# The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

Source: https://onco.cc/key-papers/paper-smyth-dibh-cardiac-sparing-review-jmrs-2015/  
OnCo record `paper-smyth-dibh-cardiac-sparing-review-jmrs-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A review of ten studies comparing radiotherapy plans for left breast cancer made in deep breath-hold and in free breathing. Breath-hold cut the average heart dose by up to 3.4 Gy, which on published dose-risk estimates corresponds to a 13.6 per cent smaller projected rise in heart disease risk.

## Summary

Smyth and colleagues searched PubMed to July 2014 for studies comparing mean heart dose between deep inspiration breath-hold and free-breathing plans for left breast cancer. Ten studies provided data; breath-hold reduced the mean heart dose by up to 3.4 Gy. Four studies reported the technique was stable and reproducible day to day. Using current estimates of excess cardiac toxicity from radiotherapy, the authors calculated that a 3.4 Gy reduction is equivalent to a 13.6 per cent reduction in the projected increase in risk of heart disease.

## Fields

- Kind: Key paper
- Last checked: 2026-10-20
- Tags: precision; radiation
- Journal: Journal of Medical Radiation Sciences
- Year: 2015
- DOI: 10.1002/jmrs.89
- Authors: Smyth LM, Knight KA, Aarons YK, Wasiak J.
- Findings: Ten studies: breath-hold reduced mean heart dose by up to 3.4 Gy against free breathing.; Four studies found the technique stable and reproducible daily.; A 3.4 Gy reduction corresponds to a 13.6 per cent reduction in the projected increase in heart disease risk.
- What it means: The heart benefit of breath-hold is a projection from dose: it rests on the dose-risk relationship measured by Darby and colleagues, not on a trial counting heart attacks in women treated with and without breath-hold.
- Caveats: Dosimetric studies only; no clinical cardiac outcomes.; 'Up to 3.4 Gy' is the largest reduction among the studies, not the average.

## Sources

- Journal of Medical Radiation Sciences 2015: https://doi.org/10.1002/jmrs.89
- PubMed 26229669: https://pubmed.ncbi.nlm.nih.gov/26229669/

## Connected records

- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Respiratory motion management (4D-CT, gating, breath-hold, tracking)](https://onco.cc/technologies/respiratory-motion-management/)
- terms: [Deep inspiration breath-hold (DIBH)](https://onco.cc/terms/deep-inspiration-breath-hold/)

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