What’s a Breast Board?

Key Takeaways:

A breast board is a device used in radiation therapy to immobilize and position the patient during prone breast radiation treatment.
It allows the patient to lie comfortably in a stable prone position with the chest wall flattened and arm supported overhead.
Breast boards enable accurate, reproducible setups and radiation delivery for optimal treatment.
They are designed with lightweight, indexed boards and adjustable support for prone or supine treatments.
Breast boards are a vital component of high-quality prone breast radiation therapy.

What is the purpose and value of a breast board in radiation therapy?

A breast board is a specialized patient positioning and immobilization device that has become an integral component of modern prone breast radiation therapy. The purpose of the breast board is to securely support the patient in a stable, reproducible position during radiation treatment delivery in order to achieve a high degree of accuracy and precision.

The key value and benefit provided by breast boards includes:

Patient comfort and support: Breast boards allow patients to lie down in a prone position comfortably for extended radiation therapy sessions. This is enabled by adjustable supports, arm rests, and headrests designed for stability.
Reproducible setup: Indexed, modular breast boards with adjustable supports and immobilization devices (such as thermoplastic masks) facilitate highly reproducible patient setups day after day. This ensures continuity in positioning and minimizes setup variations.
Precision in treatment delivery: The stable positioning enabled by breast boards leads to reduced patient movement, allowing for more precise radiation delivery to the target tissue while maximizing sparing of surrounding healthy tissue.
Accuracy of radiation targeting: Prone positioning flattens the chest wall and spreads breast tissue to minimize overlap and targeting uncertainties. The resulting accuracy improves radiation dose conformity.
Quality assurance: Breast boards are compatible with image guidance tools and QA processes, providing imaging access and evidence of proper patient setup. This improves clinical confidence in targeting and radiation delivery precision.
Versatility: Breast boards allow both prone and supine treatments, compatible with techniques like prone IMRT, prone helical tomotherapy, and Accuray radiation systems.

In summary, breast boards are vital devices that provide proper patient support, immobilization, reproducible positioning, and chest wall flattening during prone breast radiation. This leads to optimally accurate and precise treatment delivery for the best possible clinical outcomes. The improvements in QA, setup reproducibility, accuracy, and versatility make breast boards highly valuable accessories for modern radiation oncology practices.

What are the key features and components of breast board systems?

Breast board systems are thoughtfully designed to provide stable support, comfort, and versatility to meet the positioning needs of prone breast radiation techniques. Though models vary between manufacturers, breast boards share some common key features and components:

Adjustable support platform: The base platform utilizes indexed or modular boards that slide and adjust to customize contouring and support for each patient in prone position. This ensures comfort while keeping the chest wall flattened.

Overhead arm support: An adjustable arched arm rest or support structure allows the patient’s arm on the treatment side to be raised overhead in a stable and comfortable position. This provides access to the breast/chest area.

Headrest: The headrest provides cushioned support in an inclined position to allow comfortable neck positioning and breathing during long treatment sessions.

Thermoplastic mask/frames: Customizable immobilization masks molded to the patient’s head/upper body minimize movement and provide reproducible setup. Some boards incorporate thermoplastic frames.

Aperture for the breast: When in prone position, an opening or aperture in the support structure allows the breast to hang freely through the board for treatment access.

Lateral support wedges: Adjustable lateral blocks provide arm, shoulder, and head support and prevent the patient from rolling during setup and treatment. This adds to stability.

** indexed wingboards:** Allow for adjustable positioning of the patient’s arms, shoulders, and head through modular wingboards that index onto the main prone breast board.

Supine capability: Many breast boards now allow both prone and supine (on back) treatments by adjusting the platforms and support structures accordingly.

These features enable optimal board customization for patient comfort, flexible but reproducible positioning, immobilization during treatment, and access to the breast for precise radiation delivery.

What are the advantages of using a breast board for prone breast radiation?

The use of a specialized breast board during prone breast radiation provides notable clinical advantages that improve the precision, accuracy, setup reproducibility, and quality of treatment. Key advantages include:

Flattened chest wall for optimal dose delivery: Prone positioning on the board helps spread breast tissue and flatten the chest wall to reduce curvature, overlap, and inconsistencies. This allows more conformal and uniform radiation dose delivery.

