Breast LP

Patient Treatment Setup

Simulation and Setup

  • Positioning is extremely important in radiation therapy and the patient is carefully positioned in the same position throughout the radiation treatment.

Immobilization

  • During the patient treatment setup the immobilization device will be selected.
  • Patient positioning and immobilization for breast treatments will range from simple positioning devices to raised arm systems - all designed to improve accuracy, reproducibility and patient comfort.
  • Use the links below to learn more about immobilization devices for the TomoTherapy® and Radixact™ Treatment Delivery Systems.

The following companies are known for providing breast immobilization devices for the TomoTherapy® and Radixact™ Treatment Delivery Systems.

Orfit Immobilization Systems for Breast Treatment

MammoRx® Patient Positioning System

The carbon fiber MammoRx® Breast Board meets changing needs of radiation therapists. It allows for easy patient immobilization that is comfortable and reproducible. The breast board is thin, strong, yet light and features low attenuation levels.

Orfit MammoRx Patient Positioning System

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Sagittilt® Prone Breast Solution

Sagittilt® allows rotation of a patient along the sagittal axis in a reproducible and safe way. The rotation makes the breast hang further away from the heart and lung and improves patient comfort by decreasing pressure on the ribs and the contralateral breast.

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AIO Breast- and Lung Board

The All-In-One Breast- and Lung-Board cushion set is designed to achieve a comfortable and reproducible supine position of the patient. The set consists of wedges, with different angles to increase patient comfort, and arm rests to allow for a comfortable but reproducible positioning of the arms above the head and out of the treatment fields. Hand grips and head supports will further help in increasing the precision and in finding the correct patient position.

AIO Breast- and Lung Board

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CIVCO Breast Boards

C-Qual™ Breastboard

The carbon fiber C-Qual Breastboard is lightweight, features a low-attenuating IGRT treatment zone and is designed for patient comfort by allowing the use of either arm & wrist supports or the Monarch™ Overhead Arm Positioner.

Civco C-Qual Breastboard

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New Horizon™ Prone Breastboard

The New Horizon Prone Breastboard assists in providing accessible, comfortable and reproducible patient positioning for prone breast treatments. The modular design and variety of accessories provide options for many prone breast setup challenges, allowing customized patient setups and meeting clinical needs for treatment.

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TomoHelical™ Delivery Mode

Increased degrees of freedom for dose delivery

The linear accelerator completes multiple 360° rotations around the patient while the couch passes through the bore of the system thus delivering radiation in a continuous helical delivery pattern.

 

Features of TomoHelical

  • Field lengths of to up to 135cms can be treated with no field junctions or patient repositioning
  • TomoEDGE™ Dynamic Jaws - Two field-defining jaws move dynamically to conform to a target in the craniocaudal direction, producing a sharp dose fall-off, thus reducing integral dose
  • IMRT Planning Mode - The intensity of the beam is simultaneously modulated along and across the treatment volume(s)

Clinical Applications

  • Highly conformal dose distributions to concave or complex shaped target volumes
  • Organ at risk avoidance
  • Simultaneous irradiation of multiple target volumes

Simplicity for Complex Volumes

Post-mastectomy irradiation of bilateral chest wall and nodes.

TomoDirect™ Treatment Delivery

When fewer beam angles are needed

TomoDirect is a clinical compliment to the TomoHelical delivery mode. Non-rotational beam delivery combined with couch translation in the longitudinal direction across the beam for each gantry angle.

 

Features of TomoDirect

  • Beam expansion - Open additional leaves beyond the target as "flash" to compensate for possible target motion (up to 5 leaves can be opened per angle)
  • Define a modulation level, or for tissue-compensated delivery
  • Field lengths of up to 135cms can be treated with no field junctions or patient repositioning
  • TomoEDGE Dynamic Jaws - Two field-defining jaws move dynamically to conform to a target in the craniocaudal direction, producing a sharp dose fall-off, thus reducing integral dose

Clinical Applications

  • Target dose homogeneity and conformality for noncomplex target volumes
  • Geometrical placement of beams for whole- breast irradiation

Conformal, Homogeneous Coverage

Breast conserving approach to whole right breast radiotherapy.

