Breast technique Flashcards
What are the signs and symptoms of breast cancer? (5)
- Breast lump
- Axilla lump
- Change in breast shape or size
- Skin changes
- Nipple changes
What are the main skin changes to indicate breast cancer? (3)
- Dimpled or puckered also known as peau d’orange
- Redness, swelling and increased warmth may be a sign of inflammatory breast cancer
- Itching of the breast or nipple may be a sign of inflammatory breast cancer
What are the factors associated with increased risk of breast cancer? (11)
- being female
- increasing age
- personal/family history
- inherited gene (most common BRCA 1/2)
- radiation exposure to chest as child or young adult
- obesity
- beginning period at a young age
- beginning menopause at an older age
- first child at an older age
- postmenopausal hormone therapy
- drinking alcohol
What can cause the nipple to invert?
- when the cancer is behind the nipple or areola
- can occur naturally for whole life for less then 1 in 100, but check with doctor
What are the later sign and symptoms of breast cancer? (9)
- bone pain
- nausea
- loss of appetite
- weight loss
- pleural effusion (cough, dyspnea)
- headache
- double vision
- muscle weakness
- jaundice
What equipment is used to cheap the patient stable? (5)
- headrest
- elbow rest
- arm rest
- knee support
- footboard
Why are the arms lifted superioly when in the supine position? (4)
- it lifts breasts superioly, reducing cardiac dose
- provides symmetry if contralateral breast needs to be irradiated
- better access to chest area
- avoid treating through the arms
What is the benefit of having the sternum horizontal/ breast board inclined?
- decreases need for collimater angulation
What can decrease skin folds when treating the SCF field?
- turning the head to the non treatment side
What can be used to decrease folds in the breast tissue?
- breast cast or orfit
What does the breast cast do to the breast?
- brings the lateral an inferior part anterioly from the heart, lung and abdomen
- better skin reaction in the inframammary fold
What are the scan limits for a breast?
- superioly include chin and neck
- inferioly include all of the ipsilateral lung and 5 cm below breast tissue
Why is it important that the entire lung is scanned?
- for the lung DVH which is used from determining fibrosis and pneumonitis which are late effects from treatment
What are the critical structures for a breast patient?
- heart
- lung
- contralateral breast
Why is the whole breast usually treated?
- hard to treat partially due to it being highly mobile and composed of interconnected fatty and glandular tissue
What are the three main nodel regions likely to also need irradiation?
- supraclivicular fossa
- axilla
- internal mammary nodes
How is the isocentre established?
- setting the bed height or setting an anterior SSD to known chest mark and moving laterally to the affected breast as specified by the moves on the treatment sheet
Where is the isocentre usually placed for a breast patient?
- mid-separation (medial/lateral and chest wall/anterior skin surface)
Why is a zero jaw used at the inferior edge?
- to reduce beam divergence into lung
What are the SCF RT field margins?
- inferior = 2nd costal cartilage
- medial = 1-2cm off midline
- lateral = at coracoid process
- superior = cricoid cartilage
What are the prognosis factors associated with SCF node recurrence?
- lymphovascular invasion
- extracapsular extension
- the number and level of involved axillary nodes
NOTE: for patient with 2 or more factors, SCF irradiaion is highly reccomended
What can restrict using a monoisocentric technique?
- by field size if the breast is in excess of 20cm may require a divergent field superioly
What are the most common electron boost doses?
- 10Gy/5#
- 14GY/5#
- 16Gy/10#
Why is the applicator for an electron boost bigger then the target volume?
- due to the lateral penumbra of electron beams
