Large bore ct scanner

Patients were immobilised with a custom-made 5-point thermoplastic mask and scanned in the supine position on a large-bore CT scanner (Philips Medical, Cleveland, OH). Scans were acquired in 2 mm slices. At the Royal Marsden Hospital, patients with pharyngeal and laryngeal HNC were scanned and treated in an extended neck position. This originates from the PARSPORT trial where the neck was comfortably extended to help reduce the radiotherapy dose to the oral cavity whilst also sparing the parotid glands.^{8,9 (link)} Other HNC sites, such as the oral cavity and paranasal sinuses, were scanned and treated in a neutral neck position. The difference in neck positions is illustrated in Figure 2.

From April 2009, the first fifteen left-sided breast cancer patients (T3/4, metastatic axillary lymph nodes > 4) treated in our department, with the mean age of 48 years (39 to 58), were enrolled in the study. All patients had undergone post-mastectomy and Level I–II nodal dissection and received the combined chemotherapy with or without trastuzumab. Patients were set up on a breast board (Med-Tec Corporation, USA) with the sternum parallel to the table and the left arms elevated above their heads. The patient’s head turned to the right side. The radio-opaque markers were placed on the patient’s midline, mid axillary line, the inferior aspect of the clavicle head, the inferior border at 1 cm below the contralateral infra mammary fold and the superior aspect of the fourth rib. CT images were acquired from the level of mandible to the lung base on a large bore CT scanner (Philips Medical, Fitchburg, WI, USA) with a slice thickness of 5 mm. All the images were exported to the Pinnacle treatment planning system (Pinnacle3 (link) version 9.0, Philips Radiation Oncology Systems, Andover, MA) for contouring and treatment planning.