Voluntary Deep Inspiration Breath Hold (vDIBH) for Radiotherapy to the Breast

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The information provided is about holding your breath for radiotherapy treatment.

It will go through the instructions that the radiographers give during treatment and what these instructions mean. This means that you can start to practice breath hold before attending for radiotherapy

Radiotherapy for Breast Cancer

What is vDIBH?

vDIBH (voluntary deep inspiration breath hold) is a process by which you hold your breath for short periods of time during your radiotherapy planning CT scan and treatment. This is offered if you are receiving radiotherapy to the left breast or chest wall, or the lymph nodes alongside your breast bone.

We use vDIBH in these cases because the heart sits behind the left breast and chest wall. When you hold your breath, your lungs fill with air and your chest moves away from the heart. Therefore, vDIBH minimises the amount of heart tissue that will be in the treatment area.

Coming for your planning scan

When you attend for your CT scan, the radiographers will explain the breath hold technique. This will be done with a translator if required. At this point, the radiographers will check that you are able to hold your breath for at least twenty seconds. The radiographers will use specific phrases when instructing you to hold your breath. These instructions are:

When you are ready, breathe in

At this point, you should take a deep, controlled breath in through your nose

Hold

At this point, you should stop breathing in and hold your breath

Breathe normally

At this point, you should breathe out and resume your normal breathing until instructed otherwise

Photo showing the CT scanner in the scanning room

In the scanning room, there will be a camera mounted on the ceiling which monitors your breath hold. There is also a screen for you to look at. This is called a “coaching screen” and can help you achieve a consistent breath each time. The screen will show a grey background with a white section in the middle. There will also be a yellow bar at the bottom of the screen that looks like this:

Image of the coaching screen with yellow bar.

When you breathe in, the yellow bar will rise towards the white section of the screen. When instructed to breathe in, you should breathe in whilst watching the screen. Once the yellow bar reaches the middle of the white section, you should hold your breath. When holding you breath, the screen should look like this:

Image of the coaching screen with green bar.

Once you have practiced using the coaching screen, the radiographers will leave the room to take a CT scan. You will have one CT scan whilst breathing normally. Then, you will have another CT scan whilst holding your breath.

During the breath hold scan, you will be asked to hold your breath for the whole scan (usually around fifteen seconds). The radiographers will talk to you through an intercom, using the same instructions as before.

Coming back for treatment

Your radiotherapy will start a couple of weeks after your planning scan. Although the treatment machine will look different to the CT scanner, the method and instructions for holding your breath will be the same. There will be a coaching screen in the treatment room to help you with this. The position that you are in will be the same as for your CT scan.

Photo showing an medical linear accelerator (LINAC)

You will be asked to hold your breath for short periods (at least twenty seconds each time) whilst the radiotherapy treatment in delivered. There are cameras in the treatment room which monitor your breath hold and position throughout the treatment. These cameras are linked to the treatment machine. Therefore, if you release your breath without being told to, the treatment beam will automatically stop until you are back in the required position. The radiographers will explain this in more detail to you before your first treatment.