# Deep Inspiration Breath Hold **URL:** https://forum.sgrt.org/c/deep-inspiration-breath-hold/15.md [Latest](https://forum.sgrt.org/latest.md) · [Categories](https://forum.sgrt.org/categories.md) · [Tags](https://forum.sgrt.org/tags.md) --- ## [About the Deep Inspiration Breath Hold category](https://forum.sgrt.org/t/about-the-deep-inspiration-breath-hold-category/268)
**Author:** [@system](https://forum.sgrt.org/u/system)\ **Replies:** 0\ **Last updated:** [August 19, 2025, 8:25pm UTC](https://forum.sgrt.org/t/about-the-deep-inspiration-breath-hold-category/268 "2025-08-19T20:25:47Z")
--- ## [DIBH technique translating into other languages](https://forum.sgrt.org/t/dibh-technique-translating-into-other-languages/189)
**Author:** [@nicola\_mullins](https://forum.sgrt.org/u/nicola_mullins)\ **Replies:** 9\ **Last updated:** [August 14, 2026, 7:26am UTC](https://forum.sgrt.org/t/dibh-technique-translating-into-other-languages/189 "2026-08-14T07:26:10Z")
Hi all Apologies if this has been asked before. We have a set up a DIBH service here in the UK that relies on coaching the patient into the treatment position. However, we have patients that don’t speak English that we … --- ## [Changing the ROI during a breathhold](https://forum.sgrt.org/t/changing-the-roi-during-a-breathhold/388)
**Author:** [@meral\_reyhan](https://forum.sgrt.org/u/meral_reyhan)\ **Replies:** 1\ **Last updated:** [April 22, 2026, 10:32am UTC](https://forum.sgrt.org/t/changing-the-roi-during-a-breathhold/388 "2026-04-22T10:32:23Z")
Should you change an ROI during a fraction due to camera blockage, without taking imaging to confirm alignment. Once you have an ROI specified and that is tied to an image alignment, i.e., captured after shifts are made … --- ## [DIBH Protocol/Candidate Criteria](https://forum.sgrt.org/t/dibh-protocol-candidate-criteria/192)
**Author:** [@phillip\_harmer](https://forum.sgrt.org/u/phillip_harmer)\ **Replies:** 2\ **Last updated:** [November 26, 2025, 10:30am UTC](https://forum.sgrt.org/t/dibh-protocol-candidate-criteria/192 "2025-11-26T10:30:34Z")
What criteria does a patient need to meet to be a good DIBH candidate? I understand they would need to be able to repeat the same BH each time but is there a certain amount of chest rise you require? We recently had a be… --- ## [Multiple Plans (Tans + SCF)](https://forum.sgrt.org/t/multiple-plans-tans-scf/201)
**Author:** [@robertr](https://forum.sgrt.org/u/robertr)\ **Replies:** 5\ **Last updated:** [July 29, 2024, 2:52pm UTC](https://forum.sgrt.org/t/multiple-plans-tans-scf/201 "2024-07-29T14:52:29Z")
Hi all, I wanted to get input into the use of SGRT for DIBH in patients with multiple plans. We plan our SCF patients as a separate plan (Plan 1: Tans, Plan 2: SCF), but they have a common ISO position. Technically it’s… --- ## [Low breathing signal in AlignRT and ROI design](https://forum.sgrt.org/t/low-breathing-signal-in-alignrt-and-roi-design/233)
**Author:** [@Steven\_de\_Boer](https://forum.sgrt.org/u/Steven_de_Boer)\ **Replies:** 4\ **Last updated:** [June 13, 2024, 5:45am UTC](https://forum.sgrt.org/t/low-breathing-signal-in-alignrt-and-roi-design/233 "2024-06-13T05:45:12Z")
Following the guidelines for ROI drawing for lung cases we have excluded regions below the rib cage (where the Varian marker block is located). We are finding that many patients will have a strong 2.5 cm Varian marker bl… --- ## [2 CT scans for DIBH patients](https://forum.sgrt.org/t/2-ct-scans-for-dibh-patients/230)
**Author:** [@alison\_mendes](https://forum.sgrt.org/u/alison_mendes)\ **Replies:** 3\ **Last updated:** [May 2, 2024, 10:36am UTC](https://forum.sgrt.org/t/2-ct-scans-for-dibh-patients/230 "2024-05-02T10:36:54Z")
Hi, We are using the ABC system for our breath hold patients but are looking to use AlignRT for our DIBH patients. We have proposed the idea to our breast consultant and she is not very happy to do 2 CT scans for the lo… --- ## [Rt Breast/Chestwall with DIBH](https://forum.sgrt.org/t/rt-breast-chestwall-with-dibh/208)
