Forums Deep Inspiration Breath Hold DIBH Breast Case Imaging Reply To: DIBH Breast Case Imaging

Alissa Fischer

<span style=”font-family: Georgia, serif;”>Thanks for all the feedback, this is helpful.  We are using a Varian ix machine.</span>


<span style=”font-family: Georgia, serif;”>I did forget to mention that every treatment we take one CINE image during one of the tangent fields to make sure Vision is reading the patients surface correctly and that there is no heart in the treatment field (unless planned).  The way we use Vision is a little different in that we only use it to check the patients breath hold and monitor the vertical value in Vision during a patients treatment as we are using the Breath hold DICOM Surface for treatment.    We do not currently set-up patients using Vision- we are in the process of potentially changing the way we use the system.  In fact we only import the DICOM Breath hold surface into Vision and only reacquire a new surface if needed based on our daily CINE images.  We set patient up (free breathing and THEN turn on vision, have patient take breath in and either coach patient to get within vertical threshold or can adjust the couch vertical +/- 3mm in either direction from the couch vertical value noted from Day 1.  (We check the patients Free breathing PIN and DIBH PIN Day 1 and stick with that Couch vertical value throughout treatment unless we start having trouble getting the patient to the correct breath hold)  The way we use it works, but there are times when we have set-up issues and trouble shooting these cases can be cumbersome.  Like I mentioned we do take orthogs and all tx ports day 1.  We do pay attention to the separation between the spine and sternum and this flags us if the patient needs to adjust their breath.  Once in a while we will have trouble with patients slightly arching their back to be able to get to the same breath hold they were taking at the time of the sim, and this trouble shooting can be tedious. </span>