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Wood L, Holman R, Nguyen U, Nguyen H, Senaratna A, Adams M, Apath A. Patient Education Materials for Immobilisation Masks in Radiation Therapy for Adult Head and Neck Cancer Patients: A Scoping Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:479-489. [PMID: 38592655 PMCID: PMC11461644 DOI: 10.1007/s13187-024-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
Immobilisation masks (IMs) are used for people with head and neck cancer (HNC) undergoing radiation therapy (RT) treatment to ensure accuracy and reproducibility between treatments. Claustrophobia-related mask anxiety in HNC patients is common and can compromise treatment due to patient distress. This scoping review aimed to describe the content of publicly available Patient Education Materials (PEMs) for people with HNC undergoing RT. Three search engines (Bing, Yahoo, and Google) were systematically searched using standard terms. PEMs in audio-visual or written formats were eligible for inclusion if the target readership was adults with HNC and included content on IMs for RT. Content was appraised using the Patient Education Materials Assessment Tool for Printable and Audio-Visual Materials to assess understandability and actionability. In total, 304 PEMs were identified of which 20 met the inclusion criteria. Sixteen PEMs were webpages, three were PDF format, and one was a standalone video. The understandability and actionability of PEMs ranged between 47 to 100% and 0 to 80%, respectively. PEMs authored by Foundations/Organisations scored higher in understandability (80-100%) and were more likely to discuss mask anxiety coping strategies. In comparison, News sites and IM manufacturers published PEMs with the lowest understandability scores (20-80%). The significant variations in the quality of IM PEMs identified suggest that some sources may be more effective at informing patients about IMs. Although multiple aspects of the PEMs were consistent across the reviewed materials, many PEMs lacked information, and a stronger focus on understandability and actionability is required.
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Affiliation(s)
- Lucy Wood
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Ruby Holman
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Uyen Nguyen
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Helen Nguyen
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Aurora Senaratna
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Misha Adams
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Apajok Apath
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Lundin E, Axelsson S, Ohlsson-Nevo E. Open or closed: Experience of head and neck radiotherapy masks - A mixed-methods study. J Med Radiat Sci 2024. [PMID: 39332941 DOI: 10.1002/jmrs.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 09/06/2024] [Indexed: 09/29/2024] Open
Abstract
INTRODUCTION In radiotherapy for head and neck cancer, a mask is used to immobilise the head and shoulders. An open mask that does not cover the face is expected to cause less anxiety, but there is need to further investigate the patients' experience of open versus closed masks. Therefore, the aim of this study is to evaluate patient preferences for open or closed masks and whether an open mask can reduce discomfort and anxiety for patients. METHODS Twenty participants were treated in alternating weeks using open and closed masks. Their distress was evaluated through semi-structured interviews and patient-reported outcome measures. RESULTS When using the open mask, it took longer to position the patient correctly. The closed mask felt more confining and could induce a sense of claustrophobia. Participants employed both internal and external strategies to cope with the stressful situation. The Hospital Anxiety and Depression Scale (HADS) showed a significant reduction in anxiety over time during the treatment period, but no significant difference between the masks. When participants chose which mask to use for the final treatments, 12 chose the open mask, while 8 chose the closed mask. In addition to the 20 analysed participants, two participants withdrew from the study because they could only tolerate the open mask, one due to anxiety and the other due to swelling. CONCLUSIONS The open mask seems to provide a less confined experience but may lead to greater difficulties in achieving the correct treatment position. While both masks can be viable options for most patients, some cannot tolerate closed masks but do tolerate open masks.
