The Tangential Breast Match Plane: Practical Problems and Solutions

Abstract

The three-field breast set-up, in which tangential oblique opposed fields are joined to an anterior supraclavicular field, has been the method of choice for treatment of breast cancer for many years. In the last several years many authors have suggested refinements to the technique that improve the accuracy with which fields join at a match plane. The three-field breast set-up, using a rotatable half-beam block is the technique used at our institution. In instituting this procedure, several practical problems were encountered. Due to the small collimator rotation angles used it is possible to clinically reverse the collimator angle without observing an error noticeable on fluoroscopy. A second error can occur when the table base angle is used to compensate for the incorrect collimator rotation. These potential sources of error can be avoided if a programmable calculator or computer program is used to assist the dosimetrist during the simulation. Utilization of fluoroscopy, digital table position displays and a caliper provide accurate input for the computer program. This paper will present a hybrid procedure that combines practical set-up procedures with the mathematical calculation of ideal angles to result in an accurate and practical approach to breast simulation.