A Prospective Study to Investigate the Placement of Setup Skin Markings for Larger Breasted Women Undergoing External Beam Radiotherapy (RT) for Breast Cancer

Authors

  • Chris Osam Doudoo  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Neill Roberts  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Emmanuel Amankwaa Frempong  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Clement Edusa  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Kwamena Beecham  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Kofi Agyiri  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Promise Ahiagbenyo  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • George Felix Acquah  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Phillip Oppong Kyeremeh  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Dominic Gadeka  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Eric Abakuri  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Michael Mordey  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Anna Maria Anim-Sampong  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana
  • Bismark Djan  Department of Radiation Oncology, Sweden Ghana Medical Centre, East - Legon Hills, Accra - Ghana

DOI:

https://doi.org//10.32628/IJSRST19622

Keywords:

Skin Markings, Beam Radiotherapy, Breast Cancer, tumor, BMI, TPRP

Abstract

Background: The technique of placing all three skin marks (reference skin marks) on a single position during CT simulation for setup of patients undergoing conventional breast radiotherapy becomes a challenge when presented with larger breasted women (bra cup size ≥ D). A new way of using skin marks in setting these patients up has been developed where three skin marks are made on the patient (one on the sternum and two lateral skin marks more inferiorly beneath the breasts) for setup as against the departmental standard of using only a single skin mark on the sternum, and employing an SSD (Source to Skin Distance) technique.

This study therefore reviewed the placement of the skin markings for larger breasted women undergoing external beam radiotherapy for breast cancer by quantifying treatment field alignment errors and setup errors between the two different setup techniques.

Method: 36 patients were used in this study. Out of this number, 18 were setup using three reference skin marks and the remaining 18 were setup using one reference anterior skin mark. With an acceptable patient treatment field alignment error of 2 degrees, portal images (AP and lateral) of the different skin mark techniques were analysed for field alignment errors using an Iview GT system. More so, portal images (AP and lateral) of setup for both techniques were analysed for systematic (Σ) and random (σ) errors.

Results:The AP images of the single skin mark setup and the three skin mark setup yielded no significant difference as they recorded a p- value (p<0.05) of 0.089 and 0.110 respectively when compared to the treatment field alignment threshold error of 2 degrees. The lateral images of the three skin mark also yielded no significant difference as a p- value (p<0.05) of 0.091 was recorded. The lateral images of the single skin mark yielded a significant difference with a p- value (p<0.05) of 0.026.

Secondly, mean comparisons of the field alignment errors between the two setup techniques yielded no significant difference in the AP images as a p- value (p<0.05) of 0.089 was detected. On the contrary, a p- value (p<0.05) of 0.026 was recorded in the field alignment errors of the lateral images. This difference is significant.

Lastly, random errors were reduced in all directions (AP- anterior-posterior, SI- superior-inferior and LR- Left-right) in the three skin mark setup (4.5mm AP, 4.9mm SI and 2.4mm LR) as compared to the single skin mark setup (4.7mm AP, 5.2mm SI and 2.6mm LR). Systematic errors were also reduced in the three skin mark setup (1.7mm AP and 1.8mm SI) compared to the single skin mark setup (2.0mm AP, 2.1mm SI). Systematic errors in the LR direction on the other hand increased from 2.0mm in the single skin mark to 2.2mm in the three skin marks.

Conclusion

For setup of larger breasted women undergoing external beam radiotherapy for breast cancer, the three skin mark setup technique is superior to the single skin mark setup technique.

