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British Journal of Radiology (2003) 76, 254-259
© 2003 British Institute of Radiology
doi: 10.1259/bjr/59091776
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Survey of tangential field planning and dose distribution in the UK: background to the introduction of the quality assurance programme for the START trial in early breast cancer

E A Winfield, DCR(T), BSc1, A Deighton, DCR(T), BSc1, K Venables, MSc, MIPEM1, P J Hoskin, FCRP, FRCR1 and E G A Aird, PhD, FIPEM2 on behalf of the START Trial Working Party

1 Marie Curie Research Wing, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN and 2 Department of Medical Physics, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK



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  		Figure 1. Sample patient outlines of varying sizes sent to departments, together with the initial START trial quality assurance questionnaire, for planning according to each individual department's protocol. (a) Outline for chest wall, (b) outline of medium breast size and (c) outline of larger breast size.

 


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  		Figure 2. Positioning of the START trial reference point; all plans analysed were normalized to the reference point, R. a, posterior beam edge; b, perpendicular distance between lung surface and skin surface.

 


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  		Figure 3. The beam energies used by departments to plan the each of the three outlines.

 


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  		Figure 4. The beam energies used to plan the larger breast size outline and the resultant central axis dose gradient demonstrating that a number of departments exceed a 10% gradient for this size of patient.

 


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  		Figure 5. Box plot of wedge compensation. Horizontal dashed line shows median, box represents interquartile range, bars represent range of values excluding outliers (these are shown as * and {circ}). Medial field (MED), lateral field (LAT). The chest wall results demonstrate a large range of angles in use across centres. The data also suggest that the majority of departments surveyed use similar wedge angles for both medial and lateral fields.

 




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