Abstract

Purpose: To evaluate the impact of a customised immobilisation system on field placement accuracy, simulation and treatment delivery time, radiographer convenience and patient acceptability. Patients and methods: Thirty men receiving radical radiotherapy for prostate cancer were randomised using a cross over trial design to have radiotherapy planning and treatment given either in a conventional treatment position (CTP) or using an immobilisation system (IMS). The randomisation was to have either the CTP or IMS for the initial 3 weeks of radiotherapy after which patients were replanned and changed to the alternative treatment set-up. Treatment accuracy was measured using an electronic portal imaging device. Radiographers and patients completed weekly questionnaires. Results: Median simulation time was 22.5 min (range 20–30 min) in the CTP and 25 min (range 15–40 min) for the IMS ( P<0.001). Median treatment time was 9 min for CTP (range 8–10 min), and 10 min (range 8.5–13.5 min) for IMS ( P<0.001). Median isocentre displacement for anterior fields was 1.7 mm from the simulated isocentre for the CTP compared to 2.0 mm for IMS ( P=0.07). For left lateral fields values were 1.8 and 1.8 mm ( P=0.98), and for right lateral fields 2.1 and 1.7 mm ( P=0.06), respectively. No clinically significant reduction in either systematic or random field placement errors was demonstrated. Radiographers reported that patients found the IMS more comfortable than CTP ( P<0.001), but when using the IMS, they noticed greater difficulty in patient positioning ( P<0.001), and alignment to skin tattoos ( P<0.001). Conclusions: Although IMS may have been more comfortable, treatment accuracy was not improved compared to the CTP in our department. In addition, treatment took longer and patient set-up was more difficult.

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