title: Irregular surface compensation for radiotherapy of the breast: correlating depth of the compensation surface with breast size and resultant dose distribution.
abstract: Irregular surface compensation uses dynamic multileaf collimators to modify the fluence to an irregular surface along the cranio-caudal axis. The depth of the compensation surface can be varied by specifying a user-defined parameter called the transmission penetration depth (TPD). In our institution, a review has been carried out of 60 breast patients treated using irregular surface compensation of the tangent fields. The effect of changes in the TPD on the dose distribution was investigated, and the optimum TPD was correlated with the maximum field separation (S(max)) along the posterior border. Reducing the TPD below 50% pushes the dose towards the front of the breast. This reduces hot spots at the medial and lateral regions next to the posterior border of the tangential fields, particularly for patients with large separation. In 23/60 patients, with a mean S(max) of 23.9 +/- 1.6 cm, a TPD between 35% and 45% was used to reduce the proportion of the planning target volume receiving more than 107% of the prescribed dose by 3.4% +/- 2.8%. Our department protocol states that, subject to an acceptable dose distribution, a TPD of 40% is used if S(max) is greater than 24 cm; for smaller separations, a TPD of 50% is used.
authors.affiliation: Department of Radiotherapy Physics, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP45PD, UK. daniel.emmens@nhs.net
authors.forename: D J
authors.initials: DJ
authors.lastname: Emmens
authors.forename: H V
authors.initials: HV
authors.lastname: James
mesh_terms: D000465:Algorithms; D001830:Body Surface Area; D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D009929:Organ Size; D011835:Radiation Protection / Q000379:methods; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies