POL Scientific / JBM / Volume 11 / Issue 3 / DOI: 10.14440/jbm.2024.0047
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RESEARCH ARTICLE

Evaluation of positioning accuracy in head-and-neck cancer treatment: A cone beam computed tomography assessment of three immobilization devices with volumetric modulated arc therapy

Noor Mail1,2* ,  Khalid M. Alshamrani1,3,4 ,  Rab Nawaz Lodhi1,4 ,  Eman Khawandanh1,4 ,  Amani Saleem1,4 ,  Batoor Khan5 ,  Majed Alghamdi1,4 ,  Mohammed Nadershah6 ,  Majid S. Althaqafy1,3,4 ,  Ahmed Subahi1,4,7 ,  Suliman M. Alghamdi1,4
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1 Ministry of the National Guard - Health Affairs, Jeddah, Saudi Arabia
2 Radiation Oncology Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
3 College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
4 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
5 Department of Life Sciences, University of Toronto Mississauga, Mississauga, Canada
6 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
7 College of Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
JBM 2024 , 11(3), e99010025; https://doi.org/10.14440/jbm.2024.0047
Submitted: 29 July 2024 | Revised: 21 August 2024 | Accepted: 27 August 2024 | Published: 12 September 2024
© 2024 by the Journal of Biological Methods published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

In this study, we assessed the precision and repeatability of the daily patient positioning for three distinct immobilization devices used for head-and-neck patients undergoing RapidArc radiation therapy using cone beam computed tomography (CBCT). An analysis was conducted on the accuracy of patient setup for three distinct immobilization devices, resulting in 1204 CBCT images for 189 patients in total. Using a typical posifix supine headrest and five fixation point podcast-plus-thermoplastic masks, the first group of 39 patients (125 CBCTs) was immobilized. The identical method was used to immobilize the second group of 19 patients (158 CBCTs) in the same posture (supine), and AccuFormTM custom headrests were employed as an added measure. Over 65% of the patients in the third group had a double shell positioning system (DSPS) covering their entire head and neck. Patient-alignment-accuracy or couch shifts in the vertical, longitudinal, and lateral directions from CT-CBCT fusions were recorded from ARIA. Our results showed that in 90% of the anteriorposterior (AP), 90% of the superior-inferior (SI), and 92.7% of the right-left (RL) population in the first group, patient-alignment-accuracy or couch shifts were within 2 mm. For 99.4% (AP), 100% (SI), and 98.7% (RL) of the second group’s total population, patient-alignment-accuracy was within 2 mm. In the third group, it was within 2 mm for 92.1% (AP), ~89% (SI), and 93.3% (RL) of the total population. In conclusion, a significant improvement was seen with the application of a mouth bite and a tailored backrest cushion to the five fixation point posicast mask. In addition, significant improvement in the alignment of the lower neck area was observed with the use of DSPS. Virtually 100% of the head-and-neck patients were aligned within an accuracy of 3 mm, which is the PTV margin in our department.

Keywords
Radiotherapy
RapidArc
Immobilization
Head-and-neck tumor
Patient-setup
Mask system
Radiation Oncology
Funding
None.
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Conflict of interest
The authors declare no conflict of interest.
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Journal of Biological Methods, Electronic ISSN: 2326-9901 Print ISSN: TBA, Published by POL Scientific
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