References

  1. Acquah, G.F., Kyeremeh, P.O., Doudoo, C.O., Ahiagbenyo, P., Edusa, C. & Beecham, K. (2017). Breast Dosimetry: A Phantom study between Tangential Wedge Fields and Multiple Open field-in-field 3D Conformal Forward Planning. International Journal of Scientific Research in Science and Technology, 3 (6), 239-6011. Retrieved from https://www.researchgate.net/profile/George_Acquah/publication/318878230_Breast_Dosimetry_A_Phantom_study_between_Tangential_Wedge_Fields_and_Multiple_Open_field-in-field_3D_Conformal_Forward_Planning/links/59830ac8a6fdccc3f53b1c56/Breast-Dosimetry-A-Phantom-study-between-Tangential-Wedge-Fields-and-Multiple-Open-field-in-field-3D-Conformal-Forward-Planning.pdf
  2. Adamczyk, M., Piotrowski, T. & Adamiak, E. (2012). Evaluation of combining bony anatomy and soft tissue position correction strategies for IMRT prostate cancer patients. Reports of practical oncology and radiotherapy: journal of Polish Society of Radiation Oncology, 17(2), 104-9. doi:10.1016/j.rpor.2012.01.005
  3. Alderliesten, T., Sonke, J., Betgen, A., Honnef, J., Van Vliet-Vroegindeweij, C. & Remeijer, P. (2012). Application of 3D surface imaging in breast cancer radiotherapy. Journal of the International Society for Optical Engineering, 8316 (9). doi: 10.1117/12.911242
  4. American Cancer society. (2018). Retrieved from: https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/body-weight-and-cancer-risk/adult-bmi.html
  5. Beltran C, Krasin, M. J, Merchant, T. E. (2011) Inter- and intra- fractional positional uncertainties in pediatric radiotherapy patients with brain and head and neck tumors. . International Journal of Radiation Oncology, Biology, Physics 79(4): 1266-1274. doi: 10.1016/j.ijrobp.2009.12.057.
  6. Billingsley, J. (2001). “Breast-cancer Victims Bid Radiation Tattoos Goodbye.” Retrieved from: https://consumer.healthday.com/cancer-information-5/breast-cancer-news-94/some-breast-cancer-victims-bid-radiation-tattoos-goodbye-400312.html
  7. Campana, F., Kirova, Y., M., Rosenwald, J., C., Dendale, R., Vilcoq, J., R., Dreyfus, H. & Fourquet, A. (2005). Breast radiotherapy in the lateral decubitus position: A technique to prevent lung and heart irradiation. International Journal of Radiation Oncology, Biology, Physics, 61: 1348-1354. doi: http://dx.doi.org/10.1016/j.ijrobp.2004.08.051
  8. Cancer facts and figures (2017). Retrieved from https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf
  9. Cancer Research, U.K. (2014). 'Invisible tattoos' could improve body confidence after breast cancer radiotherapy. Retrieved from: https://www.sciencedaily.com/releases/2014/11/141102160008.htm
  10. Chang, A., J., Zhao, H., Wahab, S,.H., Moore, K., Taylor, M., Zoberi, I., Powell, S.,N. & Klein E., E. (2012). Video surface image guidance for external beam partial breast irradiation. Journal of Practical Radiotherapy and Oncology, 2(2):97-105. doi: 10.1016/j.prro.2011.06.013
  11. Chen, H. L., Zhou, M. Q., Tian, W., Meng, K. X. & He, H. F. (2016). Effect of Age on Breast Cancer Patient Prognoses: A Population-Based Study Using the SEER 18 Database. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165409
  12. Chung, M. J., Lee, G. J., Suh, Y. J., Lee, H. C., Lee, S. W., Jeong, S., Lee, J. W., Kim, S. H., Kang, D. G., … Lee, J. H. (2015). Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer. Cancer research and treatment: Journal of Korean Cancer Association, 47(4), 774-80. doi: [10.4143/crt.2014.189]
