A technique for treating local breast cancer using a single set-up point and asymmetric collimation

Using both pairs of asymmetric jaws of a linear accelerator local-regional breast cancer may be treated from a single set-up point. This point is placed at the abutment of the supraclavicular fields with the medial and lateral tangential fields. Positioning the jaws to create a half-beam superiorly permits treatment of the supraclavicular field. Positioning both jaws asymmetrically at midline to define a single beam in the inferoanterior quadrant permits treatment of the breast from medial and lateral tangents. The highest possible matching accuracy between the supraclavicular and tangential fields is inherently provided by this technique. For treatment of all fields at 100 cm source to axis distance (SAD) the lateral placement and depth of the set-up point may be determined by simulation and simple trigonometry. We elaborate on the clinical procedure. For the technologists treatment of all fields from a single set-up point is simple and efficient. Since the tissue at the superior border of the tangential fields is generally firmer than in mid-breast, greater accuracy in day-to-day set-up is permitted. This technique eliminates the need for table angles even when tangential fields only are planned. Because of half-beam collimation the limit to the tangential field length is 20 cm. Means will be suggested to overcome this limitation in the few cases where it occurs. Another modification is suggested for linear accelerators with only one independent pair of jaws.