Forums › Deep Inspiration Breath Hold › VisionRT DIBH Supraclav/Chest Wall with BOLUS + IM Field(s) › Reply To: VisionRT DIBH Supraclav/Chest Wall with BOLUS + IM Field(s)
At my centre we generally treat these patents with an IMRT plan that includes the IMC. They usually end up being about 9 Fields.
As to patient set up, we use the standardly recommended set up in FB and DIBH. I think our main learning curve for this patient group was the Bolus. Even though we use a Flab that does have a certain shine to it, we have found that the system can still see enough to correctly gate the treatment. I think this has to do with our ROI, which we draw to include chest wall inferior to the treatment area and well across the patient’s midline. After set up in FB and DIBH we use an additional DICOM surface that is the body contour in DIBH including the Bolus for imaging and treatment.
Our standard imaging for an IMRT breast treatment in DIBH would be AP-LAT Kvs and an additional tangential KV. We did some extra imaging on the first few bolus patients just to double check everything, but I think the best thing to do is remember to take your time. It is a lot of breath hold for the patient, so training on CT is also important!
Hope this is helpful, and if you want more info about how we set our beams/constraints for an IMRT IMC plan let me know,