Comparison of a lung fitting algorithm with CT data for tangential fields in radiotherapy of the breast

A method of estimating the shape and position of the lung in tangential breast fields is presented for patients who have not been CT scanned. Using the Osiris system, the external contour is obtained optically, and an estimated lung structure superimposed on the transverse outlines based on the measured lung depth in the tangential fields and an analysis of the typical lung shapes obtained from CT images. The accuracy of this fit was determined by comparison with a set of 64 CT images imported into the Osiris system. Dose distributions were calculated by two treatment planning systems: ADAC Pinnacle and GE Target2. The computed dose distributions for 6 MV photons were compared against measured doses in a specialized breast phantom. For the worst case of lung fit compared with CT, the dosimetric error (based upon ADAC Pinnacle calculations) was 2.0% in the shadow of the lung. For the complete patient data set, the relative dose errors to these points were reduced from a mean value of 8.4% and standard deviation (SD)=1.8% (no lung correction) to a mean of 0.2% and SD=1.0% (lung correction using fitted lung). It was also found that for every 1 cm of lung path length the dose to the breast along that path length increased by approximately 1%. The results of these investigations indicated that the lung fit model was satisfactory for routine clinical use, so that good dosimetric results can be obtained using lung correction without the need for CT imaging.