**Author:** [@ragu\_tirukonda](https://forum.sgrt.org/u/ragu_tirukonda)\ **Replies:** 2\ **Last updated:** [February 1, 2024, 11:12am UTC](https://forum.sgrt.org/t/rt-breast-chestwall-with-dibh/208 "2024-02-01T11:12:10Z")
We are kind of new to VisionRT, and our physician wants to use DIBH for Rt Cheswall (if nodes are involved). From what I heard, DIBH is not recommended for rt chestwalls. If you guys are doing DIBH for RT chestwall, plea… --- ## [Brass mesh bolus](https://forum.sgrt.org/t/brass-mesh-bolus/162)
**Author:** [@landon\_clark](https://forum.sgrt.org/u/landon_clark)\ **Replies:** 6\ **Last updated:** [December 1, 2023, 9:53am UTC](https://forum.sgrt.org/t/brass-mesh-bolus/162 "2023-12-01T09:53:41Z")
Hello, I was wondering if it would be possible to use SGRT with brass mesh bolus, say for a chestwall? Thanks --- ## [ABC vs SGRT for Elekta machines](https://forum.sgrt.org/t/abc-vs-sgrt-for-elekta-machines/194)
**Author:** [@sam\_wolting](https://forum.sgrt.org/u/sam_wolting)\ **Replies:** 1\ **Last updated:** [August 11, 2023, 1:53am UTC](https://forum.sgrt.org/t/abc-vs-sgrt-for-elekta-machines/194 "2023-08-11T01:53:36Z")
Hello all, I was wondering if you could please share your experience of ABC compared to SGRT (such as Align-RT) for breast patient with Elekta machines. I understand breath-hold CBCT is very difficult with SGRT due to t… --- ## [AlignRT with Elekta Hexapod couch](https://forum.sgrt.org/t/alignrt-with-elekta-hexapod-couch/198)
**Author:** [@atai1](https://forum.sgrt.org/u/atai1)\ **Replies:** 1\ **Last updated:** [November 21, 2022, 11:55am UTC](https://forum.sgrt.org/t/alignrt-with-elekta-hexapod-couch/198 "2022-11-21T11:55:50Z")
Hi, We are going to install AlignRT in a room with an Elekta Versa HD and Hexapod couch. Did anyone have any issue of using AlignRT with a Hexapod couch ? Thank you very much An --- ## [CBCT for breast DIBH](https://forum.sgrt.org/t/cbct-for-breast-dibh/188)
**Author:** [@jose\_carlos\_pichardo](https://forum.sgrt.org/u/jose_carlos_pichardo)\ **Replies:** 3\ **Last updated:** [November 15, 2022, 9:15am UTC](https://forum.sgrt.org/t/cbct-for-breast-dibh/188 "2022-11-15T09:15:26Z")
I attended the SBRT virtual presentations yesterday morning and I was surprised to find that in Europe it is common to take a CBCT for breast DIBH cases. I was wondering if anyone in the US is using CBCT for breast DIBH,… --- ## [Pendulous breasts](https://forum.sgrt.org/t/pendulous-breasts/193)
**Author:** [@kristen\_beck](https://forum.sgrt.org/u/kristen_beck)\ **Replies:** 3\ **Last updated:** [February 7, 2022, 9:14am UTC](https://forum.sgrt.org/t/pendulous-breasts/193 "2022-02-07T09:14:00Z")
Any tips or tricks for using AlignRT on patients with pendulous breasts? We currently place a syringe under the breast to create separation in the inframammary fold and see some daily setup variation on AlignRT. How do o… --- ## [CT Simulation for DIBH](https://forum.sgrt.org/t/ct-simulation-for-dibh/191)
**Author:** [@jose\_carlos\_pichardo](https://forum.sgrt.org/u/jose_carlos_pichardo)\ **Replies:** 8\ **Last updated:** [June 21, 2021, 12:15pm UTC](https://forum.sgrt.org/t/ct-simulation-for-dibh/191 "2021-06-21T12:15:16Z")
At one of our centers have been using VARIAN RPM in CT SIM to coach the patient into an appropriate breath hold level for DIBH. At another center where we recently installed a new linac and VisionRT, we do not have VARIA… --- ## [Auto Beam hold](https://forum.sgrt.org/t/auto-beam-hold/190)
**Author:** [@chris\_mcguinness](https://forum.sgrt.org/u/chris_mcguinness)\ **Replies:** 7\ **Last updated:** [April 7, 2021, 3:17pm UTC](https://forum.sgrt.org/t/auto-beam-hold/190 "2021-04-07T15:17:21Z")
Hello, I’m curious if other sites are using auto beam hold for all DIBH breast patients or manually stopping the beam if the deltas exceed thresholds. If you are using auto beam hold what tolerances are you using for DI… --- ## [DIBH Tangent and 4 Field Filming Protocols](https://forum.sgrt.org/t/dibh-tangent-and-4-field-filming-protocols/187)
