Support of large breasts during tangential irradiation using a micro-shell and minimizing the skin dose—a pilot study

Latimer, James; Beckham, Wayne; West, M; Holloway, Lois; Delaney, Geoff P.

doi:10.1016/j.meddos.2004.10.006

Cited by 8 publications

(10 citation statements)

References 10 publications

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“…Eight studies report methods or materials that could be used to immobilise the breast or chest-wall ( (14). The acrylic micro-shell horse-shoe design presents a very cost-effective approach to the problem of breast immobilisation.…”

mentioning

confidence: 99%

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

2014

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Greater use of 3D conformal, Intensity Modulated Radiotherapy (IMRT) and external beam partial breast irradiation following local excision (LE) for breast cancer has necessitated a review of the effectiveness of immobilisation methods to stabilise breast tissue.To identify the suitability of currently available breast (rather than thorax) immobilisation techniques an appraisal of the literature was undertaken. The aim was to identify and evaluate the benefit of additional or novel immobilisation approaches (beyond the standard supine, single arm abducted and angled breast board technique adopted in most radiotherapy departments). A database search was supplemented with an individual search of key radiotherapy peer-reviewed journals, author searching, and searching of the grey literature. A total of 27 articles met the inclusion criteria.The review identified good reproducibility of the thorax using the standard supine arm-pole technique. Reproducibility with the prone technique appears inferior to supine methods (based on data from existing randomised controlled trials).Assessing the effectiveness of additional breast support devices (such as rings or thermoplastic material) is hampered by small sample sizes and a lack of randomised data for comparison.Attention to breast immobilisation is recommended, as well as agreement on how breast stability should be measured using volumetric imaging.

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mentioning

confidence: 99%

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

2014

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“…One approach to the pendulous breast problem is through use of immobilization cast devices. These are typically in the form of exoskeleton-type shells or rings placed around the breast to prevent mobility with the patient in the supine position (Latimer et al 2005). Immobilization devices are used extensively already for head and neck treatments, purely for the purpose of immobilization and setup error reduction.…”

Section: Introductionmentioning

confidence: 99%

Surface dosimetry for breast radiotherapy in the presence of immobilization cast material

Kelly¹,

Hardcastle²,

Metcalfe³

et al. 2011

Phys. Med. Biol.

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Curative breast radiotherapy typically leaves patients with varying degrees of cosmetic damage. One problem interfering with cosmetically acceptable breast radiotherapy is the external contour for large pendulous breasts which often results in high doses to skin folds. Thermoplastic casts are often employed to secure the breasts to maintain setup reproducibility and limit the presence of skin folds. This paper aims to determine changes in surface dose that can be attributed to the use of thermoplastic immobilization casts. Skin dose for a clinical hybrid conformal/IMRT breast plan was measured using radiochromic film and MOSFET detectors at a range of water equivalent depths representative of the different skin layers. The radiochromic film was used as an integrating dosimeter, while the MOSFETs were used for real-time dosimetry to isolate the contribution of skin dose from individual IMRT segments. Strips of film were placed at various locations on the breast and the MOSFETs were used to measure skin dose at 16 positions spaced along the film strips for comparison of data. The results showed an increase in skin dose in the presence of the immobilization cast of up to 45.7% and 62.3% of the skin dose without the immobilization cast present as measured with Gafchromic EBT film and MOSFETs, respectively. The increase in skin dose due to the immobilization cast varied with the angle of beam incidence and was greatest when the beam was normally incident on the phantom. The increase in surface dose with the immobilization cast was greater under entrance dose conditions compared to exit dose conditions.

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“…1 Customised breast immobilisation devices can be tailored to individual patients to stabilise the breast and minimise side effects. 2 A number of studies have investigated methods of immobilisation for large pendulous breasts, however each has advantages and disadvantages, so devices are commonly department specific.…”

Section: Introductionmentioning

confidence: 99%

“…2 A number of studies have investigated methods of immobilisation for large pendulous breasts, however each has advantages and disadvantages, so devices are commonly department specific. 1 The tangential irradiation of women with large pendulous breasts can be problematic. While patients are lying supine during treatment, large flaccid breasts have a tendency to fall laterally and/or superiorly.…”

Section: Introductionmentioning

confidence: 99%

“…While patients are lying supine during treatment, large flaccid breasts have a tendency to fall laterally and/or superiorly. 1 If the lateral movement is significant, excessive amounts of lung may be incorporated into the treatment field while trying to ensure adequate posterior coverage of the breast. 3 Excessive skin folds are often present, causing loss of skin sparing, especially in the inframammary fold.…”

Section: Introductionmentioning

confidence: 99%

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2008

Radiographer

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Large pendulous breasts pose particular challenges in stabilisation for radiotherapy, due to their inherent mobility. To ensure reproducibility of their positioning between fractions, customised breast immobilisation devices are designed to improve stabilisation and minimise toxicities to the skin and underlying lung. This study aims to review current methods of immobilisation for tangential treatment techniques to the large breast, assessing the range of devices commonly used and discover if any one technique can be recommended. A survey containing 13 questions was sent to 42 randomly-selected centres performing tangential treatments for breast cancer. The questions were designed to assess each centre's opinion on the effectiveness of the immobilisation device and reproducibility of the breast position for patients with large pendulous breasts. Centres graded their responses using a Likert scale of 1-5, 1 being most effective to 5 being the least effective outcome. Additionally, centres were asked to identify if their current system had any advantages/disadvantages. Ten immobilisation devices were identified from 18 responses to the survey. The prone technique was the most popular, practiced by 22% of respondents. It also ranked consistently well over all in the questions from the survey. The breast board, thermoplastic mask, wireless bra, breast cups, Micropore tape™ (Livingstone International Pty Ltd, Rosebury, NSW, Australia), Vac fix ® (S & S Technology, Houston, Texas, USA), stockings, breast rings and plastic L-shaped supports were other devices identified by respondents. None of these other techniques were graded consistently well over the range of survey questions compared with the prone technique. Those using the prone technique were most satisfied with its effectiveness for patients with large pendulous breasts, however, it is acknowledged that the technique is not suitable for all patients.

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Support of large breasts during tangential irradiation using a micro-shell and minimizing the skin dose—a pilot study

Cited by 8 publications

References 10 publications

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

Surface dosimetry for breast radiotherapy in the presence of immobilization cast material

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