The need for individualized dosimetry for tangential breast treatment

We have examined the isodose distributions of 119 intact breast patients treated on a 6 MV linac to determine if a library of treatment plans could be used instead of individualized computer plans for patient treatments without compromising the quality of those treatments. The parameters studied were: field width, baseline separation, central axis separation, wedge angle, and isodose coverage. At least two wedges were used in the computer plans for each patient and the best plan was then chosen. In order to construct a library of plans, the choice of wedge, treatment isodose, and dose uniformity should be predictable. Our results show that for 90 out of 119 plans (76%), the 30 degrees wedge was best. In the other 29 cases, either the 15 degrees or the 45 degrees wedge yielded better plans. On average, the improvement in dose homogeneity due to choice of wedge was about 2% (range 0-7%) for these cases. Although grouping like-patient parameters generally restricted the isodose variation to +/- 2.5%, there were five patients for which up to a 7% underdosage would not have been predicted. For the set of plans using a 30 degrees wedge, a significant correlation was found for the ratio of the baseline to central axis separation vs. treatment isodose. The average isodose which covered the target area was 97% (range 90-100%) and 102 out of 107 patient plans using the 30 degrees wedge fell between 94 and 100%. We conclude from these results that the variation in dose distribution found with seemingly similar sized breasts is due to the variation in breast shape and symmetry. The use of a library plan with a single wedge and a standardized isodose line for tangential field treatment of intact breast could cause up to a 7% dose difference compared to the actual dosimetry for that patient.