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Affiliation(s)
- Erik Lundin
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sofia Axelsson
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Emma Ohlsson-Nevo
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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Sánchez-Rubio P, Rodríguez-Romero R, Pinto-Monedero M, Alejo-Luque L, Martínez-Ortega J. New findings on clinical experience on surface-guided radiotherapy for frameless non-coplanar stereotactic radiosurgery treatments. J Appl Clin Med Phys 2024:e14510. [PMID: 39287562 DOI: 10.1002/acm2.14510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 08/05/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
PURPOSE The aim of this study was to assess the accuracy of a surface-guided radiotherapy (SGRT) system for setup and intra-fraction motion control in frameless non-coplanar stereotactic radiosurgery (fSRS) using actual patient data immobilized with two different types of open-faced masks and employing a novel SGRT systems settings. METHODS AND MATERIALS Forty-four SRS patients were immobilized with two types of open-faced masks. Sixty lesions were treated, involving the analysis of 68 cone-beam scans (CBCT), 157 megavoltage (MV) images, and 521 SGRT monitoring sessions. The average SGRT translations/rotations and 3D vectors (MAG-Trasl and MAG-Rot) were compared with CBCT or antero-posterior MV images for 0° table or non-coplanar beams, respectively. The intrafraction control was evaluated based on the average shifts obtained from each monitoring session. To assess the association between the SGRT system and the CBCT, the two types of masks and the 3D vectors, a generalized estimating equations (GEE) regression analysis was performed. The Wilcoxon singed-rank test for paired samples was performed to detect differences in couch rotation with longitudinal (LNG) and lateral (LAT) translations and/or yaw. RESULTS The average SGRT corrections were smaller than those detected by CBCT (≤0.5 mm and 0.1°), with largest differences in LNG and yaw. The GEE analysis indicated that the average MAG-Trasl, obtained by the SGRT system, was not statistically different (p = 0.09) for both mask types, while, the MAG-Rot was different (p = 0.01). For non-coplanar beams, the Wilcoxon singed-rank test demonstrated no significantly differences for the corrections (LNG, LAT, and yaw) for any table rotation except for LNG corrections at 65° (p = 0.04) and 75° (p = 0.03) table angle position; LAT shifts at 65° (p = 0.03) and 270° (p < 0.001) table angle position, and yaw rotation at 30° (p = 0.02) table angle position. The average intrafraction motion was < 0.1 mm and 0.1° for any table angle. CONCLUSION The SGRT system used, along with the novel workflow performed, can achieve the setup and intra-fraction motion control accuracy required to perform non-coplanar fSRS treatments. Both masks ensure the accuracy required for fSRS while providing a suitable surface for monitoring.
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Affiliation(s)
- Patricia Sánchez-Rubio
- Medical Physics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Ruth Rodríguez-Romero
- Medical Physics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - María Pinto-Monedero
- Medical Physics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Luis Alejo-Luque
- Medical Physics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Jaime Martínez-Ortega
- Medical Physics Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Lastrucci A, Morelli I, Votta C, Maran I, Iosca N, Monaco IP, Salvestrini V, Desideri I, Marrazzo L, Wandael Y, Cornacchione P, Pallotta S, Giansanti D, Ricci R, Livi L, Bonomo P. Open-Face Masks in Radiotherapy: Enhancing Therapeutic Strategies for Head and Neck and Brain Cancer Patients-A Comprehensive Scoping Review. Cancers (Basel) 2024; 16:2899. [PMID: 39199669 PMCID: PMC11353183 DOI: 10.3390/cancers16162899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/14/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
Introduction: The main goal of radiotherapy (RT) is to deliver a precise dose to the target while sparing the surrounding normal tissue and minimizing side effects. Appropriate patient immobilization is crucial, especially for head and neck cancer (HNC) and Brain Cancer (BC). Conventional closed-face masks (CFMs), while effective in minimizing head motion, can cause significant discomfort, anxiety, and claustrophobia. Open-face masks (OFMs) have been developed to increase patient comfort while providing precise immobilization. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) extension for scoping reviews and the Arskey and O'Malley framework, an electronic search of EMBASE, PubMed, SCOPUS, and Web of Science was conducted to identify original studies reporting the use and description of OFMs in clinical practice up to April 2024. The inclusion criteria were English-language articles focusing on OFMs for HNC and BC patients undergoing RT. Results: Of 618 titles, 19 articles fulfilled the selection criteria. Most studies were comparative (n = 13) or observational (n = 6). The articles were categorized by treatment site, resulting in three groups: BC (n = 14, 68.4%), HNC (n = 4, 21.4%), and mixed (n = 2, 10.5%), which includes both BC and HNC. Of note, 82.4% (n = 16) of the included studies were published from 2020 onwards, emphasizing the recent adoption of OFM in clinical practice. Conclusions: The reviewed studies show that OFMs, in combination with SGRT, offer significant advantages in terms of patient comfort and positioning accuracy in HNC and BC treatments. Reproducibility in the sub-millimeter and sub-degree range can be achieved, which supports the use of OFMs in clinical practice. Future research should explore innovative combinations of immobilization and monitoring to further improve RT outcomes and ensure precise treatment while increasing patient comfort.
