Forums Deep Inspiration Breath Hold Imaging Protocols for Multi field breast-free breathe Reply To: Imaging Protocols for Multi field breast-free breathe

stephen davison

Hi Julie, we’re tattooless with our breasts, so we position patient on couch, eyeball them straight and set to our expected couch positions (derived from CT plan).

We then use Align . We’d correct any gross rotational error, then get couch deltas as close as we can. We then take a treatment capture to check arm position and double check hip position to fine tune the set up. We then go back to monitoring and fine tune deltas again.

One thing we struggle with is pitch occasionally, so if its an issue we get it as close as we can and see what the images look like.

We use MV glancings for imaging unless theres an SCF when we’d also do a AP/PA kV. We are discussing changing the imaging to possibly an angled kV pair. We match to chest wall primarily, but with an eye on the breast contour as well.

Any shift from imaging we take a VRT for that treatment only. We try to stick to the DICOM surface if possible. If we find a consistent imaging shift we would then use an appropriate VRT for daily set up, which would be confirmed by imaging for 2 consecutive days. If those are all in tolerance, we’d then go to weekly imaging. We also take an MV during image daliy to keep an eye on the set up offline. Any offline check 0.4cm or more would trigger pre-imaging again.

Seems to be working well, and anecdotally, we’re manually handling the patients much less. (I guess we’re not just pushing tattoos and skin around as much?!)

Any questions just ask

Stephen, Inverness