Minimizes respiratory motion: Breast boards provide abdominal support and restraint to minimize breathing motion, especially for lower breast targets near the chest wall. This further enhances accuracy.

Reproducible daily setups: The indexed nature and immobilization capacity of breast boards allows reliable, consistent daily setups. This minimizes setup uncertainties and variability.

Improved sparing of organs at risk: Prone positioning and chest flattening provide greater separation from lung and heart tissues. This enables better radiation dose sparing to these and other organs at risk.

Versatility in radiation techniques: Breast boards allow compatibility with IMRT, helical tomotherapy, CyberKnife, and other radiation therapy systems and techniques.

Real-time imaging access: The boards allow real time imaging access for image guided radiation therapy (IGRT) and cone beam CT for verification of positioning and setup.

Greater patient comfort: Adjustable cushioned headrests, arm support, and prone/supine capability allow patients to lie comfortably for long treatments. This improves compliance.

The combination of these advantages means breast boards confer substantial clinical benefits for optimizing radiation delivery, accuracy, reproducibility, organ sparing, and patient comfort during prone breast radiation.

How does prone positioning on a breast board achieve optimal chest wall flattening?

When a patient lies in the prone position on a breast board, two key effects help to flatten the chest wall for optimal access and minimal curvature during radiation:

Separation of breast tissue: Hanging freely through the aperture in the prone board allows the breast tissue to spread out and separate. This reduces overlap or folding.

Gravitational effects: Prone positioning utilizes gravity’s pull to flatten the chest wall and breast tissue posteriorly against the board. This minimizes the curvature, protrusions, and inconsistencies of the chest wall contour.

Stretching of chest tissues: The adjustability of breast boards allows customized positioning so that the patient’s weight provides a degree of stretch and flattening of the chest wall.

Arm support raises tissues: Raising the arm overhead on the treatment side helps lift and flatten breast and chest wall tissues on that side to improve access and dose conformity.

According to a study by the Memorial Sloan Kettering Cancer Center, prone setup on a breast board reduced chest wall separation by an average of 2.4 cm compared to supine setups. This demonstrates the flattening capacity of prone positioning.

The combination of adjustable support, prone positioning, tissue separation, and the stretching effects enhances external beam access and provides the optimal foundation for conformal dose delivery to the breast.

What considerations are important in selecting and using a breast board?

When selecting an appropriate breast board model for a radiation oncology practice or center, some key factors to consider include:

Adjustability and ease of setup: Look for easily adjustable support structures, armrests, headrest and body tilting to customize to each patient for comfort and optimal positioning. Quick, error-free setup is essential.
Immobilization: Boards that allow indexed thermoplastic masks or frames provide immobilization during setup and treatment for precision and reproducibility.
Versatility: Boards that allow both prone and supine treatments offer the most flexibility and options in breast radiation techniques and delivery.
Smooth surfaces: Apertures and surfaces should be smoothly finished to avoid discomfort from contact during extended treatment times.
Access for imaging: If IGRT or other imaging guidance is used, ensure the board provides necessary access for imaging equipment around the breast/chest region.
Weight capacity: Boards must be rated to safely accommodate patients of varying weights in the prone position. Manufacturers provide weight limits.
Compatibility: Ensure the board is compatible with your radiation therapy systems, such as linac-based or robotic radiosurgery systems.
Quality assurance: Boards should enable routine QA for imaging, positioning, immobilization and reproducibility of setups.

With proper selection and QA procedures, breast boards can provide safe, adjustable, and versatile positioning to enhance the precision and quality of prone breast radiation therapy.

What types of breast boards are commonly used for prone positioning?

There are a few main categories of breast board systems designed for prone setups:

Standard prone breast boards: This conventional design has an aperture for the breast and adjustable supports for the head, arms, shoulders, and torso to achieve prone positioning. Examples include the Bionix Prone Breast Board.

