A comparison of four patient immobilization devices in the treatment of prostate cancer patients with three dimensional conformal radiotherapy

Paul Y. Song, Maxine Washington, Florin Vaida, Russell J Hamilton, Danny Spelbring, Brenda Wyman, Joanne Harrison, George T Y Chen, Srinivasan Vijayakumar

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Purpose: To determine the variability of patient positioning during three- dimensional conformal radiotherapy (3D-CRT) for prostate cancer treated with no immobilization or one of four immobilization devices, and to determine the effects of patient body habitus and pelvic circumference on patient movement with each individual immobilization technique. Methods and Materials: To see whether our immobilization techniques have improved day-to-day patient movement, a retrospective analysis was carried out. A total of 62 patients treated at one facility on a single machine with 3D-CRT via a four-field box technique (anterior-pesterior and opposed laterals) in the supine position with either no immobilization or one of four immobilization devices. Five groups of patients were compared: (a) group 1-no immobilization; (b) group 2- alpha cradle from the waist to upper thigh; (c) group 3-alpha cradle from waist to below the knees; (d) group 4-styrofoam leg immobilizer (below knees); and (e) group 5-aquaplast cast encompassing the entice abdomen and pelvis to midthigh with alpha cradle immobilization to their lower legs and feet. Prior to starting radiotherapy, portal films of all four treatment fields were obtained 1 day before treatment. Subsequently, portal films were then obtained at least once a week. Portal films were compared with the simulation films and appropriate changes were made and verified on the next day prior to treatment. A deviation of greater than 0.5 cm or greater was considered to be clinically significant in our analysis. We studied the difference among the types of immobilization and no immobilization by looking at the frequency of movements (overall, and on each of the three axes) that a patient had during the course of his treatment. Using a logistic regression model, the probability of overall and individual directional movement for each group was obtained. In addition, the effects of patient body habitus and pelvic circumference on movement were analyzed. Results: The maximum deviation was 2 cm and the median deviation was 1.2 cm. For each patient, the probability of movement ranged from 0 to 76%, with a mean of 39%. There was no significant difference seen in overall movement with any of the immobilization devices compared to no immobilization, but there was less vertical (9 vs. 18%; p = 0.03) and AP (6 vs. 15%; p = 0.14) movement with the aquaplast than any other group. However, when examining the lateral direction, the aquaplast had significantly more movement (32 vs. 9%; p < 0.001). When accounting for body habitus and pelvic circumference, no immobilization device was effective in reducing movement in obese patients or in patients with pelvic circumference greater than 105 cm. The aquaplast group had a significantly increased amount of lateral movement with obesity (42 vs. 23%; p < 0.05), and with pelvic circumference >105 cm (33 vs. 29%; p < 0.05). Conclusions: There was no significant reduction in overall patient movement noted with any of the immobilization devices compared to no immobilization. The aquaplast group had reduced vertical and AP movement of greater than 0.5 cm. There was significantly more lateral movement with aquaplast appreciated in obese patients or patients with pelvic circumferences greater than 105 cm. The aquaplast immobilization appears to be useful in reducing movement in two very clinically important dimensions (AP and vertical). Despite our findings, other immobilization may still be useful especially in the treatment of nonobese patients. It is clear that the optimal immobilization technique and patient positioning are yet to be determined.

Original languageEnglish (US)
Pages (from-to)213-219
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume34
Issue number1
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

Fingerprint

Conformal Radiotherapy
immobilization
Immobilization
radiation therapy
Prostatic Neoplasms
cancer
Equipment and Supplies
Carboxymethylcellulose Sodium
Therapeutics
circumferences
Patient Positioning
deviation
positioning
Leg
Knee
Logistic Models
supine position
thigh
Vertical Dimension
abdomen

Keywords

  • Aquaplast
  • Immobilization
  • Patient motion
  • Prostate cancer
  • Three-dimensional conformal radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

A comparison of four patient immobilization devices in the treatment of prostate cancer patients with three dimensional conformal radiotherapy. / Song, Paul Y.; Washington, Maxine; Vaida, Florin; Hamilton, Russell J; Spelbring, Danny; Wyman, Brenda; Harrison, Joanne; Chen, George T Y; Vijayakumar, Srinivasan.

