## 3 Results
### Other Factors
showed significant advances in the combined use of continuous positive airway pressure (CPAP) and DIBH in MR-guided radiation therapy for thoracic tumors. The study was volunteer-based and evaluated the practicality of using CPAP both in combination and independently of DIBH techniques to control respiratory motion during MR linear gas pedal (MR-linac) radiotherapy. The integration of CPAP during DIBH showed a significant reduction in respiratory motion amplitude, resulting in minimized intra-fractional tumor motion during treatment sessions, as well as improved accuracy in target localization and reduced discrepancies between planned and delivered doses [18]. These findings demonstrate the potential of CPAP as an effective adjunctive tool in the context of DIBH-guided MR radiotherapy. Further large-scale studies and clinical trials are warranted to confirm and extend these encouraging results, paving the way for sophisticated and precise radiotherapy treatments for DIBH-guided thoracic oncology. * ABC The modern Active Breathing Coordinator (ABC) system greatly improves and ensures reproducible chest movements during DIBH. [PERSON] et al. confirmed the precision, feasibility, and safety of the chest irradiation field for patients treated with DIBH along with ABC and suggested that this system should be used as often as possible in combination with DIBH [42]. * BCS/Masectomy In a study by [PERSON] et al., it was noted that greater benefit after DIBH is achieved by patients after mastectomy than after BCS [36]. Similar conclusions were reached by [PERSON] et al. who in their study compared patients after BCS and after modified radical mastectomy (MRM). In both cases, the doses administered to the heart were reduced during DIBH radiotherapy; however, in MRM, significantly lower doses were applied to the lungs and LAD. This confirms that this technique may be particularly beneficial for patients undergoing mastectomy [13; 43]. Lung restrictions were less common in the group of MRM patients requiring lymph node irradiation. Further studies are needed on the effectiveness of DIBH therapy depending on the surgical treatment chosen [13]. * BMI The relevance of higher values of BMI for cardiac protection during radiation was confirmed by [PERSON] et al. [21]. BMI is another factor that influences the effectiveness of DIPH. Researchers [PERSON] et al. showed a positive correlation between body mass index and MHD and maximum LAD dose but did not determine which patients would have the best positive effects [22]. A study by [PERSON] et al., among many predictive factors, shows the relevance of BMI, an increase that correlates with a greater difference in mean heart dose (MHDD) between FB and DIBH treatment plans [36]. Studies according to the potential factors affecting the effectiveness of DIBH are presented in Table 2.  
\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}{*}{Training and patient education} & [PERSON] & [19] & 2018 & Effects of Preparatory Coaching on the DIBH treatment & \multirow{8}{*}{The benefits of DIBH are achieved by patients who have received adequate training and education prior to radiation therapy, which helps minimize cardiac complications and shorten treatment times.} \\  & [PERSON] & [23] & 2023 & \multirow{8}{*}{The patients of DIBH are achieved by patients who have received adequate training and education prior to radiation therapy, which helps minimize cardiac complications and shorten treatment times.} \\  & [PERSON] & [24] & 2020 & \multirow{8}{*}{The patients of DIBH are achieved by patients who have received adequate training and education prior to radiation therapy, which helps minimize cardiac complications and shorten treatment times.}