  13. Clarke, M., Collins, R., Darby, S., Davies C, Elphinstone, P., Evans, E…………Wang,Y. (2005). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet, 366 (9503), 2087–2106. DOI: https://doi.org/10.1016/S0140-6736 (05)67887-7
  14. Cochran, W.G. (1963) Sampling Technique. 2nd Edition, John Wiley and Sons Inc., New York.
  15. College Physics Labs Mechanics (CPL), (2011). Measurement and error analysis. The University of North Carolina at Chapel Hill. Available at: http://www.webassign.net/question_assets/unccolphysmechl1/measurements/manual.html 6/11/2018.
  16. Coltman, C. E., Steele, J. R & McGhee, D. M. (2017). Breast volume is affected by body mass index but not age. Journal of Ergonomics, 60 (11), 1576-1585. doi: 10.1080/00140139.2017.1330968
  17. Cram (2014). Examine the Advantages and Disadvantages of Using Both Positivist and Interpretivist Methods of Research. Retrieved from: https://www.cram.com/essay/Examine-The-Advantages-And-Disadvantages-Of/PKC9NAPK5C
  18. Creswell, J. W. (2003). Research methods in education: Qualitative and quantitative and mixed methods approaches. London: SAGE Publications.
  19.  Dash, N.K. (2005). Retrieved from: http://www.celt.mmu.ac.uk/researchmethods/Modules/Selection_of_methodology/index.php
  20. David, J. E., Castle, S. K. B. & Mossi, K. M. (2006). Localization Tattoos: An Alternative Method Using Fluorescent Inks. Radiation Therapist Journal, 15, (1). Retrieved from: http://www.people.vcu.edu/~kmmossi/downloads/Localization_Tattoos.pdf
  21. Deantonio, L., Masini, L., Loi, G., Gambaro, G., Bolchini, C. & Krengli, M. (2011). Detection of setup uncertainties with 3D surface registration system for conformal radiotherapy of breast cancer. Reports of Practical Oncology & Radiotherapy, 16 (3). 77-81, doi: https://doi.org/10.1016/j.rpor.2011.02.003
  22. Devane, D., Begley, C., M. & Clarke M. (2004). How many do I need? Basic principles of sample size estimation. Journal of Advanced Nursing,47:297–302
  23. Dobbs, J., Barrett, A., Morris, S., & Roques, T (2009). Principles of Radiotherapy planning. In Practical Radiotherapy Planning (4th Edition). Abingdon, Oxon: Taylor & Francis. 
  24. Dundas, K. L., Atyeo, J. & Cox J. (2007). What is a large breast? Measuring and categorizing breast size for tangential breast radiation therapy. Journal of Medical Imaging and Radiation Oncology, 51(6), 589-593. Doi: https://doi.org/10.1111/j.1440-1673.2007.01898.x
  25. Essapen, S., Knowles, C., Norman, A. & Tait, D. (2002). Accuracy of set-up of thoracic radiotherapy: prospective analysis of 24patients treated with radiotherapy for lung cancer. British Journal of Radiology; 75 (890):162–169. Retrieved from: https://www.birpublications.org/doi/full/10.1259/bjr.75.890.750162
  26. Essays, UK. (2013). Advantages and Disadvantages of Positivism. Retrieved from https://www.ukessays.com/essays/sociology/advantages-disadvantages-positivism-9924.php?vref=1
  27. Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5, 1-4. doi: https://doi.org/10.11648/j.ajtas.20160501.11
  28. Ferrari, A., Ivaldi, G., Leonardi, M.C., Rondi, E. & Orecchia, R. (2009).Prone Breast Radiotherapy in a Patient with Early Stage Breast Cancer and a Large Pendulous Breast. Retrieved from: https://www.researchgate.net/publication/26749833_Prone_Breast_Radiotherapy_in_a_Patient_with_Early_Stage_Breast_Cancer_and_a_Large_Pendulous_Breast
