To evaluate the dosimetric parameters of level II lymph nodes in chest wall three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) of mastectomy patients using dual-isocentric (DIT) and mono-isocentric techniques (MIT).

Computed tomography (CT) images of 20 mastectomy patients undergoing chest wall external radiotherapy were used as the input data for the abovementioned techniques. Selected dosimetric parameters were calculated for the axillary level I–III lymph nodes, chest wall, heart and lung. Paired t-test statistical analysis was used for comparing the results of MIT and DIT in both 3D-CRT and IMRT methods.

There were significant differences in Dmin (minimum dose), Dmax (maximum dose) and maximum–minimum dose between MIT and DIT techniques (13, −8·6, −52·2% differences for Dmin, Dmax and maximum–minimum, respectively) in IMRT. There were also significant differences for Dmean (mean dose), Dmax and maximum–minimum dose (7·8, −11·4, −44·6% differences in Dmean, Dmax and maximum–minimum, respectively) in 3D-CRT (p < 0·05). In addition, there were not any differences in the dosimetric parameters for heart, lung and level I and III lymph nodes.

In both 3D-CRT and IMRT methods, level II lymph node dose distribution in MIT was closer to the prescribed dose compared with DIT due to the position of these nodes in the field junction area. To achieve a better dose homogeneity, it could be recommended to use MIT instead of DIT in 3D-CRT and IMRT for mastectomy patients.

During the radiation therapy of tumoral breast, the contralateral breast (CB) will receive scattered doses. In the present study, the photon and thermal neutron dose values received by CB surface during breast cancer radiation therapy were measured.

The right breast region of RANDO phantom was considered as CB, and the measurements of photon and thermal neutron dose values were carried out on this region surface. The phantom was irradiated with 18 MV photon beams, and the dose values were measured with thermoluminescent dosimeter (TLD-600 and TLD-700) chips for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes in the presence of physical and dynamic wedges.

The total dose values (photon + thermal neutron) received by the CB surface in the presence of physical wedge were 12·06%, 15·75% and 33·40% of the prescribed dose, respectively, for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes. The corresponding dose values for dynamic wedge were 9·18%, 12·92% and 29·26% of the prescribed dose, respectively. Moreover, the results showed that treatment field size and wedge type affect the received photon and thermal neutron doses at CB surface.

According to our results, the total dose values received at CB surface during breast cancer radiotherapy with high-energy photon beams are remarkable. In addition, the dose values received at CB surface when using a physical wedge were greater than when using a dynamic wedge, especially for medial tangential fields.

The incidence of breast cancer has surpassed cervical cancer in India and it has now become the most common cancer in women. Multiple randomised studies have reported low α/β value in the range of 3–4 for breast cancer, which predict a potential radiobiological advantage for hypofractionated radiotherapy resulting in such schedules becoming standard in many centers with reduction in overall treatment time. Volumetric modulated arc therapy (VMAT) is a novel technique of delivering radiotherapy that reduces treatment delivery time, requires less monitor units (MU) and offers good conformity. The mean dose to normal tissue may be minimised using this technique although there will be inferior sparing if we consider the low-dose volume such as V5, the effect of which is not quantifiable yet.

Reporting acute toxicity, cosmetic effects, and quality of life in patients of early breast cancer treated with adjuvant hypofractionated VMAT with SIB.

The records of 44 patients registered at the hospital between August 2014 and December 2015 were included in this analysis. Acute toxicities were analysed using CTCAE v4.03. Cosmetic outcomes were assessed using Harvard scale, while quality of life outcomes were assessed using EORTC scales and Health Related quality of life (HRQOL) questionnaires (QLQ-C30 and QLQ-BR23).

No grade ≥2 skin toxicities were recorded. Breast pain was recorded as Grade 1 in 13·8% patients and Grade 1 fatigue in 18·2%. The maximum haematological abnormality grade recorded was Grade 1. Cosmesis was assessed at the baseline, 6 months, 1 year and 2 years. A total of 88·6% of the patients had an Excellent or good cosmesis at the baseline, which was similar even at 6 months, at 88·7%, improved further at 1 year to 90·9%. At 6 months post radiotherapy, high functional scale QOL scores were noted.

The technique is associated with minimum acute toxicity, good to excellent cosmesis and acceptable quality of life.

To evaluate the use of exercise in managing fatigue in breast cancer patients undergoing adjuvant radiotherapy. To explore the effectiveness of different exercise practices and explore how optimum management of fatigue might be achieved.

A CINAHL (Cumulative Index to Nursing and Allied Health Literature) database search of literature was undertaken and publications screened for retrieval with 24 qualifying for inclusion in the review.

