# Deep inspiration breath-hold for left-sided breast radiotherapy

Source: https://onco.cc/protocols/breath-hold-left-breast-radiotherapy/  
OnCo record `breath-hold-left-breast-radiotherapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For radiotherapy to the left breast or chest wall, you take a deep breath and hold it for about 20 to 30 seconds during each part of the treatment. Filling the lungs moves the heart away from the treated area, so it gets less radiation. You practise first, and the planning scan is done holding your breath. If breath-holding does not suit you, treatment while breathing normally is still safe.

## Summary

NICE NG101 1.13.2 [2018] recommends a deep inspiratory breath-hold technique for people with left-sided breast cancer to reduce heart dose; the RCR UK consensus (2016) supported, unanimously, that every department have a breath-hold technique available and, very strongly, a mean heart dose under 2 Gy for more than 90% of left-sided patients not having internal mammary chain treatment. The rationale is dose: the Darby case-control study found major coronary events rose by 7.4% per gray of mean heart dose with no threshold.

The ESTRO-ACROP implementation guideline (2023, ungraded expert consensus) sets out the practice: coach the patient before the planning CT, aim for a comfortable rather than maximal breath-hold (about 20 to 30 seconds is achievable for more than 90% of breast patients), plan on a CT taken in breath-hold with the same monitoring equipment used on the treatment machine, verify both patient position and breath-hold level with imaging, ideally daily, and be able to re-image and re-plan if the breathing pattern changes. It does not recommend a routine extra free-breathing planning CT beyond the implementation stage, because of the added dose.

Voluntary breath-hold without equipment was as reproducible and heart-sparing as a spirometry device (ABC) in the HeartSpare randomised crossover study, quicker and preferred by patients and radiographers; in larger-breasted women it gave lower heart and coronary artery doses than prone free-breathing (HeartSpare IB). Surface tracking with visual feedback is common; one small randomised trial of chest-surface versus abdominal-block feedback found no difference in accuracy.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: DIBH; deep inspiration breath hold; breath-hold radiotherapy; voluntary breath-hold; heart-sparing breast radiotherapy; active breathing coordinator; ABC breath-hold; gated breast radiotherapy

## Connected records

- protocols: [Breast radiotherapy positioning, immobilisation and daily set-up verification](https://onco.cc/protocols/breast-radiotherapy-positioning-and-setup/), [Breathing motion in lung and upper abdominal radiotherapy: 4D CT, gating, breath-hold and compression](https://onco.cc/protocols/respiratory-motion-management-4d-ct-and-gating/), [Radiotherapy planning scan (CT simulation): positioning, skin marks and what the patient does](https://onco.cc/protocols/radiotherapy-planning-ct-simulation/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [In-room imaging for radiotherapy (cone-beam CT, ExacTrac, CT-on-rails, HyperSight)](https://onco.cc/technologies/in-room-imaging-systems/), [Respiratory motion management (4D-CT, gating, breath-hold, tracking)](https://onco.cc/technologies/respiratory-motion-management/), [Surface-guided radiotherapy (SGRT)](https://onco.cc/technologies/surface-guided-radiotherapy/)
- terms: [Cardiotoxicity (LVEF decline, cardiomyopathy)](https://onco.cc/terms/cardiotoxicity/), [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/), [Radiotherapy](https://onco.cc/terms/radiotherapy/)
- ideas: [Breath-hold coaching and home practice a week before the planning scan, in the patient's own language](https://onco.cc/ideas/idea-pu-breath-hold-coaching-before-planning/), [Deep-breath-hold radiotherapy for every suitable person with left-sided breast cancer](https://onco.cc/ideas/idea-pu-breath-hold-left-breast-routine/), [Let the patient see their own breath-hold on a screen or in video glasses](https://onco.cc/ideas/idea-pu-breath-hold-visual-feedback/)

---
JSON: https://onco.cc/api/v1/entities/breath-hold-left-breast-radiotherapy.json