  29. Fisher, B.J., Bryant, J., Dignam, J., Anderson, S., Margolese, R. G., Deutsch, M.,.....Wolmark, N. (2002). Tamoxifen, radiation therapy, or both for the prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. Journal of Clinical Oncology, 20(20):4141–4149. doi: 10.1200/JCO.2002.11.101. 
  30. Furuya, T., Sugimoto, S., Kurokawa, C., Ozawa, S., Karasawa, K. & Sasai, K. (2012). The dosimetric impact of respiratory breast movement and daily setup error on tangential whole breast irradiation using conventional wedge, field-in-field and irregular surface compensator techniques. Journal of radiation research, 54(1), 157-65. doi: 10.1093/jrr/rrs064
  31. Gotgay, N. J. (2010).Principles of sample size calculation. Indian journal of Opthamology, 58(6): 517–518. doi: 10.4103/0301-4738.71692
  32. Glassy C. M., Glassy, M. S. & Aldasouqi, S. (2012). Tattooing: medical uses and problems. Cleveland Clinic Journal of Medicine, 79: 761–70. doi: https://doi.org/10.3949/ccjm.79a.12016
  33. Hanesbrands Incorporation (2018). Calculating your bra size. Retrieved from: https://www.hanes.com/shop/hanes/BraFitCalculator
  34. Harris, E. J., Mukesh, B., M., Donovan, E., M., Kirby, A., M., Haviland, J., S., Jena, R., P………Evans, M., P. (2016). A multi-centre study of the evidence for customized margins in photon breast boost radiotherapy. British Journal of Radiology, 89: 20150603, doi: https://doi.org/10.1259/bjr.20150603
  35. Herman, G., M. (2005). Clinical Use of Electronic Portal Imaging. Seminars in Radiation Oncology Journal, 15 (3), 157-167, doi: https://doi.org/10.1016/j.semradonc.2005.01.002
  36. Hewitt, C., Hahn S., Torgerson, D. J, Watson J. & Bland, J. M. (2005). Adequacy and reporting of allocation concealment: review of recent trials published in four general medical journals. British Medical Journal; 330:1057–8. doi: 10.1136/bmj.38413.576713.AE
  37. Huang, S.Y., Boone, J. M., Yang, K., Packard, N. J., McKenney, S. E., Prionas, N. D., … Yaffe, M. J. (2011). The characterization of breast anatomical metrics using dedicated breast CT. Medical Physics, 38(4), 2180–2191. http://doi.org/10.1118/1.3567147
  38. Huppert, N., Jozsef, G., Dewyngaert, K., & Formenti, S. C. (2011). The role of a prone setup in breast radiation therapy. Frontiers in oncology, 1, 31. doi:10.3389/fonc.2011.00031
  39. Hurkmans, C., W., Remeijer, P., Lebesque, J., V. & Mijnheer, B., J. (2001). Set-up verification using portal imaging: review of current clinical practice. Journal of Radiotherapy and Oncology, 58:105–120. doi: 10.1016/S0167-8140(00)00260-7
  40. IAEA. (2018). Transition from 2-D Radiotherapy to 3-D Conformal and Intensity Modulated Radiotherapy. Retrieved from: https://wwwpub.iaea.org/MTCD/Publications/PDF/TE_1588_web.pdf
  41. Jardines, L., Goyal, S., Fischer, P., Weitzel, J. & Royce, M. (2015). Breast Cancer Overview: Risk Factors, Screening, Genetic Testing, and Prevention. Retrieved from: http://www.cancernetwork.com/cancer-management/breast-cancer-overview-risk-factors-screening-genetic-testing-and-prevention
  42. Jung, J. H, Cho, K.H., Moon, S. K. , Bae, S. H., Min, C. K. , Kim, E. S…….Yeo, S. (2015). Rotation Errors of Breast Cancer on 3D-CRT in TomoDirect. Progress in Medical Physics Journal, 26 (1), doi: http://dx.doi.org/10.14316/pmp.2015.26.1.6
  43. Juni, P., Altman, D. G., & Egger, M. (2001). Assessing the quality of controlled clinical trials. British Medical Journal, 323(7303), 42–46. Available : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120670/
