Skin Apposition Breast Scar Setup

The target learning group of this case study was Interprofessional radiotherapy team (Radiographer, Physicist and Radiation Oncologist)

In this section

In This Section

Learning Outcomes

  • Knowledge

    • Selection of appropriate electron beam energy.

    • Identification of accurate skin apposition angles.

    • Factors influencing electron monitor unit calculation.

  • Skills

    • Generating electron plan for post-lumpectomy breast scar.

    • Performing skin apposition setup.

    • Calculating lead cutout and bolus thickness and determining monitor units.

  • Attitudes/Behaviours

    • Communication
      Patient-centred care

    • Team working

    • Safe working (checking)

Scenario Environment


Treatment planning room and linear accelerator bunker.


  • Notes
  • Prescription
  • VERT
  • 3D glasses
  • Electron depth dose data
  • MU calc worksheet




DICOM datasets on ECLIPSE and VERT


Planning facilitator, Physics facilitator, VERT facilitator.

Potential Distracters

Environment – staff, calls etc.



Initial Simulation Setup

Initial set up - Eclipse:

  • Log into ECLIPSE and load patient (ID …)
  • Enter “External Beam Planning” workspace
  • “Switch off” tangential fields, dose and previous CTV and PTV.
  • “Switch on” volumes “Boost CTV” and “Boost PTV”

Initial set up - VERT:

  • Switch on VERT 3.3 and choose Elekta Synergy
  • Import patient C:/VERT DATA/VERT Patient Data/PUBLIC DICOM DATA/Dataset1/PUB_VHF_Cover
  • Scene – Electron (7 x 10 and baseplate)
  • Scene – Electron Setup NUMBER 6
  • Full 3D stereoscopy engaged and glasses ready

First actions

Access patient notes and prescription

  • Electron beam depth dose tables available

Case Introduction

  • This patient is undergoing external beam therapy to the breast. She has now attended for mark up for electron therapy to her lumpectomy scar. The treatment site has been delineated on the patient and the treatment site has been outlined on her CT scans.
  • The gantry, collimator and floor angles necessary for skin apposition must be determined using VERT
  • This information must then be used to generate an electron beam plan on ECLIPSE
  • An appropriate beam energy must be chosen based on the plan and PTV profile
  • A monitor unit calculation must be performed

Available Collateral Information


Instructions for Personnel


Provide assistance with ECLIPSE controls and commands when requested


Provide assistance or advice regarding lead and bolus thickness / monitor
unit calculation when requested

VERT Setup

Provide assistance or advice with achievement of skin apposition or VERT controls

Evaluation Strategy

Pre- and post-event completion of the "Readiness for Interprofessional Learning Scale" to measure impact and a Likert-style survey to gather participant feedback.


  • Dr Andrew Williams

    Name: Dr Andrew Williams

    Job title: Senior Lecturer (Radiotherapy)

    Department: School of Radiology, AECC University College, Bournemouth

    Simulation experience / simulation research:

    I have been using VERT since 2008 with activities covering pre-clinical preparation, including fundamental principles of radiotherapy and workflows, skin apposition techniques and image review and approval.

    I also have experience of using VERT as a platform for both summative and formative assessment.