Minimal mask immobilization with optical surface guidance for head and neck radiotherapy

Purpose Full face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck ma...

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Veröffentlicht in:Journal of applied clinical medical physics Jg. 19; H. 1; S. 17 - 24
Hauptverfasser: Zhao, Bo, Maquilan, Genevieve, Jiang, Steve, Schwartz, David L.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States John Wiley & Sons, Inc 01.01.2018
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ISSN:1526-9914, 1526-9914
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Abstract Purpose Full face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance. Methods Twenty patients enrolled onto this IRB‐approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard‐of‐care IMRT to 60–70 Gy in 30–33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in‐room CBCT. Following six‐dimensional robotic couch correction, a new optical real‐time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self‐administered surveys. Results Setup error was measured as six‐dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were −0.51 ± 2.42 mm, −0.49 ± 3.30 mm, 0.23 ± 2.58 mm, −0.15 ± 1.01o, −0.02 ± 1.19o, and 0.06 ± 1.08o, respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface‐guided treatment was confirmed on patient surveys. Conclusion These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow‐up validation, with direct comparison to standard mask immobilization, appears warranted.
AbstractList Purpose Full face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance. Methods Twenty patients enrolled onto this IRB‐approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard‐of‐care IMRT to 60–70 Gy in 30–33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in‐room CBCT. Following six‐dimensional robotic couch correction, a new optical real‐time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self‐administered surveys. Results Setup error was measured as six‐dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were −0.51 ± 2.42 mm, −0.49 ± 3.30 mm, 0.23 ± 2.58 mm, −0.15 ± 1.01o, −0.02 ± 1.19o, and 0.06 ± 1.08o, respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface‐guided treatment was confirmed on patient surveys. Conclusion These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow‐up validation, with direct comparison to standard mask immobilization, appears warranted.
Full face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance.PURPOSEFull face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance.Twenty patients enrolled onto this IRB-approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard-of-care IMRT to 60-70 Gy in 30-33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in-room CBCT. Following six-dimensional robotic couch correction, a new optical real-time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self-administered surveys.METHODSTwenty patients enrolled onto this IRB-approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard-of-care IMRT to 60-70 Gy in 30-33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in-room CBCT. Following six-dimensional robotic couch correction, a new optical real-time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self-administered surveys.Setup error was measured as six-dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were -0.51 ± 2.42 mm, -0.49 ± 3.30 mm, 0.23 ± 2.58 mm, -0.15 ± 1.01o , -0.02 ± 1.19o , and 0.06 ± 1.08o , respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface-guided treatment was confirmed on patient surveys.RESULTSSetup error was measured as six-dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were -0.51 ± 2.42 mm, -0.49 ± 3.30 mm, 0.23 ± 2.58 mm, -0.15 ± 1.01o , -0.02 ± 1.19o , and 0.06 ± 1.08o , respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface-guided treatment was confirmed on patient surveys.These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow-up validation, with direct comparison to standard mask immobilization, appears warranted.CONCLUSIONThese pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow-up validation, with direct comparison to standard mask immobilization, appears warranted.
Full face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance. Twenty patients enrolled onto this IRB-approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard-of-care IMRT to 60-70 Gy in 30-33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in-room CBCT. Following six-dimensional robotic couch correction, a new optical real-time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self-administered surveys. Setup error was measured as six-dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were -0.51 ± 2.42 mm, -0.49 ± 3.30 mm, 0.23 ± 2.58 mm, -0.15 ± 1.01 , -0.02 ± 1.19 , and 0.06 ± 1.08 , respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface-guided treatment was confirmed on patient surveys. These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow-up validation, with direct comparison to standard mask immobilization, appears warranted.
PurposeFull face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance.MethodsTwenty patients enrolled onto this IRB‐approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard‐of‐care IMRT to 60–70 Gy in 30–33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in‐room CBCT. Following six‐dimensional robotic couch correction, a new optical real‐time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self‐administered surveys.ResultsSetup error was measured as six‐dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were −0.51 ± 2.42 mm, −0.49 ± 3.30 mm, 0.23 ± 2.58 mm, −0.15 ± 1.01o, −0.02 ± 1.19o, and 0.06 ± 1.08o, respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface‐guided treatment was confirmed on patient surveys.ConclusionThese pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow‐up validation, with direct comparison to standard mask immobilization, appears warranted.
Author Maquilan, Genevieve
Jiang, Steve
Zhao, Bo
Schwartz, David L.
AuthorAffiliation 1 Department of Radiation Oncology The University of Texas Southwestern Medical Center Dallas TX USA
2 Department of Radiation Oncology University of Tennessee Health Science Center‐West Cancer Center Memphis TN USA
AuthorAffiliation_xml – name: 1 Department of Radiation Oncology The University of Texas Southwestern Medical Center Dallas TX USA
– name: 2 Department of Radiation Oncology University of Tennessee Health Science Center‐West Cancer Center Memphis TN USA
Author_xml – sequence: 1
  givenname: Bo
  surname: Zhao
  fullname: Zhao, Bo
  organization: The University of Texas Southwestern Medical Center
– sequence: 2
  givenname: Genevieve
  surname: Maquilan
  fullname: Maquilan, Genevieve
  organization: The University of Texas Southwestern Medical Center
– sequence: 3
  givenname: Steve
  surname: Jiang
  fullname: Jiang, Steve
  organization: The University of Texas Southwestern Medical Center
– sequence: 4
  givenname: David L.
  surname: Schwartz
  fullname: Schwartz, David L.
  email: dschwar4@uthsc.edu
  organization: University of Tennessee Health Science Center‐West Cancer Center
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29119677$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2017 UT Southwestern. published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.
2017 UT Southwestern. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.
2018. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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Keywords SGRT
head and neck
immobilization
interfraction motion
intrafraction motion
image guidance
Language English
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2017 UT Southwestern. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.
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Bo Zhao and Genevieve Maquilan contributed equally to this study
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Snippet Purpose Full face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable...
Full face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and...
PurposeFull face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable...
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StartPage 17
SubjectTerms Adult
Aged
Aged, 80 and over
Biopsy
Cancer therapies
Feasibility Studies
Head & neck cancer
head and neck
Head and Neck Neoplasms - diagnostic imaging
Head and Neck Neoplasms - radiotherapy
Humans
image guidance
Image Processing, Computer-Assisted - methods
immobilization
Immobilization - methods
interfraction motion
intrafraction motion
Medical imaging
Middle Aged
Oncology
Organs at Risk - radiation effects
Patient Positioning
Patients
Phantoms, Imaging
Radiation Oncology Physics
Radiation therapy
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy Setup Errors - prevention & control
Radiotherapy, Image-Guided - methods
Radiotherapy, Intensity-Modulated - methods
SGRT
Skin
Tomography, X-Ray Computed - methods
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Title Minimal mask immobilization with optical surface guidance for head and neck radiotherapy
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Facm2.12211
https://www.ncbi.nlm.nih.gov/pubmed/29119677
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Volume 19
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