  44. Keller, L.M.M., Cohen, R.J., Sopka, D., Li, T., Li, L, Penny, A., Fowble, B, L & Freedman, G.M. (2013). Practical radiation oncology- Effect of Bra Use during Radiotherapy for Large-Breasted Women: Acute Toxicity and Treated Heart and Lung Volumes. Retrieved from: https://www.researchgate.net/publication/235786999_Effect_of_Bra_Use_during_Radiotherapy_for_Large-Breasted_Women_Acute_Toxicity_and_Treated_Heart_and_Lung_Volumes
  45. Kim, J. & Shin, W. (2014). How to Do Random Allocation (Randomization). Clinics in Orthopedic Surgery, 6(1), 103–109.doi: http://doi.org/10.4055/cios.2014.6.1.103
  46. Kirby, A., M., Evans, P., Helyer, S., J., Donovan, E., Convery, H., & Yarnold, J. (2011). A randomised trial of supine versus prone breast radiotherapy: Comparing set?up errors and respiratory motion. Journal of Radiotherapy and Oncology; 100: 221–6. doi: https://doi.org/10.1016/j.radonc.2010.11.005
  47. Kirova, Y.M., Hijal, T., Campana, F., Fournier-Bidoz, N., Stilhart, A., Dendale, R. & Fourquet, A. (2014). Whole breast radiotherapy in the lateral decubitus position: A dosimetric and clinical solution to decrease the doses to the organs at risk (OAR). Radiotherapy and oncology, 110 (3), 477-481. doi: https://doi.org/10.1016/j.radonc.2013.10.038
  48. Laerd.com. Lund Research Limited. (2012). Retrieved from: http://dissertation.laerd.com/purposive-sampling.php
  49. Lakosi, F., Gulyban, A., Janvary, L., Simoni, S., B., Jansen, N., Seidel, L…… Coucke, P. (2015). Respiratory motion, anterior heart displacement and heart dosimetry: Comparison between prone (Pr) and supine (Su) whole breast irradiation. The journal of Pathology and Oncology Research, 21:1051-1058. doi: 10.1007/s12253-015-9932-9
  50. Landeg, S. J., Kirby, A. M., Lee, S. F., Bartlett, F., Titmarsh, K., Donovan, E. … McNair, H. A. (2016). A randomized control trial evaluating fluorescent ink versus dark ink tattoos for breast radiotherapy. The British journal of radiology, 89(1068), 20160288. doi: 10.1259/bjr.20160288
  51.  Langmack, K. (2001). Portal Imaging. British Journal of Radiology, 74(885), 789-804. doi: 10.1259/bjr.74.885.740789
  52. Latimer, J.G, Beckham, W., West, M. & Holloway, L. (2005). Support of large breasts during tangential irradiation using a micro-shell and minimizing the skin dose – a pilot study. Medical Dosimetry, 30: 31–5. doi: https://doi.org/10.1016/j.meddos.2004.10.006
  53. Linder, J. M. & Schiska, A. D. (2015). Progress in diagnosis of breast cancer: Advances in radiology technology. Asia-Pacific journal of oncology nursing, 2(3), 186-191. doi: 10.4103/2347-5625.158017
  54. Lozano, E., M., Pérez, L., A., Torres, J., Carrascosa, C., Sanz, M., Mendicote, F. & Gil, A. (2011). Correction of systematic set-up error in breast and head and neck irradiation through a no-action level (NAL) protocol. Journal of Clinical and Translational Oncology, 13(1):34-42, doi: 10.1007/s12094-011-0614-0.
  55. Mahe, M. A., Classe, J. M., Dravet, F., Cussac, A. & Cuilliere, J. C. (2002). Preliminary results for prone-position breast irradiation. International Journal of Radiation Oncology, Biology, Physics, 52: 156-160.
  56. Matsopoulos, G., Asvestas, P., A., Delibasis, K., A., Kouloulias, V., Uzunoglu, N., Karaiskos, P. & Sandilos, P. (2004). Registration of electronic portal images for patient set-up verification. Physics in Medicine and Biology Journal, 49(14):3279-89. doi:10.1088/0031-9155/49/14/018 
