Implementing Deep Inspiration Breath-Hold (DIBH) for Left-Sided Breast Cancer Radiotherapy at the Anbar Cancer Center, Iraq: Early Report

Background: Deep inspiration breath-hold (DIBH) is an established cardiac-sparing technique for left-sided breast radiotherapy; however, its implementation can be challenging in routine practice, particularly in resource-constrained settings. Methods: We conducted a retrospective cohort study at Anbar Cancer Center (Iraq) after DIBH introduction (August-November 2025). Forty-three consecutive women with left-sided breast cancer treated with adjuvant radiotherapy after breast-conserving surgery or modified radical mastectomy were evaluated for DIBH. Patients achieving a reproducible ≥ 20 s breath-hold received DIBH (n = 33), whereas those unable to do so were treated using free breathing (FB) and served as a pragmatic comparator (n = 10). Dosimetric endpoints included PTV coverage (V95%), cardiac indices (mean heart dose, Heart V3/V5, maximum LAD dose), and lung/contralateral structures metrics; workflow measures included scan and treatment times. Results: DIBH significantly improved target coverage (median PTV V95% 94.0% vs 90.5% with FB; p Conclusion: In routine clinical implementation, DIBH provided substantial cardiac/LAD sparing and improved PTV coverage with minimal change in ipsilateral lung dosimetry, but with increased workflow time and minor contralateral low-dose trade-offs.