Deep inspiration breath-hold — or DIBH — is often introduced to patients in a single sentence. It is described as a technique that helps protect the heart during left-sided breast radiotherapy. What is rarely explained is how patients are prepared for it, what training actually looks like, and what happens if it doesn’t feel easy at first. This gap is where anxiety usually begins.
Before DIBH Is Ever Used, There Is Preparation
DIBH is not something patients are suddenly asked to perform during treatment. It is introduced gradually, explained calmly, and adjusted to each individual. Patients are not expected “know how to do it.” They are guided. The goal of preparation is not to teach a perfect breath-hold, but to reduce unfamiliarity. Understanding what will happen matters more than doing it well.
What Training for DIBH Actually Means
Training for DIBH is often imagined as something technical or demanding. In reality, it is simple. Patients are shown how a slow, comfortable breath-in creates a small but important
change inside the chest — enough to move the heart slightly away from the treatment field.
- Breath-holds are short.
- They are monitored.
- They are repeated only as long as they feel comfortable.
- There is no target time patients must reach.
- Training is about finding a breath that feels manageable, not impressive
Practicing at Home: Optional, Gentle, and Pressure-Free
Some patients feel reassured knowing they can familiarize themselves with the sensation of slow breathing at home. This is not mandatory.
When home practice is suggested, it is intentionally simple:
- slow breathing
- relaxed posture
- brief awareness of breath
Not endurance. Not control. Not long breath-holds.
If practice feels calming, it can help. If it increases anxiety, it should be stopped. DIBH does not rely on home training to be safe or effective.
What If I Still Can’t Do It?
Most of the time, this question comes from worry—not because the breath-hold is uncomfortable, but because patients fear it could affect their treatment. The truth is: if the breath-hold isn’t good enough, radiation simply doesn’t start. If your breathing becomes unstable, the machine pauses automatically. And if DIBH isn’t working well that day, your team can switch to another approach. There’s no “failing” here—treatment won’t be delivered in an unsafe way.
DIBH is a tool, not an obligation.
Read Our Special Article About Breast Radiotherapy Late Effects
A Common Concern About the Heart
Because DIBH is explained as a way to protect the heart, some patients assume that imperfect breath-holding puts the heart at risk. This is not the case. Cardiac protection in breast radiotherapy does not depend on patient performance. It depends on planning, monitoring, and built-in safety systems. Patients are not responsible for cardiac safety. That responsibility belongs to the treatment team. Knowing this often reduces pressure enough for DIBH to feel easier.
If One Day Feels Harder Than Another
DIBH does not feel the same every day. Fatigue, stress, or emotional tension can change how breathing feels. A difficult day does not mean DIBH has stopped working. It means the body is responding to the day it is having. Adjustments are always possible. Patients are never expected to push through discomfort for the sake of technique.
A Final Perspective That Helps Many Patients
DIBH works best when it is approached without fear of failure. There is no success or failure state. There is only adaptation. If it works easily, that is helpful. If it takes time, that is normal. If it is not suitable, it remains safe.
Training for DIBH is not about teaching patients to perform. It is about helping them feel secure. And that security is what makes the technique effective.
Written By Eftychia Tataridou, MD