ESTRO course on Image Guided Radiotherapy in Clinical Practice 2018

Some caveats of breath hold

2nd patient treated in DIBH

CT CBCT

•peripheral target + mediastinal lymph nodes

•10th fraction: match on mediastinum, 1.6 cm shift CC direction for peripheral tumour

Josipovic et al Acta Oncol 2014

Don’t (blindly) trust external surrogates: markers, spirometry, surface based etc… Daily breath hold CBCT is mandatory Intra fraction monitoring highly desirable