In: International Journal of Radiation Oncology Biology Physics, Vol. 34, No. 1, 01.01.1996, p. 213-219.

Research output: Contribution to journalArticle

Song, Paul Y. ; Washington, Maxine ; Vaida, Florin ; Hamilton, Russell J ; Spelbring, Danny ; Wyman, Brenda ; Harrison, Joanne ; Chen, George T Y ; Vijayakumar, Srinivasan. / A comparison of four patient immobilization devices in the treatment of prostate cancer patients with three dimensional conformal radiotherapy. In: International Journal of Radiation Oncology Biology Physics. 1996 ; Vol. 34, No. 1. pp. 213-219.
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AU - Song, Paul Y.

AU - Washington, Maxine

AU - Vaida, Florin

AU - Hamilton, Russell J

AU - Spelbring, Danny

AU - Wyman, Brenda

AU - Harrison, Joanne

AU - Chen, George T Y

AU - Vijayakumar, Srinivasan

PY - 1996/1/1

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N2 - Purpose: To determine the variability of patient positioning during three- dimensional conformal radiotherapy (3D-CRT) for prostate cancer treated with no immobilization or one of four immobilization devices, and to determine the effects of patient body habitus and pelvic circumference on patient movement with each individual immobilization technique. Methods and Materials: To see whether our immobilization techniques have improved day-to-day patient movement, a retrospective analysis was carried out. A total of 62 patients treated at one facility on a single machine with 3D-CRT via a four-field box technique (anterior-pesterior and opposed laterals) in the supine position with either no immobilization or one of four immobilization devices. Five groups of patients were compared: (a) group 1-no immobilization; (b) group 2- alpha cradle from the waist to upper thigh; (c) group 3-alpha cradle from waist to below the knees; (d) group 4-styrofoam leg immobilizer (below knees); and (e) group 5-aquaplast cast encompassing the entice abdomen and pelvis to midthigh with alpha cradle immobilization to their lower legs and feet. Prior to starting radiotherapy, portal films of all four treatment fields were obtained 1 day before treatment. Subsequently, portal films were then obtained at least once a week. Portal films were compared with the simulation films and appropriate changes were made and verified on the next day prior to treatment. A deviation of greater than 0.5 cm or greater was considered to be clinically significant in our analysis. We studied the difference among the types of immobilization and no immobilization by looking at the frequency of movements (overall, and on each of the three axes) that a patient had during the course of his treatment. Using a logistic regression model, the probability of overall and individual directional movement for each group was obtained. In addition, the effects of patient body habitus and pelvic circumference on movement were analyzed. Results: The maximum deviation was 2 cm and the median deviation was 1.2 cm. For each patient, the probability of movement ranged from 0 to 76%, with a mean of 39%. There was no significant difference seen in overall movement with any of the immobilization devices compared to no immobilization, but there was less vertical (9 vs. 18%; p = 0.03) and AP (6 vs. 15%; p = 0.14) movement with the aquaplast than any other group. However, when examining the lateral direction, the aquaplast had significantly more movement (32 vs. 9%; p < 0.001). When accounting for body habitus and pelvic circumference, no immobilization device was effective in reducing movement in obese patients or in patients with pelvic circumference greater than 105 cm. The aquaplast group had a significantly increased amount of lateral movement with obesity (42 vs. 23%; p < 0.05), and with pelvic circumference >105 cm (33 vs. 29%; p < 0.05). Conclusions: There was no significant reduction in overall patient movement noted with any of the immobilization devices compared to no immobilization. The aquaplast group had reduced vertical and AP movement of greater than 0.5 cm. There was significantly more lateral movement with aquaplast appreciated in obese patients or patients with pelvic circumferences greater than 105 cm. The aquaplast immobilization appears to be useful in reducing movement in two very clinically important dimensions (AP and vertical). Despite our findings, other immobilization may still be useful especially in the treatment of nonobese patients. It is clear that the optimal immobilization technique and patient positioning are yet to be determined.

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KW - Aquaplast

KW - Immobilization

KW - Patient motion

KW - Prostate cancer

KW - Three-dimensional conformal radiotherapy

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