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Abducting both arms improves stability during breast radiotherapy: The Bi Arm study in radiotherapy

Published online by Cambridge University Press:  23 November 2010

SG Simon Goldsworthy ,
NS Noreen Sinclair ,
JT Jean Tremlett ,
AC Anthony Chalmers ,
MF Michael Francis  and
RS Richard Simcock
SG Simon Goldsworthy*
Affiliation:
Radiotherapy, The Beacon centre, Musgrove Park Hospital Taunton, Somerset, UK; formerly Radiotherapy, Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
NS Noreen Sinclair
Affiliation:
Therapeutic Radiography, Faculty of Health and Social Care, London South Bank University, London, UK
JT Jean Tremlett
Affiliation:
Radiotherapy, Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
AC Anthony Chalmers
Affiliation:
Genome Damage and Stability Unit, University of Sussex, Brighton, UK
MF Michael Francis
Affiliation:
The Royal Marsden Hospital, Sutton, UK
RS Richard Simcock
Affiliation:
Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
*
Correspondence to: SG Simon Goldsworthy, 1 Baileys gate, Cotford St Luke, Taunton, TA4 1JE. E-mail: Goldsworthy@tst.nhs.uk;simon.goldsworthy@googlemail.com
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Abstract

Background: A randomised study to investigate whether bilateral arm abduction is superior to unilateral abduction with respect to stability using shifts on treatment as the main outcome measure.

Material and Methods: 50 consecutive female patients were randomised to ipsilateral or bilateral arm abduction. Central lung depth (CLD) and cranial caudal depth (CCD) on the simulator image was compared with that featured on three Electronic Portal Images (EPI) captured during treatment for each patient. Systematic and random errors were analysed with respect to the average translational displacement and standard deviation per patient and per population between the planning image and the EPI.

Results: The CLD average translational displacement in the test group was −1.7 mm (95% CI = −5 to 1.6 mm) Σ pop = 2.3 mm, σ pop = 1.6 mm, and in the control group −1.9 mm (95% CI = −6 to 3 mm) Σ pop = 4 mm, σ pop = 2.1 mm. The average translational displacement of CCD in test group was 0 mm (95% CI = − 5.3 to 5.1 mm) Σ pop = 2.2 mm, σ pop = 2.6 mm. CCD translational displacement was greater in the unilateral arm abduction group at − 1.6 mm (95% CI = −6.7 to 3.4 mm) Σ pop = 3.6 mm, σ pop = 2.4mm.

Conclusion: The reduction in systematic error and inter-patient variability observed in the test group is evidence that bilateral arm abduction is a more stable and reproducible position than unilateral arm abduction. The CCD translational data indicates that patients treated with unilateral arm abduction were moving inferiorly on the breast board. These results support the adoption of bilateral arm abduction as a standard technique.

Keywords

ImmobilisationImmobilizationBreastBreast CancerRadiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 10 , Issue 4 , December 2011 , pp. 250 - 259
Copyright
Copyright © Cambridge University Press 2010

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