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• W2088094907 abstract "Purpose/Objective(s)Patient movement during the delivery of frameless Stereotactic Radiation therapy (SRT) can be a source for errors. Silverman head rests and thermoplastic masks are the conventional method of immobilization. Although the intrafraction image guidance system corrects for patient movement prior to delivery of the beam, patient movement after imaging can be a source of errors during beam delivery and cause inefficiency which lengthens treatment for individual patients. We conducted a study using customized head cushions (HC), in addition to the standard immobilization for patients receiving intracranial SRS to determine if this would help reduce patient movement.Materials/MethodsCK correction logs of 86 consecutive patients treated with 245 fractions of frameless SRT for intracranial lesions between Sept 2010 and Oct 2011 were extracted using TFDL software. Data regarding intrafraction imaging, translation and rotation corrections, couch shifts and e-stops were extracted from the logs using customized in house program and analysed using statistical software. The nonparametric Mann-Whitney U test was used to detect differences in the medians.ResultsTwenty-seven patients (102 fractions) had SRT using the HC and 59 patients (143 fractions) were treated without it. Addition of the HC reduced the median number of couch shifts required per fraction from 10 to 7 (p = 0.00042). The reduction persisted even if the initial setup shifts (4 to 2; p = 0.0043) and the shifts prior to path changes were eliminated (1 to 0; p = 0.037). Use of the HC reduced translation along the long axis of the couch (Std dev Y: 0.18 to 0.13mm; p = 0.000013); there was trend to reduction in translations in the other 2 directions but this did not reach statistical significance. The median no. of imaging X-rays/fraction was reduced from 144 to 139 (p = 0.031). The mean no. of e-stops were also reduced from 0.98 to 0.66 but this difference did not reach significance (p = 0.27).ConclusionA customized inexpensive HC has become the standard of care in our department as it reduced intrafraction patient motion and imaging frequency, improving overall treatment efficiency. Further research to determine a margin recipe for these treatments from this data is underway. This could have implications for cranial immobilization in other radiation delivery systems which do not have intrafraction image guidance. Purpose/Objective(s)Patient movement during the delivery of frameless Stereotactic Radiation therapy (SRT) can be a source for errors. Silverman head rests and thermoplastic masks are the conventional method of immobilization. Although the intrafraction image guidance system corrects for patient movement prior to delivery of the beam, patient movement after imaging can be a source of errors during beam delivery and cause inefficiency which lengthens treatment for individual patients. We conducted a study using customized head cushions (HC), in addition to the standard immobilization for patients receiving intracranial SRS to determine if this would help reduce patient movement. Patient movement during the delivery of frameless Stereotactic Radiation therapy (SRT) can be a source for errors. Silverman head rests and thermoplastic masks are the conventional method of immobilization. Although the intrafraction image guidance system corrects for patient movement prior to delivery of the beam, patient movement after imaging can be a source of errors during beam delivery and cause inefficiency which lengthens treatment for individual patients. We conducted a study using customized head cushions (HC), in addition to the standard immobilization for patients receiving intracranial SRS to determine if this would help reduce patient movement. Materials/MethodsCK correction logs of 86 consecutive patients treated with 245 fractions of frameless SRT for intracranial lesions between Sept 2010 and Oct 2011 were extracted using TFDL software. Data regarding intrafraction imaging, translation and rotation corrections, couch shifts and e-stops were extracted from the logs using customized in house program and analysed using statistical software. The nonparametric Mann-Whitney U test was used to detect differences in the medians. CK correction logs of 86 consecutive patients treated with 245 fractions of frameless SRT for intracranial lesions between Sept 2010 and Oct 2011 were extracted using TFDL software. Data regarding intrafraction imaging, translation and rotation corrections, couch shifts and e-stops were extracted from the logs using customized in house program and analysed using statistical software. The nonparametric Mann-Whitney U test was used to detect differences in the medians. ResultsTwenty-seven patients (102 fractions) had SRT using the HC and 59 patients (143 fractions) were treated without it. Addition of the HC reduced the median number of couch shifts required per fraction from 10 to 7 (p = 0.00042). The reduction persisted even if the initial setup shifts (4 to 2; p = 0.0043) and the shifts prior to path changes were eliminated (1 to 0; p = 0.037). Use of the HC reduced translation along the long axis of the couch (Std dev Y: 0.18 to 0.13mm; p = 0.000013); there was trend to reduction in translations in the other 2 directions but this did not reach statistical significance. The median no. of imaging X-rays/fraction was reduced from 144 to 139 (p = 0.031). The mean no. of e-stops were also reduced from 0.98 to 0.66 but this difference did not reach significance (p = 0.27). Twenty-seven patients (102 fractions) had SRT using the HC and 59 patients (143 fractions) were treated without it. Addition of the HC reduced the median number of couch shifts required per fraction from 10 to 7 (p = 0.00042). The reduction persisted even if the initial setup shifts (4 to 2; p = 0.0043) and the shifts prior to path changes were eliminated (1 to 0; p = 0.037). Use of the HC reduced translation along the long axis of the couch (Std dev Y: 0.18 to 0.13mm; p = 0.000013); there was trend to reduction in translations in the other 2 directions but this did not reach statistical significance. The median no. of imaging X-rays/fraction was reduced from 144 to 139 (p = 0.031). The mean no. of e-stops were also reduced from 0.98 to 0.66 but this difference did not reach significance (p = 0.27). ConclusionA customized inexpensive HC has become the standard of care in our department as it reduced intrafraction patient motion and imaging frequency, improving overall treatment efficiency. Further research to determine a margin recipe for these treatments from this data is underway. This could have implications for cranial immobilization in other radiation delivery systems which do not have intrafraction image guidance. A customized inexpensive HC has become the standard of care in our department as it reduced intrafraction patient motion and imaging frequency, improving overall treatment efficiency. Further research to determine a margin recipe for these treatments from this data is underway. This could have implications for cranial immobilization in other radiation delivery systems which do not have intrafraction image guidance." @default.
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• W2088094907 date "2012-11-01" @default.
• W2088094907 modified "2023-09-26" @default.
• W2088094907 title "Customized Head Cushions Reduce Patient Movement During Intracranial Radiosurgery" @default.
• W2088094907 doi "https://doi.org/10.1016/j.ijrobp.2012.07.1922" @default.
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