A frame providing tactile feedback for the reproducibility of deep inspiratory breath-hold (DIBH) is described. The frame, fitted across the patient, comprises a horizontal bar, parallel to the patient’s long axis, and holds a graduated pointer perpendicular to it. The pointer provides individualized tactile feedback for reproducibility of DIBH. Within the pointer is a movable pencil, bearing a 5 mm coloured strip which becomes visible only during DIBH, and acts as a visual cue to the therapist. The average variation in separation in the planning and pretreatment cone-beam computed tomography of 10 patients was 2 mm (confidence interval 1.95–2.05). Frame-based tactile feedback is a novel, reproducible technique for DIBH.
Most common lymphatic spread of carcinoma breast is ipsilateral axiilary lymph nodes, internal mammary lymph nodes and supraclavicular lymph nodes. Inguinal lymph nodes involvement in carcinoma breast is quite uncommon. Surgery and irradiation for breast cancer may interfere with conventional pathways of spread, leading to bizarre patterns of dissemination through lymphatics or through hematogenous route. Other possible reasons could be occurrence of primary breast cancer in accessory breast tissue retained in the vulva following involution of milk line. We describe a case of right breast carcinoma who developed right ingquinql lymph node mets, brain mets after one month of neoadjuvant chemotherapy and mastectomy.
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