A single-institution study published in the Journal of Applied Clinical Medical Physics evaluated the accuracy and reproducibility of voluntary deep-inspiration breath-hold (vDIBH) for whole-breast radiotherapy using real-time surface imaging. As part of the immobilization workflow, the institution utilized customized upper-body molds with or without the SaBella Flex breastboard from CDR Systems AAPM Journal-SBS14 and DIBH. This integration provided a stable and reproducible platform for patients performing repeated breath-holds, a key requirement for ensuring dosimetric advantages in DIBH.
The clinical results highlight how high-quality immobilization directly supports surface-imaging–based workflows. Across 58 patients and more than 7,200 breath-holds, the study demonstrated sub-millimeter intra-breath-hold stability and intrafraction reproducibility within approximately 2 mm—performance that depends on consistent patient positioning (including arms, torso, and chest wall) throughout treatment. By reducing positional variability, the SaBella Flex system contributed to the team’s ability to achieve setup margins of roughly 4.8–6.4 mm across all translational axes, comparable to or better than margins reported in studies relying on spirometry or x-ray positioning.
The findings reinforce the importance of purpose-designed breast immobilization when implementing voluntary DIBH programs. A supportive, anatomically adaptive platform such as the SaBella Flex breastboard ensures patients can reproduce breath-hold position comfortably and consistently across the entire course of treatment. This stability allowed the investigators to rely on the CT-generated reference surface for daily guidance, quantify systematic and random errors accurately, and maintain the dosimetric benefits associated with heart and lung sparing.
As more clinics transition to surface-guided DIBH, this study provides a compelling example of how thoughtful immobilization selection—such as the integration of CDR Systems’ SaBella Flex—helps enable precise, reproducible, and clinically efficient breast radiotherapy workflows.
Read the full article by Annie Xiao, Jennie Crosby et al. here