26/11/2025
Breast Gating: When Breathing Protects the Heart ❤️
In breast radiotherapy—especially for left-sided treatments—the heart sits very close to the target, making cardiac protection a major concern.
To limit heart exposure, one technique has become essential: respiratory gating, also known as DIBH (Deep Inspiration Breath Hold).
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How It Works
During a deep inspiration, lung volume expands, which mechanically moves the heart away from the treated breast.
This simple anatomical shift helps reduce cardiac dose while still maintaining excellent PTV coverage.
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Why Use Gating for Left-Sided Breast Treatments?
✔️ Significantly lowers the dose to the heart
✔️ Reduces irradiation of the left anterior descending (LAD) coronary artery, a key factor in preventing late toxicities
✔️ Better protects the contralateral lung
✔️ Improves overall dosimetric quality
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The Role of the Treatment Team
Implementing gating relies on several crucial steps:
• Patient selection based on their ability to maintain a stable breath hold
• Breathing coaching to ensure a comfortable and reproducible apnea
• Real-time monitoring during treatment to verify that the respiratory window is respected
This technique requires strong coordination between RTTs, physicists, and physicians to ensure safety and precision.
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When Gating Truly Makes a Difference
In many cases, DIBH/gating is not just helpful—it is essential.
✓ Particularly effective for left breast irradiation
✓ Even more important when treating the breast + lymph node chains, which lie closer to the heart
✓ Indispensable when the patient’s anatomy naturally brings the heart near the PTV
Gating: protecting more, without treating less. 💙