**Author:** [@brett\_thomas](https://forum.sgrt.org/u/brett_thomas)\ **Replies:** 3\ **Last updated:** [June 1, 2020, 7:33am UTC](https://forum.sgrt.org/t/dibh-tangent-and-4-field-filming-protocols/187 "2020-06-01T07:33:09Z")
Just wondering what everyone’s filming protocols are for DIBH. How often are you filming and what images are you taking? --- ## [Vertical shifts from radiographic images](https://forum.sgrt.org/t/vertical-shifts-from-radiographic-images/184)
**Author:** [@jose\_carlos\_pichardo](https://forum.sgrt.org/u/jose_carlos_pichardo)\ **Replies:** 10\ **Last updated:** [March 19, 2020, 8:53am UTC](https://forum.sgrt.org/t/vertical-shifts-from-radiographic-images/184 "2020-03-19T08:53:33Z")
I am having difficulty deciding what to do with couch vertical shift calculated from kV imaging pairs and MV imaging pairs. If we apply the VRT shift we are changing the breath hold level from that in our DICOM BH refere… --- ## [DIBH LNG findings](https://forum.sgrt.org/t/dibh-lng-findings/183)
**Author:** [@marko\_laaksomaa](https://forum.sgrt.org/u/marko_laaksomaa)\ **Replies:** 6\ **Last updated:** [March 15, 2020, 9:10pm UTC](https://forum.sgrt.org/t/dibh-lng-findings/183 "2020-03-15T21:10:48Z")
Hi At the moment we acquire daily tangential and weekly additional AP+LAT images in DIBH n+ and mastectomy cases with AlignRT, usually there is no surprises due to exceeding of IGRT tolerances in the weekly AP+LAT image… --- ## [Imaging Protocols for Multi field breast-free breathe](https://forum.sgrt.org/t/imaging-protocols-for-multi-field-breast-free-breathe/186)
**Author:** [@julie\_morzy](https://forum.sgrt.org/u/julie_morzy)\ **Replies:** 3\ **Last updated:** [March 9, 2020, 9:20am UTC](https://forum.sgrt.org/t/imaging-protocols-for-multi-field-breast-free-breathe/186 "2020-03-09T09:20:16Z")
It has been our experience, that we sometimes struggle with arm position and surface aligning simultaneously. Our physicians have requested to correct arm position prior to treating. When setting up our patients, all del… --- ## [DIBH Insufficient Surface Overlap Error](https://forum.sgrt.org/t/dibh-insufficient-surface-overlap-error/185)
**Author:** [@jose\_carlos\_pichardo](https://forum.sgrt.org/u/jose_carlos_pichardo)\ **Replies:** 3\ **Last updated:** [March 4, 2020, 11:51am UTC](https://forum.sgrt.org/t/dibh-insufficient-surface-overlap-error/185 "2020-03-04T11:51:26Z")
We are having an issue with a left breast DIBH mono-isocentric setup patient. Patient is laying flat on the couch on a mat with a wingboard and small vac loc for the arms and head. We get an “insufficient surface overlap… --- ## [DIBH DICOM](https://forum.sgrt.org/t/dibh-dicom/182)
**Author:** [@marko\_laaksomaa](https://forum.sgrt.org/u/marko_laaksomaa)\ **Replies:** 1\ **Last updated:** [November 1, 2019, 6:13pm UTC](https://forum.sgrt.org/t/dibh-dicom/182 "2019-11-01T18:13:37Z")
Hi all Have you noticed that in DIBH DICOM reference surface there may be 1-2 mm systematic error in the location of the sternum in vertical in the LAT image such that there is need to raise the couch vertical to reach … --- ## [Planning DIBH](https://forum.sgrt.org/t/planning-dibh/181)
**Author:** [@ConorWard](https://forum.sgrt.org/u/ConorWard)\ **Replies:** 3\ **Last updated:** [July 25, 2019, 8:21pm UTC](https://forum.sgrt.org/t/planning-dibh/181 "2019-07-25T20:21:57Z")
I’m just wondering how people are approaching planning the DIBH/FB plans with Align RT. I understand the logic of setting up to the FB contour and then switching to DIBH contour in breath hold. However I feel like I’m mi… --- ## [DIBH: CT process](https://forum.sgrt.org/t/dibh-ct-process/180)