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Affiliation(s)
- Andrea Lastrucci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Ilaria Morelli
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
| | - Claudio Votta
- Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Irene Maran
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Nicola Iosca
- Radiation Oncology, Department of Diagnostic Pathology, Bioimages and Public Health, Azienda Ospedaliero-Universitaria Consorziale Policlinico, 70120 Bari, Italy
| | - Ilaria Pia Monaco
- Radiation Oncology, Department of Diagnostic Pathology, Bioimages and Public Health, Azienda Ospedaliero-Universitaria Consorziale Policlinico, 70120 Bari, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Livia Marrazzo
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
- Medical Physics Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Yannick Wandael
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Patrizia Cornacchione
- Dipartimento Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
- Medical Physics Unit, Careggi University Hospital, 50134 Florence, Italy
| | | | - Renzo Ricci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, 50134 Florence, Italy (L.M.)
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Mulla Z, Hashem R, Joseph V, Maumenah H, Weber A, Khasim A, Altoukhi H. Treatment Reproducibility in Brain Stereotactic Radiotherapy Using a Shim Mask Versus a Standard Mask. Cureus 2024; 16:e66108. [PMID: 39229440 PMCID: PMC11369750 DOI: 10.7759/cureus.66108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction This study aimed to evaluate the setup accuracy of the new shim mask with mouth bite compared to the standard full brain mask in stereotactic radiosurgery (SRS) and radiotherapy (SRT) treatments for brain metastases or tumors. Method A combined retrospective and prospective design was employed, involving 40 patients treated at our center. Patients previously treated using standard head masks formed the retrospective cohort, while those treated with the Shim mask and mouth bite formed the prospective cohort. Daily cone-beam computed tomography (CBCT) scans were obtained before each treatment session to ensure patient setup accuracy. Key metrics included absolute shifts in translational and rotational directions, the number of repeat CBCTs, and the time interval between CBCTs. Results The Shim mask significantly reduced the mean setup errors in the lateral translation (p=0.022) from 0.17 cm (SD=0.10) to 0.10 cm (SD=0.10), and in X-axis rotation (p=0.030) from 0.79° (SD=0.43) to 0.47° (SD=0.47). By considering cutoff points of 1 mm in translational and 1° in rotational directions, the Shim mask was significantly more accurate in the lateral direction (p=0.004). Moreover, while 70% of patients in the standard group required repeat CBCT scans, none in the Shim group did, resulting in an average time saving of 10.4 minutes per patient. Conclusion The Shim mask with mouth bite offers enhanced immobilization accuracy in SRT/SRS treatments, leading to time and potential cost savings by reducing the need for repeat CBCT scans. This underscores the importance of adopting innovative immobilization techniques to optimize patient outcomes.
