Verification imaging for breast and nodal breast diseases: a Varian user’s experience

The complexity of radiotherapy for breast cancer has increased in recent years with the introduction of more conformal techniques such as IMRT (intensity-modulated radiation therapy) and VMAT (volumetric modulated arc therapy). Furthermore, sequential treatments such as photon boosts are now increasingly integrated into the whole breast treatment. MV imaging was, and is for many departments, the main method for set-up verification, however with the move towards more complex planning techniques a different approach using alternative modalities is required.

We introduced IMRT for all breast patients, with simultaneous integrated boost (SIB) where required, as standard into our department in 2017; at that time MV imaging was still used as the standard imaging modality. The image match process used an MV lateral tangent electronic portal image (EPI) measuring central lung distance, breast contour and focus to skin distances following an ‘extended no action level’ (eNAL) correction strategy.

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