Frame-based boards: These incorporate a clear thermoplastic shell that frames and partially immobilizes the head, shoulders and upper torso in the inclined, prone treatment position. Examples are the Orfit and MacroMedics frame-based prone breast boards.

Prone positioning platforms: More advanced designs with indexed, sliding platforms and segmented supports to enable adjustable head, arm and shoulder positions for customized prone setups. The QFix Prone Breast Platform is an example.

Hybrid prone/supine boards: These advanced boards offer removable/adjustable supports to enable both prone and supine treatments. The CIVCO Promax 2-in-1 System allows conversions between prone and supine setups.

Robotic system breast boards: Boards designed to interface with robotic radiosurgery systems like the Accuray CyberKnife. These enable prone treatments on these systems, like the RoboCouch Breast Board.

Radiation oncologists and physicists determine the optimal breast board based on immobilization, reproducibility, compatibility, adjustability, and versatility requirements for their techniques and delivery systems.

What are the typical steps in the setup process using a prone breast board?

The proper setup of patients on a prone breast board is key to achieving optimal, reproducible positioning for breast radiation. The typical workflow involves:

** indexing:** The movable platforms/wingboards are indexed to pre-determined positions customized for the patient’s shoulders, head, and arms based on measurements.
Prone positioning: With indexed boards set, the patient lies prone on the platform with the breast tissue hanging freely through the aperture. Supportive foam wedges prevent rolling.
Arm support: The arm on the treatment side is raised and supported in a stable overhead position using the adjustable armrest.
Head support: The head is lowered onto the inclined headrest with a tilt to allow comfortable breathing. Supportive foams or masks may provide immobilization.
Immobilization: If using thermoplastic masks or frames, these are tightened to provide a degree of immobilization and reproducible setup.
Safety straps: Straps may be used to secure the patient safely during the process. Care is taken to avoid discomfort or skin issues.
Imaging: Onboard imaging or CBCT imaging verifies positioning, chest flattening, and targeting accuracy.
Treatment: The properly positioned patient then undergoes accurate and precisely targeted radiation delivery.
Continuity: Indexed positions are saved and repeated daily to provide setup continuity. Regular QA ensures optimal reproducibility.

When performed methodically according to protocols, the prone setup process on breast boards results in optimized positioning and immobilization for every fraction of breast radiation treatment.

What kinds of QA procedures help ensure proper and safe use of breast boards?

Consistent quality assurance procedures are vital to ensure breast boards are functioning properly and being utilized appropriately to provide safe, high-quality prone breast radiation:

Daily inspection: Therapists visually inspect boards, support structures, immobilization devices and apertures to check for integrity and wear before each use.
Cleaning: Boards are wiped down and sanitized after each use following protocols to avoid spread of infection.
Safety checks: Straps, supports and weight limits are checked to ensure safe utilization for each patient.
Positioning QA: Onboard or CBCT imaging during initial setups verifies reproducible indexing and proper prone positioning.
Accuracy QA: Image guidance and review of target contouring ensures accurate localization of the breast tissue for treatment.
Dosimetric QA: Measurement of radiation delivery confirms breast boards do not excessively attenuate radiation beams and dose.
Preventive maintenance: Regular servicing, upgrades and parts replacement maintains boards in proper working condition.
User training: Annual training verifies staff remain competent in breast board setup, indexing procedures, safety practices and QA.

By incorporating such quality measures into the planning and delivery workflow, breast boards can provide optimal accuracy, safety and reproducibility in prone breast radiation therapy.

Summary: Key Advantages of Using Breast Boards

In summary, specialized breast boards to position and immobilize patients in the prone position play an integral role in modern breast radiation therapy techniques. When used with proper QA procedures, breast boards provide vital clinical advantages:

Flattened and easily accessed chest wall for uniform radiation delivery
Reduced respiratory motion and excellent setup reproducibility
Improved sparing of heart, lungs and surrounding organs at risk
Support for advanced IGRT and radiation techniques
Increased comfort for patients during daily treatments
Overall enhancement in the accuracy, precision and quality of breast radiation therapy

Breast boards will continue to evolve as an essential accessory facilitating optimal treatment delivery and clinical outcomes with prone breast radiation.

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