1

Minimizing clearance issues with prone breast patients on Varian linear accelerators
through isocenter placement

Lauren Wilson; Rob Rohe, BS, R.T.(T)

Medical Dosimetry Program at the University of Wisconsin-La Crosse, WI

I. Abstract
II. Introduction
A. PI: Details and statistics on breast cancer. Different treatment techniques used and
OAR. Introduce benefits of treating patients with pendulous breasts prone.
(Reference: Yao S et al,1 Deseyne P et al,2 Boyages J et al,3 Fahimian B et al.4)
B. PII: Cover general disadvantages of prone breast treatments. Discuss
immobilization device and setup reproducibility strategies. (Reference: Yao S et
al,1 Fahimian B et al,4 Huppert N et al,5 Lakosi F et al,6 Nguyen SM et al.7)
C. PIII: Cover Varian accelerators and explain tertiary MLC. Make connection
between tertiary MLC and less clearance. (Reference: Huppert N et al,5 Lakosi F
et al,6 Nguyen SM et al,7 Gupta A et al,8 Mohan R et al,9 Boyer A et al.10)
D. PIV: Summarize introduction points
1. Problem: Prone breast set ups occasionally result in collisions of
the gantry head with the immobilization device and/or patient positioning
system depending on the isocenter location, which can negatively impact
treatment and patient experience.
2. Purpose: To compare plan isocenter locations to determine if a
guideline can be established to prevent collisions of the gantry head with
the immobilization device and patient positioning system in all directions
while maintaining quality treatment plans. Therefore, researchers teste
3. Hypotheses: Therefore, the research hypothesis (H1) is that an
isocenter location guideline can be developed to prevent collisions with
the prone breast immobilization and gantry head, while still creating a
clinically acceptable treatment plan. The null hypothesis (H0) is that a
guideline isocenter location cannot be developed that will prevent
collisions and create a clinically acceptable plan.
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III. Materials and Methods

A. Patient selection and setup
1. PI: Patient population
a. 17 patients
b. Inclusion criteria (left/right sided breast irradiation, prone breast
treatment position, treated at same clinic, treated on Varian linac)
c. Exclusion criteria (no regional lymph nodes; treated on Civco
Horizon breast board)
2. PII: Equipment set-up image (Figure 1)
a. Prone breast position set-up
1. Civco Horizon breast board, immobilization devices
(Reference: Fahimian B et al4)
2. Figure of clearance for Varian linear accelerator and Civco
breast board (Figure 2)
b. Imaging for set-up reproducibility (Reference: Nguyen SM et al7)
B. Isocenter Location
1. PI: Isocenter (Reference: Van Asselen et al12)
a. Move isocenter location medially within +/- 6cm from ML
1. Anterior isocenter shift to table top measurement of less
than or equal to 16cm
2. Minimal superior or inferior shifts as needed due to field
size limitations.
b. Recalculate plan
1. Adjust plan as needed to meet objectives
2. PII: Objectives
a. Objectives to be met after isocenter shifts
1. CTV, heart, lungs
C. Plan Comparison
1. PI: Evaluated metrics (Figure 3)
a. Isocenter: location within clearance parameters
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b. OAR: Mean heart dose, mean lung dose, D95 heart dose, D95 lung
dose, D1 heart dose, D1 lung dose
1. Meets RTOG 1005 constraints, % difference original plan
OAR D95, D1 and mean
a. Target: PTV (% volume receiving 90%, 95%, 100% of dose)
1. Within 3% difference original plan
D. PI: Statistical Analysis
1. Q-Q plots, Shapiro-Wilk
2. Wilcoxon Signed Rank test will be used for OAR and target
metrics (Figure 4)
a. Non-parametric study compares doses in original plan versus re-
plans with new isocenter
3. False Discovery Rate will be used if needed to address multiple
comparisons
4. P <3.0 is considered statistically significant
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References
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