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Affiliation(s)
- Zaheeda Mulla
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Rania Hashem
- Radiology, King Abdul-Aziz University, Jeddah, SAU
| | - Victor Joseph
- Radiology, King Abdul-Aziz University Hospital, Jeddah, SAU
| | - Hani Maumenah
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
| | - Amina Weber
- Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
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Keane M, Weitkamp N, Madani I, Day J, Dal Bello R, Zamburlini M, Schiess A, Moreira A, Perryck S, Tomuschat K, Spencer M, Tanadini-Lang S, Guckenberger M, Brown M. Randomized self-controlled study comparing open-face vs. closed immobilization masks in fractionated cranial radiotherapy. Radiother Oncol 2024; 196:110314. [PMID: 38677329 DOI: 10.1016/j.radonc.2024.110314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/01/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE To compare patient discomfort and immobilisation performance of open-face and closed immobilization masks in cranial radiotherapy. MATERIAL AND METHODS This was a single-center randomized self-controlled clinical trial. At CT simulation, an open-face and closed mask was made for each patient and treatment plans with identical dose prescription were generated for each mask. Patients were randomised to start treatment with an open-face or closed mask. Masks were switched halfway through the treatment course; every patient was their own control. Patients self-reported discomfort, anxiety and pain using the visual analogue scale (VAS). Inter- and intrafraction set-up variability was measured with planar kV imaging and a surface guided radiotherapy (SGRT) system for the open-face masks. RESULTS 30 patients with primary or metastatic brain tumors were randomized - 29 completed radiotherapy to a median total dose of 54 Gy (range 30-60 Gy). Mean discomfort VAS score was significantly lower with open-face masks (0.5, standard deviation 1.0) vs. closed masks (3.3, standard deviation 2.9), P < 0.0001. Anxiety and pain VAS scores were significantly lower with open-face masks (P < 0.0001). Closed masks caused more discomfort in infraorbital (P < 0.001) and maxillary (P = 0.02) areas. Two patients and 27 patients preferred closed or open-face masks, respectively. Interfraction longitudinal shifts and roll and yaw rotations were significantly smaller and lateral shifts were significantly larger with closed masks in combination with the laser system (P < 0.05) compared to open masks in combination with a SGRT system. Intrafraction variability did not differ between the masks. CONCLUSIONS Open-face masks are associated with decreased patient discomfort without compromising patient positioning and immobilisation accuracy.
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Affiliation(s)
- Michèle Keane
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Nienke Weitkamp
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Jonathan Day
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Mariangela Zamburlini
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Antonia Schiess
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Amanda Moreira
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Sophie Perryck
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Katja Tomuschat
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Marilyn Spencer
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Michelle Brown
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
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Glynn AM, Harwood R, Garrett B, Harper D, Dunne M, Nicholson J, Rangaswamy G, Duane F, Armstrong J, McArdle O, Brennan S. Unmasking anxiety: a head-to-head comparison of open and closed masks in head and neck cancer radiotherapy. Rep Pract Oncol Radiother 2024; 29:219-227. [PMID: 39143970 PMCID: PMC11321773 DOI: 10.5603/rpor.99905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/18/2024] [Indexed: 08/16/2024] Open
Abstract
Background Facemasks accurately immobilise patients with head and neck cancer (HNC) receiving radiotherapy (RT). However, such masks are associated with treatment related distress, a prognostic factor for poorer survival. Open masks offer increased comfort and patient satisfaction. We investigated whether open masks could immobilise patients without affecting treatment accuracy. Materials and methods Over an 18-month period, all HNC RT patients with anxiety were offered open masks. Once 30 patients had completed treatment, set-up data was compared to patients in closed masks. The mean displacement and one-dimensional standard deviations (SD) of the mean, systematic and random set-up errors were calculated for translational directions: anterior-posterior (x), superior-inferior (y), medial-lateral (z). The mean and SD of the mean was calculated for rotational displacements. Mann-Whitney U was used to determine any significant differences between set-up data. Results Sixty patients were included (30 open & 30 closed masks). There was no statistically significant difference found in the x (p = 0.701), y (p = 0.246) or z (p = 0.535) direction for the SD of the mean displacements between both masks. No statistically significant difference was found in the SD of means for rotational displacements. The calculated planning target volume (PTV) margin requirements were minimally less for the closed masks 3.5, 2.6, and 2.7 mm (x, y, z, respectively) versus 4.2, 3.2, and 3.7 mm, respectively, for open masks. Conclusion Our study demonstrates that open masks maintain accuracy at levels comparable to closed masks in patients with anxiety. The minor difference in the calculated PTV margin could be rectified with daily on-line imaging or surface guided imaging.
