AIMS: Deep inspiratory breath-hold (DIBH) techniques for left breast and chest wall radiotherapy can reduce cardiac dose. We investigated the use of 'upfront selection' criteria for DIBH based on @entity5 bed position and whether cardiac shielding was used. MATERIALS AND METHODS: Four methods of selecting @entity1 for DIBH were assessed retrospectively in a cohort of left breast and chest wall treatments. These were: (1) free @entity1353 scan on all @entity1 , selecting DIBH treatment for those with a predicted mean heart dose >= 3  Gy; (2) selective DIBH for those with @entity299 ( @entity299 ) on free @entity1353 scan >= 1  cm; (3) use of an 'upfront selection process' using @entity5 bed position as initial selection and measurement of @entity299 on those not selected upfront; (4) DIBH on all. The methods were assessed on predicted mean heart dose, proportion needing two scans, sensitivity, specificity and the positive and negative predictive values. These were compared with method (1) as the gold standard. RESULTS: In total 134 cases were analysed. The predicted mean heart dose in free @entity1353 was >= 3  Gy in 28 (20.9%). Therefore, applying method (1), 28/134 (20.9%) would be selected for DIBH treatment. Applying method (2), 66/134 (49.2%) would be selected for DIBH treatment, all requiring two scans. Of these, 40/66 (60.6%) would receive < 3  Gy in free @entity1353 so are over-selected; 2/68 (2.9%) would have received >3  Gy in free @entity1353 so failed to be selected. Selection using method (3) was similar to method (2), but only five @entity1 required two planning scans; 61/134 (45.5%) cases would be selected for DIBH upfront and 5/134 (3.7%) after initial free @entity1353 scan; 42/66 (63.6%) of those selected for DIBH treatment would receive <3  Gy in free @entity1353 and 4/68 not selected (6%) would receive >3  Gy in free @entity1353 . For methods (2) and (3) most @entity1 not selected for DIBH would have had a mean heart dose of <= 3  Gy (64/68, 90%). Using method (3), 86% (95% confidence interval 67-96%) of @entity1 with a mean heart dose >3  Gy would be selected for DIBH treatment. The estimated mean and standard error for the area under the receiver operator characteristic curve for @entity299 as a predictor for mean heart dose was 0.85 (0.03). CONCLUSION: This study supports the use of proposed an 'upfront selection process' as a means of selecting @entity1 for treatment with DIBH and avoiding two radiotherapy planning scans. Calculation of @entity299 can be used as a surrogate for mean heart dose in the selection of cases for DIBH.

Assessment of Upfront Selection Criteria to Prioritise XXXX for Breath-hold Left-sided Breast Radiotherapy.

@entity5 :: ('MESH:D009369', 'Disease') :: ['tumour'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity299 :: ('MESH:D006331', 'Disease') :: ['maximum heart depth', 'MHD'] @entity1353 :: ('MESH:D004417', 'Disease') :: ['breathing']
@entity1 :: (9606,Species) :: ['Patients']
