Abstract
Background:
Automatic Cone-beam computed tomography (CBCT) based image matching for set-up verification is recommended as compared to 2-D match for post-operative local / loco-regional radiotherapy of breast cancer patients by Volumetric Modulated Arc Therapy (VMAT) technique. However, in supine position, off-midline peripheral body Clinical Target Volume (CTV) of unilateral breast cancer patients immobilized on Breast and Lung board of All-in-One (AIO) positioning systemmay necessitate augmented movement of couch in ‘x’ and ‘z’ axis thereby raising the risk of collusion of x-ray sources / detectors system with couch.
Methods and Materials:
VMAT was planned by a pair of partial arc for whole target volume for seven consecutive post-operative breast cancer patients (five post-mastectomy and two post-breast conservation patients). Tattoo based set-up by shift of treatment table in x-, y- and z-axis as determined by Treatment Planning System followed by X-rays with planar image acquisition and online 2-D imaging matching was performed for set-up verification. In-room 360°rotation of x-ray source and detector system of linear accelerator (linac) was performed before x-ray planar image acquisition.
Results:
Completion of 360°rotation in-room of x-ray source and detector system of linacaround the machine iso-centre was not possible in six out of seven patients due to possibility of collusion of gantry with contralateral side of the couch.
Conclusion:
Performing CBCT for generating 3D images for computed tomography (CT) reconstruction may not be practical for patient set-up verification of post-operative radiotherapy of unilateral breast cancer patients positioned supine on breast and lung board.
Diagnostic performance of PET/computed tomography versus PET/MRI and diffusion-weighted imaging in the N- and M-staging of breast cancer patients
