Artificial Intelligence-Based Patient Selection for Deep Inspiration Breath-Hold Breast Radiotherapy from Respiratory Signals  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via [PERSON] 2, 33081 Aviano, Italy 1  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via [PERSON] 2, 33081 Aviano, Italy 1  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via [PERSON]. [PERSON] 2, 33081 Aviano, Italy 1  
[PERSON]  
2 Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via [PERSON] 2, 33081 Aviano, Italy 2  
[PERSON]  
3 Institute of Nuclear Medical Physics (INMP), Bangladesh Atomic Energy Commission (BAEC), Dhaka 1349, Bangladesh 3  
[PERSON]  
2 Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via [PERSON] 2, 33081 Aviano, Italy 2  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via [PERSON] 2, 33081 Aviano, Italy 1  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. [PERSON] 2, 33081 Aviano, Italy 1  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. [PERSON] 2, 33081 Aviano, Italy 1  
[PERSON]  
1 Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via F. [PERSON] 2, 33081 Aviano, Italy 1  
breath-hold (DIBH) RT technique, where radiation is delivered while the patient reaches and holds a predetermined level of inspiration, in order to maximise the distance between the heart and the radiation field [11; 12; 13]. A RT linear accelerator with DIBH capability is equipped with a system which tracks the respiratory cycle, by measuring the position of a marker on the chest. The system automatically triggers beam-hold when the chest is outside a specified window of DIBH [14]. The threshold for DIBH is chosen by the radiation oncologist, using the respiratory track acquired during acquisition of the pre-treatment computed tomography (CT). DIBH has been shown to effectively reduce the dose to structures that are correlated with cardiovascular side effects and, therefore, DIBH could be become a routine clinical practice for left-sided patients. Aside from decreasing the dose to the heart, DIBH also reduces the dose to the left anterior descending artery (LAD), which is the cardiovascular structure at risk of receiving the highest dose because of its proximity to the target tissue [15; 16]. Moreover, by minimizing motion due to patient breathing [11; 17; 18], DIBH reduces the intra-fraction dosimetric uncertainty [19; 20]. Not all of the patients, however, comply with DIBH, because it requires training the patients to hold their breath reproducibly, and it also increases the time required for delivering RT. Moreover, the benefit, in terms of decreased dose to organs at risk, may be reduced for patients with limited expansion of the lung. [PERSON] and co-authors [21] found that para-sagittal cardiac contact distance correlated well with mean heart dose, and may potentially be used for patient selection. A thorough assessment of the dosimetric benefit of DIBH requires comparing treatment plans, with or without DIBH, in terms of dose to the organs at risk, in particular those related to cardiovascular side effects [15]. [PERSON] et al. [22] used a rapid planning method to select patients with unfavourable cardiac anatomy based on dosimetry. Patients underwent a FB CT scan. A plan was produced within 9 min, using an automated script in the Pinnacle3 (Philips Healthcare, Best, The Netherlands) planning system. If the FB plan resulted in a heart V50% >10 cm\({}^{3}\), then the patient underwent a DIBH procedure. Although this method is able to select patients for DIBH, it requires the acquisition of an FB CT scan and the generating an FB RT plan, in order to compare dose to the cardiovascular structures between DIBH and FB RT treatments.