Effects of a sonographic technique for determining chest wall thickness in treatment planning for breast carcinoma

This study investigated the use of a sonographic technique of determining chest wall thickness and the impact of dosimetric correction for lung inhomogeneity on treatment planning for breast irradiation after lumpectomy or partial mastectomy. The thickness of the chest wall in three planes of the radiation field was obtained using a B-mode ultrasound scanner and the location of the pleura-lung interface was marked on the contour of the chest wall in each plane. Treatment plans for 88 patients were developed with and without correction for the lung tissue included in the radiation volume. All patients were irradiated with an opposing pair of tangential fields to the breast with a 6 MV X ray beam using an isocentric set-up. Within the treatment volume, dose variation of +/- 5% of the prescribed tumor dose was aimed for in the treatment planning. With correction for lung tissue, the proportion of treatments given with a wedge filter was found to be on the average 20% less than it would be without lung correction. The described sonographic technique is simple to perform and reproducible. It improves the accuracy of dosimetry in treatment planning for breast carcinoma.