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A Guide for Creating Optimal Breast Plans Utilizing 6X-Flattening-Filter-Free Tangential Fields

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Presented by Ryan M. Clark, MS, CMD
Certified Medical Dosimetrist
Radiation Therapy Center of Morris Hospital in Morris

Recorded October 8, 2019
​From the AAMD 44th Annual Meeting

Over the years, increased emphasis has been placed to improve the dose distribution homogeneity and plan quality for whole breast irradiation. The criteria for achieving the “optimal breast plan” has been pushed further by both clinical studies and through the evolution of technology in the field. Recent clinical studies show that dosimetric parameters such as hotspot minimization, improved homogeneity, and minimization of low dose to tissues outside of the intended target have a substantial impact on unwanted side effects such as skin desquamation, breast pain, and secondary radiation-induced carcinomas respectively.

Newer technologies such as the linear accelerator with 6X-flattening-filter-free (6X-FFF) beam energy have made plan quality improvements possible. This beam energy allows for the treatment of patients with a higher dose rate providing shorter beam on time. A shorter beam-on time is ideal for breast cases as the amount of intrafraction motion is reduced. This could allow for deep inspiration breath hold patients having a single breath-hold per tangential field to become feasible. Also, 6X-FFF also has the beam properties of a sharper penumbra and less out of field dose when compared to traditional flattened fields. These physical beam properties are advantageous as they reduce the amount of dose scatter contributed to the contralateral breast. This work has been done to help treatment planners efficiently generate treatment plans that utilize the advantageous 6X-FFF tangential beams for clinical use. The unique profile of 6X-FFF beam requires inverse planning techniques to be utilized to achieve homogeneous dose distributions. This is in contrast to traditional flattened beam energies where forward planning techniques could be employed. This guide highlights the steps a treatment planner can implement to achieve optimal treatment plans based on this preferred 6X-FFF beam energy.

Learner Outcomes:

  1. Demonstrate how to produce treatment plans for breast cases when utilizing 6X-flattening-filter-free tangential beams
  2. Understand the importance of improving dosimetric homogeneity in breast treatment plans
  3. Know the advantages and disadvantages of using 6X-FFF

Presenter:
Ryan Clark is a certified medical dosimetrist at the Radiation Therapy Center of Morris Hospital in Morris, Illinois. He completed his Master of Science degree in medical dosimetry at the University of Wisconsin - La Crosse. Ryan is passionate about furthering his knowledge and skills within both dosimetry and computer science.