The radiation oncologist makes these selections based on a specific disease, tumor bed position, excised tissue pathology, compressed breast thickness, surgical clips position, and texture in the breast tissue. While the breast is still compressed, the radiation oncologist examines the image and overlays physical transparencies of different applicators to make a visual assessment to choose the applicator type, position, and size. This image is used to localize the lumpectomy cavity and surgical clips that were placed in the margins of tumor bed by the surgeon. The pre-treatment process begins with the breast being immobilized between the compression paddles with moderate compression, so a mammographic image can be taken. The applicators are attached to a mammography unit with an added 2D planar indexing grid to position the applicators. The applicators also come in different shapes, round and D-shaped, and multiple sizes to treat different shapes and positions of lumpectomy cavities.
The applicators are designed to either be skin dose optimized (SDO) or dose rate optimized (DRO). ĪccuBoost involves a set of specially designed applicators that are connected to an HDR 192Ir remote afterloader. The treatments are either performed as a boost to the tumor bed in conjunction with external-beam radiotherapy (EBRT) or as accelerated partial breast irradiation (APBI) monotherapy. AccuBoost treatments are applied following lumpectomy to deliver radiotherapy to the tumor bed.
AccuBoost ® (Advanced Radiation Therapy, LLC, Tewksbury, MA, USA) is a complex non-invasive breast treatment using high-dose-rate (HDR) brachytherapy.