  57. Mertens, D. M. (2005). Research methods in education and psychology: Integrating diversity with quantitative approaches. (2nd ed.). Thousand Oaks: Sage
  58. Mileusni, D. (2005).Verification and correction of geometrical uncertainties in conformal radiotherapy. International journal of Archive Oncology, 13(3-4):140-4.doi: 10.2298/AOO0503140M
  59. Millsted, R. & Frith, H. (2003). Being large-breasted: women negotiating embodiment. Women's Studies International Forum, 26(5), 455-465
  60. Murthy, K. K., Al-Rahbi, Z., Sivakumar, S. S., Davis, C. A., Ravichandran, R., & El Ghamrawy, K. (2008). Verification of setup errors in external beam radiation therapy using electronic portal imaging. Journal of medical physics, 33(2), 49-53. doi: 10.4103/0971-6203.41192
  61. On Target (2008). Ensuring geometrical accuracy in radiotherapy. The Royal College of Radiologists, Society and college of radiographers, Institute of Physics and Engineering in medicine. Retrieved from https://www.rcr.ac.uk/system/files/publication/field_publication_files/BFCO%2808%295_On_target.pdf
  62. Padilla, L., Kang, H., Washington, M., Hasan, Y., Chmura, S. J., & Al-Hallaq, H. (2014). Assessment of inter-fractional variation of the breast surface following conventional patient positioning for whole-breast radiotherapy. Journal of applied clinical medical physics, 15(5), 4921. doi:10.1120/jacmp.v15i5.4921
  63. Pisani, L., Lockman, D., Jaffray, D., Yan, D., Martinez, A. & Wong, J. (2000). Setup error in radiotherapy: on-line correction using electronic kilovoltage and megavoltage radiographs. International Journal of Radiation Oncology, Biology, Physics, 47(3):825–839. doi: 10.1016/S0360-3016(00)00476-4
  64. Plattard, D., Soret, M., Troccaz, J., Vassal, P., Jean-Yves, G., Champleboux, G., Artignan, X., & Bolla, M. (2000). Patient Set-Up Using Portal Images: 2D/2D Image Registration Using Mutual Information, Computer Aided Surgery Journal, 5(4) 246-262. doi: 10.3109/10929080009148893
  65. Probst, H., Bragg, C., Dodwell, D., Green, D. & Hart, J. (2013). A systematic review of methods to immobilize breast tissue during adjuvant breast irradiation. Available from Sheffield Hallam University Research Archive (SHURA) at: http://shura.shu.ac.uk/7467/
  66. Probst, H., Dodwell, D., Gray, J., C. & Holmes, M. (2006). An evaluation of the accuracy of semi-permanent skin marks for breast cancer irradiation. Radiography, 12:186–188. doi:101016/jradi20050700
  67. Radiology Info.org (2016). Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=breast-cancer-therapy
  68. Rafi, M., Tunio, M., A, Hashimi, A., H. & Ahmed, Z. (2009). The South African Radiographer, 47(2). Retrieved from: https://pdfs.semanticscholar.org/371f/08b1214df90096cc7adf1374da063f3d6749.pdf
  69. Rathod, S., Munshi, A., & Agarwal, J. (2012). Skin markings methods and guidelines: A reality in image guidance radiotherapy era. South Asian journal of cancer, 1(1), 27-29. doi: 10.4103/2278-330X.96502
  70. Remeijer, P., Geerlof, E., Ploeger, L., Gilhuijs, K., Van Herk, M. & Lebesque, J., V. (2000). 3-D Portal image analysis in clinical practice. An evaluation of 2-D and 3-D analysis techniques as applied to 30 prostate cancer patients. International Journal of Radiation Oncology, Biology, Physics, 15; 46 (5):1281-90. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/10725642
