## 5 Conclusions  
The primary factors influencing the reproducibility and saving of normal tissues are adequate education, respiratory training, and patient preparation prior to radiation therapy. Studies confirm that a patient's awareness, motivation for treatment, and mental state significantly affect the effectiveness of treatment. Lack of consent, fear, anxiety, depression, and comorbid mental disorders disqualify some patients from the DIBH method. The best candidates for treatment with DIBH are patients who have a high level of health consciousness, understand the importance of performing the DIBH technique accurately, \begin{table}
\begin{tabular}{l l l l l l} \hline \hline
**Potential Factor** & **Reference** & **Citation** & **Year** & **Short Description of the Study** & **Effectiveness of DIBH Conclusions** \\ \hline \multirow{8}{*}{Smoking} & [PERSON] & [32] & 2022 & Irradiation incidence of cardiac & \multirow{8}{*}{Non-smoking patients benefit from DIBH, as risks} \\  & [PERSON] & [33] & 2020 & Importance of baseline cardiac risks & & \\  & [PERSON] & [35] & 2019 & DIBH heart toxicity & & \\  & [PERSON] & [5] & 2021 & Various aspects of clinical utility of & & \\  & [PERSON] & [16] & 2021 & DIBH & therapy & \\  & [PERSON] & [16] & 2018 & Individual risk estimates of & & \\  & [PERSON] & [16] & 2018 & ischemic heart disease & & \\ \hline \multirow{8}{*}{IMRT, VMAT, proton techniques vs. DIBH} & [PERSON] & [35] & 2019 & DIBH heart toxicity & \multirow{8}{*}{Combining DIBH with IMRT: Patients with minimal or well-controlled respiratory motion, which will allow for the full benefit of IMRT to be realized in terms of conformal dose delivery, while minimizing the impact of organ motion.} \\  & [PERSON] & [20] & 2022 & & \\  & [PERSON] & [38] & 2023 & DIBH cardiorespiratory dose & & \\  & [PERSON] & [39] & 2022 & DIBH therapy for mediastinal & & \\  & & & & lymphoma & & \\  & & & & & & \\  & & & & & & \\  & & & & & & \\  & & & & & \\  & & & & & & \\ \hline \multirow{8}{*}{Use of CPAP} & \multirow{8}{*}{[PERSON]} & \multirow{8}{*}{[18]} & \multirow{8}{*}{2022} & Positive airway pressure for thoracic respiratory motion & \multirow{8}{*}{Patients with thoracic tumors who have significant respiratory motion, as CPAP can reduce the amplitude of respiratory motion} \\  & & & & & & \\  & & & & & & and improve the accuracy of radiation therapy. \\ \hline \multirow{8}{*}{ABC} & \multirow{8}{*}{[PERSON]} & \multirow{8}{*}{[42]} & \multirow{8}{*}{2023} & Efficacy of active breathing & \multirow{8}{*}{In patients who require repetitive chest movements during DIBH because the ABC} \\  & & & & coordinator-assisted DIBH & & system provides precise and reproducible \\ \hline \multirow{8}{*}{BCS/Masetectomy} & [PERSON] & [13] & 2022 & DIBH versus free breathing in radiotherapy & \multirow{8}{*}{Post-mastectomy patients may benefit more from DIBH compared to BCS patients} \\  & [PERSON] & [42] & 2023 & Feasibility and efficacy of active breathing coordinator & & \\  & [PERSON] & [43] & 2021 & Cardiac dose reduction using & \\  & & & & & \\  & & & & & \\ \hline \multirow{8}{*}{BMI} & [PERSON] & [21] & 2019 & Patient Selection Criteria for DIBH & Patients with a higher BMI may show a greater difference in mean heart dose (MHDD) \\  & [PERSON] & [23] & 2023 & Implementation of breath-hold & & between FB and DIBH treatment plans. This \\  & [PERSON] & & & & & means that DIBH may more effectively protect \\  & [PERSON] & [42] & 2023 & Feasibility and efficacy of active & & the heart from radiation in patients with a \\ \hline \hline \end{tabular}
\end{table} 
Table 2: _Cont._and do not have problems with anxiety or other psychiatric disorders. Patients who meet these criteria are more likely to perform the procedure correctly, resulting in better treatment outcomes and minimizing the risk of cardiac complications. Many patients are unable to hold their breath properly due to obesity, poor physical condition, or asthma. For respiratory diseases and smokers, alternative breathing methods should be considered.