Correction Method on Mismatched Posterior Edge of Medial and Lateral Tangential Fields for Three Fields Techniques in Breast Cancer

Kim, Hun Jung; Loh, John JK; Kim, Woo Cheol; Park, Sung Young

Abstract

PURPOSE: The target volume for the three field technique in breast cancer include the breast tangential and supraclavicular areas. The techniques rotating the gantry and couch angles, to match these two areas, will geometrically produce mismatching of the posterior edge between the medial and lateral tangential beams. This mismatch was confirmed by film dosimetry and three-dimensional computer planning. The correction methods of this mismatching were studied in this article.
MATERIALS AND METHODS
After the supraclavicular field was simulated using a half beam block and the medial and lateral tangential fields, by the rotation of the couch and gantry, we compared the following two methods to correct the mismatch. The first method was the rotation of collimator until a line drawn on the posterior edge of tangential beams before the rotation of couch aligned the line drawn on the posterior edge after the rotation. The second method was the rotation of collimator according to the formula developed by the author as follows; Co=2sin(-1){sin angle x sin (C/2)} (Co: collimator angle, angle: angle between tangential beam and table, C: couch angle)
RESULTS
The film dosimetry showed the mismatching of posterior edges of the medial and lateral tangential fields prior to the rotation of collimator, while the posterior edges matched well after the rotation of collimator according to the formula. The three-dimensional computer plan also showed that the posterior edges matched well after the rotation of collimator accordingly. The DVH of the ipsilateral lung with the proper rotation of collimator angle was better than that without the rotation of collimator angle.
CONCLUSION
The mismatching of the posterior edges of the medial and lateral tangential fields can be recognized on the three field technique in breast irradiation when the gantry and couch are simultaneously rotated and can be corrected with the proper rotation of the collimator angle. The radiation dose to the ipsilateral lung could be lowered with this technique.