  71. Saunders, M., Lewis, P. & Thornhill, A. (2012) “Research Methods for Business Students” 6th edition, Pearson Education Limited
  72. Seizeguide (2017). Bra size guide and converter (BSGC). Retrieved from: http://www.sizeguide.net/bra-sizes.html
  73. SGMC cancer registry, 2017.
  74. Steber, C. (2017). Quantitative Research Design: Methods & Appropriate Uses. Communications for Research. Retrieved from: https://www.cfrinc.net/cfrblog/quantitative-research-design
  75. The Royal College of Radiologists, London (2008).The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine: On Target: Ensuring Geometric Accuracy in Radiotherapy. Retrieved from: https://www.rcr.ac.uk/system/files/publication/field_publication_files/BFCO%2808%295_On_target.pdf
  76. Topolnjak, R., Van Vliet?Vroegindeweij, C., Sonke , J., Minkema, D., Rameijer, P., Nijkamp, J…… Rasch, C., (2008). Breast?conserving therapy: Radiotherapy margins for breast tumor bed boost. International Journal of Radiation Oncology, Biology, Physics, 72: 941–8, doi: https://doi.org/10.1016/j.ijrobp.2008.06.1924
  77. University of Iowa Breast Health Centre. (2013). Bra Size: How to Properly Measure Yourself [Video file]. Retrieved from https://www.youtube.com/watch?v=yIcwLBt4S64.
  78. Veldeman, L., De Gersem, W., Speleers, B., Truyens, B., Van Greveling, A., Van den Broecke, R. & De Neve, W.(2012). Alternated prone and supine whole-breast irradiation using IMRT: Setup precision, respiratory movement and treatment time. International Journal of Radiation Oncology, Biology, Physics, 82(5):2055-2064. doi: 10.1016/j.ijrobp.2010.10.070
  79. Veronesi, U., Cascinelli, N., Mariani, L., Greco, M., Saccozzi, R., Luini, A.,.….Marubini, E. (2002). Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. The New England Journal of Medicine, 347(16):1227–1232. doi: 10.1056/NEJMoa020989.
  80. White, E. A, Cho, J., Vallis, K., A, Sharpe, M., B., Lee, G., Blackburn, H…….Jaffray, D, A. (2007). Cone beam computed tomography guidance for setup of patients receiving accelerated partial breast irradiation. International Journal of Radiation Oncology, Biology, Physics, 68: 547–54, doi: https://doi.org/10.1016/j.ijrobp.2007.01.048
  81. Wilson, J. (2010) “Essentials of Business Research: A Guide to Doing Your Research Project” SAGE Publications
  82. Wittmer, M. H., Pisansky, T. M., Kruse, J. & Herman, M. G. (2005). Patient-Specific Protocol to Reduce Radiation Therapy Setup Variation Using an Electronic Portal Imaging Device. Journal of Applied Clinical Medical Physics 6(4). doi: 10.1120/jacmp.v6i4.1954
  83. Zheng, Y. & Ding, X. (2017). Inter-Observer Variability of a Commercial Patient Positioning and Verification System in Proton Therapy. Journal of Radiology and Oncology, 1: 031-038. doi: 10.29328/journal.jro.1001004

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[1]
Chris Osam Doudoo, Neill Roberts, Emmanuel Amankwaa Frempong, Clement Edusa, Kwamena Beecham, Kofi Agyiri, Promise Ahiagbenyo, George Felix Acquah, Phillip Oppong Kyeremeh, Dominic Gadeka, Eric Abakuri, Michael Mordey, Anna Maria Anim-Sampong, Bismark Djan, " A Prospective Study to Investigate the Placement of Setup Skin Markings for Larger Breasted Women Undergoing External Beam Radiotherapy (RT) for Breast Cancer , International Journal of Scientific Research in Science and Technology(IJSRST), Online ISSN : 2395-602X, Print ISSN : 2395-6011, Volume 6, Issue 2, pp.99-122, March-April-2019. Available at doi : https://doi.org/10.32628/IJSRST19622