Breast Technique Flashcards
Signs and symptoms of breast cancer?
Breast/Axilla lump
Changes in breast shape and size
Skin changes
Nipple changes (inverted, discharge, crusting)
What are the common skin changes of the breast?
Peau’d orange
Redness and swelling
Itching
What may be an indicator for inflammatory breast cancer?
Warm breast
Factors associated with BC?
Being female Personal/family history Gene mutation-BRCA1/2 IR Obesity first child at young age Period at yg age Menopause at an old age Postmenopausal hormone therapy Alcohol
What are the late signs and symptoms?
Bone pain Nausea Loss of appetite Weight loss Pleural effusion Headache Double vision Muscle weakness Jaundice
What is the patient setup position?
reproducible/stable supine with immobilisation breast superiorly to reduce cardiac dose sternum flat to reduce lung dose Reduce folds
What are the two inclination angles for CT
7-15 degrees for 75cm and 17-20 degrees for 85cm
What is a common CT protocol?
Record all board settings RO mark up med, lat, sup and Inf limits RO to mark on electron boost Using readout on scanner find central axis Place radio opaque markers on Three reference tattoos on central slice
What are the benefits of a breast cast?
For large or pendulous breasts Loss of skin sparing effect Reduces skin reactions Moves lateral and inferior part of breast anteriorly to reduce lung and cardiac dose. Cannot use for LN
Limits of CT sim?
SUP- above shoulders to include neck
INF- cover the whole ipsilateral lung and 5cm below.
Critical structures for breast?
Heart
Lungs
Spinal cord
Contralateral breast
Planning considerations for breast?
Seeds CLD less 2cm MHD less 1cm Contour LAD separately Shielding large separation may require higher energy
What are common radiotherapy volumes?
Whole breast after BCS
Chest wall after mastectomy
Nodal irradiation
How can you heat your plan up?
Move reference point to chest wall higher MU required more breast tissue
Common isocentre placement?
mid separation
Sup limit of SCF
What are DRR used for in breast cancer?
Show lung present in field
Med and lat tangent
SCF technique?
Monoisocentric Sup limit-cricoid cartilage Lat limit-coracoid process Inf limit-2nd costal cartilage Med limit-1-2cm off midline
prognostic factors of SCF RT
Lymphovascular invasion
Extracapsular extension
4 or more axillary LN more the worse
What is the maximum field wedge of SCF field?
15-20cm may require divergent sup jaw if larger.
Electron boost rationale?
Primary recurrence around tumour bed
Benefits of trials
Electron boost prescriptions?
10 in 5
14 in 5
16 in 10
4-15MeV used may use small MV beams with wedges
What is the common tangent+boost prescription?
50 in 25 with 10 in 5 to the tumour bed
What are the benefits of hypofractionation?
Decreased treatment time
More patients treated
Reduction in waiting times
Hypofraction prescriptions?
42.5 in 16
41.6 in 13 over 5 weeks
40 in 15 over 3 weeks +/- boost
Criteria for 42.5 in 16?
No nodes
Invasive cancer treated with lumpectomy
Tumour under 5cm
Breast under 25cm sep
Partial radiation therapy can include?
Brachytherapy Mammosite TARGIT ELIOT 3DCRT
Accelerated partial irradiation criteria?
Over 60 age
Less than 2cm in size
No LN
T1
What is the image verification process?
First three fractions then weekly
orthogonal images and DRR
5mm tolerance in CLD and isocentre position
What are acute side effects?
Skin changes
What are late/chronic side effects
Breast oedema, shrinkage, pain, skin talengiectasia, symptomatic lung fibrosis, arm lymphoedema
Grading of skin reactions?
1- erythema
2-Dry desquamation
3-mois desquamation
4Exfoliative desquamation
What is the patient care for skin reactions?
Avoid abrasion when washing
Use simple soap
Aqueous cream applied before and after XRT
One percent hydrocortisone cream
May stop XRT if severe use hydrogel sheet
Loose garments
No gentian violet (antiseptic)
Management of skin reactions?
Soap Aqueous cream Corticosteroid and non steroidal cream Flamazine R1 R2 Strata XRT
