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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| Vydáno v: | Journal of applied clinical medical physics Ročník 19; číslo 1; s. 17 - 24 |
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| Hlavní autoři: | , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
John Wiley & Sons, Inc
01.01.2018
John Wiley and Sons Inc |
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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. 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. 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. |
| 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 |
| License | Attribution http://creativecommons.org/licenses/by/4.0 2017 UT Southwestern. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
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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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| 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 |
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