiographers will monitor you the whole time; they can see and hear you and will help guide you through the procedure.

The treatment takes about 10-15 minutes.

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish), so that they can be of help and support.

What happens afterwards?

If you have any general enquiries prior to starting your scan/treatment, please contact the Radiotherapy Information and Support Team,

Monday to Friday 8:00am to 6:00pm

Telephone: (01482) 461206

Email: Radiotherapy.Info@hey.nhs.uk

Please also use this number if you have any concerns during or after treatment.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.