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Prone to Supine; Custom Breast Guard for Heart and Lung Dose Reduction

S Koren*, Y Tova , I Tzadok , E Gez , J Zidan , Ziv Medical Center, Safed, ISRAEL


(Sunday, 7/14/2019)  

Room: ePoster Forums

Purpose: To deliver breast treatments with segnificant lower heart and lung doses using the custom made breast guard.

Methods: Prone position will allow a smaller lung and heart exposures, as the breast falls away from the body by gravity. Nonetheless, this setup is for irradiating the breast only and cannot be used for patients who need radiation to the lymph nodes. In addition, prone position is not comfortable for many patients, and can have more set-up uncertainties. We are suggesting a custom made breast guard support to enable the prone breast tissue setup benefits in a supine treatment. We have used a patient prone CT SIM to construct a 2 mm guard in a 3D printer. The height of the guard is about 5-10 cm and is sufficient to support the breast. After the guard is printed, the patient inserts the breast tissue through the guard. Then, a supine CT simulation is carried out with the breast guard for the treatment planning and delivery.

Results: Using the breast guard allowed a supine treatment with heart mean dose of 0.5 Gy and negligible Lung V20. In the prone treatment, the heart mean dose was 0.42 Gy and the lung V20 was negligible. A corresponding supine plan without the guard was retrieved by mirroring a right breast plan to the left with the corresponding adaptations. This plan showed a V20 of 18% for the lung and a 1.5 Gy mean heart dose.

Conclusion: The breast guard allowed a reasonably comfortable reproducible immobilization to the breast tissue, throughout the Tx course. The supine plan allowed a compatible plan to the prone plan with superior reduction in heart dosage. One should consider implementing this technique, in particular for patients who need radiation to the regional lymph nodes, which cannot be treated in prone setup.


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