There is evidence to support various forms of exercise including aerobic, resistance, alternative and combination exercise in the management of fatigue in early stage breast cancer patients undergoing adjuvant radiotherapy. The benefits of exercise for patients with later stage and metastatic disease is less clear and there is a lack of published research related to this category of patient.

Exercise is considered a safe, non-pharmacological intervention for early stage breast cancer patients receiving adjuvant radiotherapy. Further investigation is required into optimum exercise interventions and the effectiveness and viability of supervised and unsupervised models. Patient centred tailored advice and guidance needs to be developed and effectively promoted by therapeutic radiographers in order for patients to fully realise the benefit.

The goal of this study was to assess the effectiveness of immersive virtual reality (VR) distraction technology in reducing pain and anxiety among female patients with breast cancer.

A randomized control trial design was used with a sample of 80 female patients with breast cancer at a specialized cancer center in Jordan. Participants were randomly assigned into intervention and comparison groups.

The study findings showed that one session of the immersive VR plus morphine made a significant reduction in pain and anxiety self-reported scores, compared with morphine alone, in breast cancer patients.

Immersive VR is an effective distraction intervention for managing pain and anxiety among breast cancer patients. Using immersive VR as an adjuvant intervention is more effective than morphine alone in relieving pain and anxiety; furthermore, VR is a safe intervention more than pharmacological treatment.

The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported that the risks of breast cancer treatment in woman smokers may outweigh the benefits. The data used doses from published reports using a variety of treatment techniques. In our study, the risks of lung cancer and heart disease were determined from a modern era tangential-only technique.

Doses to the lung and heart were obtained for tangential radiotherapy to the breast or chest wall. The risk of lung cancer incidence and cardiac mortality were calculated by taking the ratio of our doses to those published by the EBCTG.

A total of 77 women were identified meeting our inclusion criteria. The mean combined whole lung dose was 2·0 Gy. The mean whole heart dose was 0·9 Gy. The estimated risk of lung cancer and cardiac mortality in a 50-year-old life-long smoker was estimated to be 1·5 and <1%, respectively.

Tangential only radiotherapy delivered substantially lower doses to the combined whole lung and whole heart than those reported by the EBCTCG. In this cohort, the risks of radiation induced lung cancer and heart disease are outweighed by the benefits of radiotherapy even in those that are smokers.

Breast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.

A computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.

IORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.

Although the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.

During the treatment of breast cancer, radiotherapy to the supraclavicular fossa region results in absorption of radiation by the thyroid gland and consequently leads to hypothyroidism in 40% of patients. The aim of this study was to compare thyroid gland radiation absorption during radiotherapy with different anterioposterior beam radiation of 6–15 and 15–15 MV photon beam energies.

In total, 29 patients with breast cancer were recruited to this study. Adjuvant radiotherapy with a total dose of 50 Gy was performed for each participant. Thyroid gland dosimetric measurements were evaluated including, mean dose, minimum and maximum dose, and V20, V30, V40 and V50 (percentage of thyroid volume receiving ≥20, ≥30, ≥40 and ≥50 Gy, respectively). The irradiation delivered doses were measured using Prowess Panther treatment planning system (Version 5.5). All data were evaluated using SPSS software.

In total, 29 subjects with mean age of 53·4±9·4 were studied. According to the obtained results, at 15–15 MV energies, a significantly lower dose was absorbed by the thyroid gland, was observed in contrast to their counterparts who were treated with 6–15 MV photon beam energies.

Using 15–15 MV photon beam energies field can significantly reduce the absorbed dose to the thyroid gland and consequently can reduce the risk of developing hypothyroidism in breast cancer patients treated with radiotherapy.

Accurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.

This was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.

In total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.

The PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.

The purpose of this study was to investigate whether significant difference exists on radiation dose delivered to organs at risks in megavoltage computed tomography (MVCT) verification using three predefined scanning modes, namely fine (2 mm), normal (4 mm) and coarse (6 mm). This will provide information for the imaging protocol of tomotherapy for the left breast.

Organ doses were measured using thermoluminescent dosimeters (TLD-100) placed within a female Rando phantom for MVCT imaging. Kruskal–Wallis test was conducted with p<0·05 to evaluate the significant difference between the three MVCT scanning modes.

Statistically significant difference existed in organ absorbed dose between different scan mode selections (p<0·001). Relative to the normal scan selection (4 mm), the absorbed dose to the organs of interests can be scaled down by 0·7 and scaled up by 2·1 for coarse (6 mm) and fine scans (2 mm) respectively.

Optimisation of imaging protocols is of paramount importance to keep the radiation exposure ‘as low as reasonably achievable’. The recommendation of undergoing daily coarse mode for MVCT verification in breast tomotherapy not only mitigates the radiation exposure to normal tissues, but also trims the scan-acquisition time.