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Development of an Immobilization Device for Total Marrow Irradiation

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  • Pietro Mancosu, Humanitas University
  • ,
  • Pierina Navarria, Humanitas University
  • ,
  • Ludvig Paul Muren
  • Luca Castagna, Humanitas University
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  • Giacomo Reggiori, Humanitas University
  • ,
  • Elena Clerici, Humanitas University
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  • Barbara Sarina, Humanitas University
  • ,
  • Stefania Bramanti, Humanitas University
  • ,
  • Chiara De Philippis, Humanitas University
  • ,
  • Stefano Tomatis, Humanitas University
  • ,
  • Armando Santoro, Humanitas University
  • ,
  • Marta Scorsetti, Humanitas University

Purpose: A body frame dedicated to total marrow (lymph node) irradiation (TMI/TMLI) could minimize patient motion during the potentially extended beam-on time with this technique. We present the development of a dedicated immobilization system for TMI/TMLI using volumetric modulated arc therapy. Methods and Materials: Since 2010, 59 adult patients were treated with TMI/TMLI using a multi-isocenter volumetric modulated arc therapy technique. Two computed tomographies (CTs) were required (1 head-first supine and 1 feet-first supine) to cover the whole volume. For the first 10 patients, 2 standard commercial frames with personalized masks (with/without personalized vacuum cushion for the lower extremities) were used without specific interfixation (frame A). For the next 49 patients a homemade 3-frame immobilization system was adopted (frame B), where each frame was interlocked with the next one and thermoplastic masks used to fix the patient. The effectiveness of the 2 immobilization systems was assessed by offline/online matching between daily cone beam CT of each isocenter and the simulation CTs. Results: Mean offline shifts for frame A were 3 to 12 mm in anterior–posterior, 2 to 5 mm in cranilal–caudal, and 2 to 6 mm in left–right directions. Larger shifts were found for feet-first supine series (shifts up to 23 mm). In frame B, mean offline shifts were 1 to 4 mm in anterior–posterior, 1 to 4 mm in cranial–caudal, and 1 to 4 mm in left–right directions. Mean online adjustments were –1 ± 4 mm in anterior–posterior, 0 ± 2 mm in cranial–caudal, and 0 ± 4 mm in left–right directions. Conclusions: The patient positioning shifts for TMI/TMLI irradiation were mitigated by a homemade immobilization system and the use of individualized masks.

Original languageEnglish
JournalPractical Radiation Oncology
Pages (from-to)e98-e105
Number of pages8
Publication statusPublished - Jan 2021

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