**Author:** [@ashleigh\_holden](https://forum.sgrt.org/u/ashleigh_holden)\ **Replies:** 7\ **Last updated:** [May 14, 2019, 7:21am UTC](https://forum.sgrt.org/t/dibh-ct-process/180 "2019-05-14T07:21:23Z")
Hi everyone, apologies in advance if this is a stupid question… our AlignRT isn’t actually installed yet & still to complete training so I have basic knowledge only. Does anyone perform CT for breast patients to be trea… --- ## [Right Side Breast Tx post Left Side Breast Treat with DIBH](https://forum.sgrt.org/t/right-side-breast-tx-post-left-side-breast-treat-with-dibh/179)
**Author:** [@james\_murray](https://forum.sgrt.org/u/james_murray)\ **Replies:** 2\ **Last updated:** [March 6, 2019, 2:50pm UTC](https://forum.sgrt.org/t/right-side-breast-tx-post-left-side-breast-treat-with-dibh/179 "2019-03-06T14:50:16Z")
We have a breast patient successfully treated with Vision RT & DIBH to the left whole breast 6 months ago (267 cGy x 15). Patient is returning for right whole breast treatment. We thought we might do DIBH for the right s… --- ## [DIBH with bolus](https://forum.sgrt.org/t/dibh-with-bolus/171)
**Author:** [@jen\_r](https://forum.sgrt.org/u/jen_r)\ **Replies:** 8\ **Last updated:** [February 4, 2019, 12:33pm UTC](https://forum.sgrt.org/t/dibh-with-bolus/171 "2019-02-04T12:33:38Z")
We have one patient we are treating that is a DIBH with bolus (3mm). The issue that we are facing is that once we recapture, with the patient in breath hold, the deltas are still in tolerance once she is told to breath. … --- ## [AlignRT with a floor twist](https://forum.sgrt.org/t/alignrt-with-a-floor-twist/174)
**Author:** [@ben\_allen](https://forum.sgrt.org/u/ben_allen)\ **Replies:** 2\ **Last updated:** [November 13, 2018, 8:41am UTC](https://forum.sgrt.org/t/alignrt-with-a-floor-twist/174 "2018-11-13T08:41:52Z")
Hi. We use AlignRT for our DIBH patients and when we have a monoisocentric SCF field, we apply a 90 degree floor twist to the SCF field. I have noticed that when AlignRT is monitoring in the SCF position, it often wants … --- ## [DIBH patient set up](https://forum.sgrt.org/t/dibh-patient-set-up/178)
**Author:** [@teddi\_lynce](https://forum.sgrt.org/u/teddi_lynce)\ **Replies:** 4\ **Last updated:** [October 23, 2018, 12:01pm UTC](https://forum.sgrt.org/t/dibh-patient-set-up/178 "2018-10-23T12:01:45Z")
Good morning, I am curious as to whether centers are using the CIVCO breast board for their DIBH patients. We have found that we have issues with pitch when we do have the patients on the CIVCO board, so therefore have … --- ## [DIBH Coaching](https://forum.sgrt.org/t/dibh-coaching/177)
**Author:** [@mellat\_alemayehu](https://forum.sgrt.org/u/mellat_alemayehu)\ **Replies:** 5\ **Last updated:** [October 9, 2018, 11:07am UTC](https://forum.sgrt.org/t/dibh-coaching/177 "2018-10-09T11:07:42Z")
Hello, We are interested in providing DIBH coaching sessions for our patients, prior to their simulation. Mainly looking at patient reproducibility as well as the amount of time they spend on the table. Even though we p… --- ## [Diaphragm variation in BH](https://forum.sgrt.org/t/diaphragm-variation-in-bh/175)
**Author:** [@paul\_robertson](https://forum.sgrt.org/u/paul_robertson)\ **Replies:** 3\ **Last updated:** [October 9, 2018, 4:58am UTC](https://forum.sgrt.org/t/diaphragm-variation-in-bh/175 "2018-10-09T04:58:57Z")
Hello All, Recently we have started seeing in a few patients a marked difference in diaphragm level compared to the planning CT (1-3cm sup). We use a set-up workflow similar to most posters on this forum and CBCT everyd… --- ## [Thresholds](https://forum.sgrt.org/t/thresholds/176)
**Author:** [@kristen\_beck](https://forum.sgrt.org/u/kristen_beck)\ **Replies:** 1\ **Last updated:** [October 4, 2018, 4:05pm UTC](https://forum.sgrt.org/t/thresholds/176 "2018-10-04T16:05:53Z")
What thresholds do you use for tracking for free-breathing or DIBH breasts? Did you keep the default of +/- 3mm or increase the allowable ranges? Are there any papers that can justify the thresholds you use? Thank you in… [Next page](https://forum.sgrt.org/c/deep-inspiration-breath-hold/15.md?page=1)