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Affiliation(s)
| | | | - Bill Garrett
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Dean Harper
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Mary Dunne
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | | | - Fran Duane
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Orla McArdle
- St. Luke's Radiation Oncology Network, Dublin, Ireland
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Reitz D, Muecke J, da Silva Mendes V, Landry G, Reiner M, Niyazi M, Belka C, Freislederer P, Corradini S. Intrafractional monitoring of patients using four different immobilization mask systems for cranial radiotherapy. Phys Imaging Radiat Oncol 2022; 23:134-139. [PMID: 35958289 PMCID: PMC9361321 DOI: 10.1016/j.phro.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background and purpose Patients receiving cranial radiotherapy are immobilized with a thermoplastic mask to restrict patient motion. Depending on the target volume margins and treatment dose, different mask systems are used. Intrafractional movements can be monitored using stereoscopic X-ray imaging. The aim of the present work was to compare the magnitudes of intrafractional deviation for different mask systems. Material and methods Four different head mask systems (open face mask, open mask, stereotactic mask, double mask) used in the treatment of 40 patients were investigated. In total 487 treatment fractions and 3708 X-ray images were collected. Deviations were calculated by comparison of the acquired X-ray images with digitally reconstructed radiographs. The results of intrafractional X-ray deviations for translational and rotational axes were compared between the different mask systems. Results Deviations were below 0.6 mm for translations and below 0.6° for rotations for all mask systems. Along the lateral and longitudinal directions the stereotactic mask was superior, while along the vertical direction the double mask showed the lowest deviations. For low rotational deviations the double mask is the best amongst all other mask systems. Conclusion As expected, the lowest movement was shown using cranial stereotactic mask systems. The results have shown deviations lower than 0.6 mm and 0.6° using any of the four thermoplastic mask systems.
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Zhou S, Li J, Zhu X, Du Y, Yu S, Wang M, Yao K, Wu H, Yue H. Initial clinical experience of surface guided stereotactic radiation therapy with open-face mask immobilization for improving setup accuracy: a retrospective study. Radiat Oncol 2022; 17:104. [PMID: 35659685 PMCID: PMC9167505 DOI: 10.1186/s13014-022-02077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose To propose a specific surface guided stereotactic radiotherapy (SRT) treatment procedure with open-face mask immobilization and evaluate the initial clinical experience in improving setup accuracy. Methods and materials The treatment records of 48 SRT patients with head lesions were retrospectively analyzed. For each patient, head immobilization was achieved with a double-shell open-face mask. The anterior shell was left open to expose the forehead, nose, eyes and cheekbones. The exposed facial area was used as region-of-interest for surface tracking by AlignRT (VisionRT Inc, UK). The posterior shell provided a sturdy and personalized headrest. Patient initial setup was guided by 6DoF real-time deltas (RTD) using the reference surface obtained from the skin contour delineated on the planning CT images. The endpoint of initial setup was 1 mm in translational RTD and 1 degree in rotational RTD. CBCT guidance was performed to derive the initial setup errors, and couch shifts for setup correction were applied prior to treatment delivery. CBCT couch shifts, AlignRT RTD values, repositioning rate and setup time were analyzed. Results The absolute values of median (maximal) CBCT couch shifts were 0.4 (1.3) mm in VRT, 0.1 (2.5) mm in LNG, 0.2 (1.6) mm in LAT, 0.1(1.2) degree in YAW, 0.2 (1.4) degree in PITCH and 0.1(1.3) degree in ROLL. The couch shifts and AlignRT RTD values exhibited highly agreement except in VRT and PITCH (p value < 0.01), of which the differences were as small as negligible. We did not find any case of patient repositioning that was due to out-of-tolerance setup errors, i.e., 3 mm and 2 degree. The surface guided setup time ranged from 52 to 174 s, and the mean and median time was 97.72 s and 94 s respectively. Conclusions The proposed surface guided SRT procedure with open-face mask immobilization is a step forward in improving patient comfort and positioning accuracy in the same process. Minimized initial setup errors and repositioning rate had been achieved with reasonably efficiency for routine clinical practice.