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Bibliography

TomoHelical™

  1. Rong Y, Fahner T, Welsh JS. Hypofractionated breast and chest wall irradiation using simultaneous in-field boost IMRT delivered via helical tomotherapy. Technol Cancer Res Treat 2008; 7:433-439.
  2. Van Parijs H, Miedema G, Vinh-Hung V, et al. Short course radiotherapy with simultaneous integrated boost for stage I-II breast cancer, early toxicities of a randomized clinical trial. Radiat Oncol 2012; 7:80.
  3. Chira C, Kirova YM, Liem X, et al. Helical tomotherapy for inoperable breast cancer: a new promising tool. Biomed Res Int 2013; 2013:264306.
  4. Caudrelier JM, Meng J, Esche B, Grimard L, Ruddy T, Amjadi K. IMRT sparing of normal tissues in locoregional treatment of breast cancer. Radiat Oncol 2014; 9:161.
  5. De Paula U, D'Angelillo RM, Barbara R, et al. Once Daily Accelerated Partial Breast Irradiation: Preliminary Results with Helical Tomotherapy(R). Anticancer Res 2016; 36:3035-3039.
  6. Han EY, Paudel N, Sung J, Yoon M, Chung WK, Kim DW. Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, including TomoHDA. Oncotarget 2016; 7:22960-22969.
  7. Aoulad N, Massabeau C, de Lafontan B, et al. [Acute toxicity of breast cancer irradiation with modulated intensity by tomotherapy(R)]. Cancer Radiother 2017; 21:180-189.
  8. Wadasadawala T, Jain S, Paul S, et al. First clinical report of helical tomotherapy with simultaneous integrated boost for synchronous bilateral breast cancer. Br J Radiol 2017; 90:20170152.

TomoDirect™

  1. Borca VC, Franco P, Catuzzo P, et al. Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study. Radiat Oncol 2012; 7:211.
  2. Franco P, Zeverino M, Migliaccio F, et al. Intensity-modulated and hypofractionated simultaneous integrated boost adjuvant breast radiation employing statics ports of tomotherapy (TomoDirect): a prospective phase II trial. J Cancer Res Clin Oncol 2014; 140:167-177.
  3. Lee HC, Kim SH, Suh YJ, et al. A prospective cohort study on postoperative radiotherapy with TomoDirect using simultaneous integrated boost technique in early breast cancer. Radiat Oncol 2014; 9:244.
  4. Michalski A, Atyeo J, Cox J, Rinks M, Morgia M, Lamoury G. A dosimetric comparison of 3D-CRT, IMRT, and static tomotherapy with an SIB for large and small breast volumes. Med Dosim 2014; 39:163-168.
  5. Hashimoyo H, Omura M, Matsui K, et al. Tangent field technique of TomoDirect improves dose distribution for whole-breast irradiation. J Appl Clin Med Phys 2015; 16:5369.
  6. Han EY, Paudel N, Sung J, Yoon M, Chung WK, Kim DW. Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, including TomoHDA. Oncotarget 2016; 7:22960-22969.
  7. Meyer P, Niederst C, Scius M, et al. Is the lack of respiratory gating prejudicial for left breast TomoDirect treatments? Phys Med 2016; 32:644-650.
  8. Nagai A, Shibamoto Y, Yoshida M, Inoda K, Kikuchi Y. Intensity-modulated radiotherapy using two static ports of tomotherapy for breast cancer after conservative surgery: dosimetric comparison with other treatment methods and 3-year clinical results. J Radiat Res 2017:1-8.
Radixact™ Treatment Delivery System
A uniquely smart radiation therapy system