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Correlation between maximum heart distance and thoracic diameter changes and diaphragmatic descent in left-sided breast cancer patients during deep inspiration breath-hold (DIBH)

He-Gou Wu
He-Gou Wu
, 
Guang-Wei Zhang
Guang-Wei Zhang
, 
Jian-Feng Liu
Jian-Feng Liu
, 
Jun-Guo Yang
Jun-Guo Yang
 and 
Xiao-Hui Su
Xiao-Hui Su
   | Nov 30, 2023
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Article Category: Research Article
Published Online: Nov 30, 2023
Page range: 530 - 537
Received: Apr 13, 2023
Accepted: Aug 28, 2023
DOI: https://doi.org/10.2478/raon-2023-0053
Keywords
© 2023 He-Gou Wu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

Parameter measurement diagram. For each patient, at the height of the vertebral body corresponding to the right diaphragm top during free breathing, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD) and maximum heart distance (MHD) were measured on free breathing CT images and deep inspiration breath-hold CT images respectively. Point A at the center of the sternum, and point B at the center of the medulla, the line AB was constructed as the ATD. Through the center of the line AB at M, a second line was constructed perpendicular to AB reaching the lateral edge of the lung at C and D, and the line CD was the TTD. The line AD approximates the direction of the tangential field, and the maximum distance from the left edge of the heart to AD is taken as the MHD.
Parameter measurement diagram. For each patient, at the height of the vertebral body corresponding to the right diaphragm top during free breathing, anteroposterior thoracic diameter (ATD), transverse thoracic diameter (TTD) and maximum heart distance (MHD) were measured on free breathing CT images and deep inspiration breath-hold CT images respectively. Point A at the center of the sternum, and point B at the center of the medulla, the line AB was constructed as the ATD. Through the center of the line AB at M, a second line was constructed perpendicular to AB reaching the lateral edge of the lung at C and D, and the line CD was the TTD. The line AD approximates the direction of the tangential field, and the maximum distance from the left edge of the heart to AD is taken as the MHD.

FIGURE 2.

Correlation between ΔMHD and left diaphragmatic descent, right diaphragmatic descent [r: Spearman rank correlation coefficient; p: p-value (2-tailed)].ΔMHD = maximum heart distance in deep inspiration breath-hold minus maximum heart distance in free breathing
Correlation between ΔMHD and left diaphragmatic descent, right diaphragmatic descent [r: Spearman rank correlation coefficient; p: p-value (2-tailed)].ΔMHD = maximum heart distance in deep inspiration breath-hold minus maximum heart distance in free breathing

The values of respiratory characteristic parameters in free breathing (FB) and/or deep inspiration breath holding (DIBH), and the differences in the values of some respiratory characteristic parameters between DIBH and FB (N = 98)

Parameters FB DIBH Δ
MHD (mm) 26.8 (±5.1) 18.4(±7.5) −8.3 (±5.9)
ATD (mm) 127. 0(±11.6) 139.0(±11.6) 11.0 (±3.8)
TTD (mm) 227.0 (±10.6) 235.6(±10.4) 8.6 (±4.4)
RDD (mm) 35.0(0.0 – 60.0)
LDD (mm) 35.0(0.0 – 55.0)
GWL (mm) 11.1(4.6 – 20.7)

Correlation between dosimetric parameters and geometric parameters

ΔDmean ΔHVIF ΔV10 ΔV5
ΔMHD r 0.468 0.464 0.481 0.484
p < 0.001 < 0.001 < 0.001 < 0.001
LDD r − 0.340 − 0.365 − 0.382 − 0.373
p = 0.001 < 0.001 < 0.001 < 0.001
RDD r − 0.439 − 0.449 − 0.462 − 0.458
p < 0.001 < 0.001 < 0.001 < 0.001
ΔATD r 0.007 0.044 0.026 0.008
p 0.943 0.669 0.801 0.935
ΔTTD r 0.012 0.055 0.062 0.065
P 0.906 0.593 0.545 0.527

Comparison of the mean of parameters in ΔATDlow (n = 46) and ΔATDhigh (n = 52) and in ΔTTDlow (n = 51) and ΔTTDhigh (n = 47)

LDD RDD ΔATD ΔTTD ΔMHD
ΔATDlow (mm) 32.2 34.0 7.7 7.5 −7.0
ΔATDhigh (mm) 34.2 35.4 13.8 9.6 −9.5
Increase of ΔATDhigh (mm) 2.0 1.4 6.1 2.1 −2.5
Increase of ΔATDhigh (%) 6.2% 4.1% 78.9% 27.9% 36.5%
ΔTTDlow(mm) 35.3 37.1 10.5 5.4 −9.7
ΔTTDhigh (mm) 31.1 32.2 11.4 12.0 −6.9
Increase of ΔTTDhigh (mm) −4.2 −4.9 0.8 6.6 2.8
Increase of ΔTTDhigh (%) −12.0% −13.2% 7.9% 122.2% −29.3%
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