Abstract
To investigate the inter‐ and intra‐fraction motion associated with the use of a low‐cost tape immobilization technique as an alternative to thermoplastic immobilization masks for whole‐brain treatments. The results of this study may be of interest to clinical staff with severely limited resources (e.g., in low‐income countries) and also when treating patients who cannot tolerate standard immobilization masks. Setup reproducibility of eight healthy volunteers was assessed for two different immobilization techniques. (a) One strip of tape was placed across the volunteer's forehead and attached to the sides of the treatment table. (b) A second strip was added to the first, under the chin, and secured to the table above the volunteer's head. After initial positioning, anterior and lateral photographs were acquired. Volunteers were positioned five times with each technique to allow calculation of inter‐fraction reproducibility measurements. To estimate intra‐fraction reproducibility, 5‐minute anterior and lateral videos were taken for each technique per volunteer. An in‐house software was used to analyze the photos and videos to assess setup reproducibility. The maximum intra‐fraction displacement for all volunteers was 2.8 mm. Intra‐fraction motion increased with time on table. The maximum inter‐fraction range of positions for all volunteers was 5.4 mm. The magnitude of inter‐fraction and intra‐fraction motion found using the “1‐strip” and “2‐strip” tape immobilization techniques was comparable to motion restrictions provided by a thermoplastic mask for whole‐brain radiotherapy. The results suggest that tape‐based immobilization techniques represent an economical and useful alternative to the thermoplastic mask.
Highlights
Whole-brain radiation therapy (WBRT) is a common treatment for patients with advanced brain cancer and brain metastases
Spikes were observed in the data and were due to sudden movements such as swallowing
While thermoplastic masks have become the standard for reducing inter- and intra-fraction position uncertainty for head and neck treatments and WBRT, this study shows that immobilization techniques using strips of tape may be reasonable alternatives for WBRT and could be used as surrogates in emergency procedures and limited resource environments
Summary
Whole-brain radiation therapy (WBRT) is a common treatment for patients with advanced brain cancer and brain metastases. Patients are typically immobilized in the supine position with a thermoplastic mask and treated with parallel opposed lateral fields.[1] The delivery of WBRT has been shown to improve intracranial control in patients with multiple brain metastases[2,3,4] and remains an integral part of palliative treatment for advanced stage metastatic brain cancer patients. The current standard of care for WBRT uses thermoplastic masks to reduce inter- and intra-fraction patient positioning uncertainties.[5] Advances in radiotherapy have led to many sophisticated solutions for head and neck immobilization.[6,7,8,9,10] in resource-limited settings, including some low- and middleincome countries, these immobilization solutions may not be widely available for clinical use. Some patients find the mask very difficult to tolerate and could benefit from a less restrictive immobilization technique
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