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The total of all possible kinds of energy present in a substance is called the internal energy (U), sometimes symbolized as E. Suppose a system with initial internal energy, Uinitial, undergoes a change in energy (transfer of work or heat), and the final internal energy of the system is Ufinal. Change in internal energy equals the difference between Ufinal and Uinitial.
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Updated: Feb 7, 2026

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
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Evaluation of a Novel Field-placement Algorithm for Locoregional Breast Cancer Radiotherapy Including the Internal

A Ranger1, A Dunlop1, P Shah2

  • 1The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|August 7, 2018
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A new points-based algorithm simplifies radiotherapy planning for internal mammary chain (IMC) irradiation. This method achieves acceptable dose coverage for breast and axillary lymph nodes, reducing the need for complex contouring.

Keywords:
Heart-sparing radiotherapyinternal mammary chain radiotherapyresource-sparing radiotherapy techniques

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Area of Science:

  • Radiation oncology
  • Medical physics
  • Radiotherapy planning

Background:

  • Irradiation of the internal mammary chain (IMC) is increasingly used in breast cancer treatment.
  • Formal delineation of lymph node volumes for IMC irradiation can be resource-intensive and slow implementation.
  • A simplified field-placement algorithm could improve the efficiency of IMC radiotherapy.

Purpose of the Study:

  • To develop and evaluate a points-based field-placement algorithm for locoregional lymph node irradiation, including the IMC.
  • To assess the algorithm's ability to achieve target volume coverage and spare organs at risk.
  • To determine the algorithm's transferability and effectiveness in multicentre settings.

Main Methods:

  • An algorithm was developed using six points on anatomical landmarks to define lymph node clinical target volume borders.
  • Single-centre testing in 20 cases evaluated PTV coverage, organ-at-risk sparing, and plan comparison with formal delineation.
  • Multicentre testing assessed the algorithm's transferability and performance in different healthcare settings.

Main Results:

  • Single-centre testing demonstrated 95% PTV coverage with no significant increase in heart or lung dose compared to formal delineation.
  • Multicentre testing showed 69% PTV coverage, with statistically significant differences in IMC PTV coverage (P < 0.01) but not axillary levels 1-4 (P = 0.11).
  • All cases met target volume constraints for the breast and axillary levels 1-4 in the multicentre setting.

Conclusions:

  • A points-based algorithm provides dosimetrically acceptable plans for breast and axillary lymph node radiotherapy without formal contouring in single-centre settings.
  • The algorithm is effective for breast and level 1-4 axilla in multicentre settings but requires further quality assurance for IMC irradiation.
  • This approach can reduce the resource impact of implementing IMC irradiation, enhancing efficiency in radiotherapy planning.