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Affiliation(s)
- Shun Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Junyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Xianggao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Yi Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China. .,Institute of Medical Technology, Peking University Health Science Center, 38 Huayuan Road, Beijing, 100191, China.
| | - Songmao Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Meijiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Kaining Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China.,Institute of Medical Technology, Peking University Health Science Center, 38 Huayuan Road, Beijing, 100191, China
| | - Haizhen Yue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China.
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Impact of Cold Weather on Setup Errors in Radiotherapy. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1463299. [PMID: 34804444 PMCID: PMC8601798 DOI: 10.1155/2021/1463299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate the influence of cold weather on setup errors of patients with chest and pelvic disease in radiotherapy. Methods The image-guided data of the patients were collected from the Radiotherapy Center of Cancer Hospital Affiliated to Guangxi Medical University from October 2020 to February 2021. During this period, the cold weather days were December 15, 16, and 17, 2020, and January 7 and 8, 2021. For body fixation in radiotherapy, an integrated plate and a thermoplastic mold were employed in 18 patients with chest disease, while an integrated plate and a vacuum pad were applied in 19 patients with pelvic disease. All patients underwent cone beam computed tomography (CBCT) scans in the first five treatments and once a week thereafter. The obtained data were registered to the planning CT image to get the setup errors of the patient in the translational direction including X, Y, and Z axes and rotational direction including R X , R Y , and R Z . Then, the Mann-Whitney U test was performed. The expansion boundary values of the chest and pelvis were calculated according to the formula M PTV=2.5∑+0.7δ. Results A total of 286 eligible results of CBCT scans were collected. There were 138 chest CBCT scans, including 26 taken in cold weather and 112 in usual weather, and 148 pelvic CBCT scans, including 33 taken in cold weather and 115 in usual weather. The X-, Y-, and Z-axis translational setup errors of patients with chest disease in the cold weather group were 0.16 (0.06, 0.32) cm, 0.25 (0.17, 0.52) cm, and 0.35 (0.21, 0.47) cm, respectively, and those in the usual weather group were 0.14 (0.08, 0.29) cm, 0.23 (0.13, 0.37) cm, and 0.18 (0.1, 0.35) cm, respectively. The results indicated that there was a statistical difference in the Z-axis translational error between the cold weather group and the usual weather group (U = 935.5; p=0.005 < 0.05), while there was no statistical difference in the rotational error between the two groups. The external boundary values of X, Y, and Z axes in the cold weather group were 0.57 cm, 0.92 cm, and 0.99 cm, respectively, and those in the usual weather group were 0.57 cm, 0.78 cm, and 0.68 cm, respectively. There was no significant difference in the translational and rotational errors of patients with pelvic disease between the cold weather group and the usual weather group (p < 0.05). The external boundary values of X, Y, and Z axes were 0.63 cm, 0.79 cm, and 0.68 cm in the cold weather group and 0.61 cm, 0.79 cm, and 0.61 cm in the usual weather group, respectively. Conclusion The setup error of patients undergoing radiotherapy with their bodies fixed by an integrated plate and a thermoplastic mold was greater in cold weather than in usual weather, especially in the ventrodorsal direction.
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