Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T04:52:14.219Z Has data issue: false hasContentIssue false
  • English
  • Français

Prone belly board device training improves geometric setup accuracy in lower GI radiotherapy

Published online by Cambridge University Press:  28 August 2013

S. Goldsworthy  and
S. McGrail
S. Goldsworthy*
Affiliation:
Radiotherapy, The Beacon Centre, Musgrove Park Hospital Taunton, Somerset, UK
S. McGrail
Affiliation:
Radiotherapy, The Beacon Centre, Musgrove Park Hospital Taunton, Somerset, UK
*
Correspondence to: Simon Goldsworthy, MSc (RT), Radiotherapy, Beacon Cancer Centre, Taunton, Somerset, Taunton, Somerset, United Kingdom. Tel: 01823344234. E-mail: simon.goldsworthy@tst.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Patients having a course of radiotherapy (RT) must be appropriately immobilised for stability and accuracy. Having opened a new cancer service in June 2009 and commenced treating lower gastrointestinal cancers in 2010, a prone belly board device (BBD) was introduced as the standard radiotherapy immobilisation. A training package was created to aid clinical skills retention of therapeutic radiographers and manage setup quality. Setup reproducibility using the BBD was retrospectively assessed with electronic portal image (EPI) verified geometric displacements as the main outcome measure both before and after the introduction of training.

Method

Twenty retrospective Pinnacle computed tomography-planned patients and their geometric displacements on treatment were evaluated between 2010 and 2011—ten prior to (Patient Group A) and ten following training (Patient Group B). The only inclusion criterion was that patients were immobilised for RT on the Medtec ContouraTM carbon fibre BBD. Patients were prone and were treated to 45–50·4 Gy in 25–28 fractions on a 6–10 MV LinAc equipped with EPI. Reproducibility was assessed by comparing geometric measurement of the bony pelvis on the Pinnacle digitally reconstructed radiograph (DRR) with an EPI captured at day 0, 1, 2 and weekly during treatment for each patient. Systematic and random errors were analysed with respect to the average geometric displacement with standard deviation per patient between the Pinnacle DRR and the EPI.

Results

The age range was 41–77 years and there were 15 male and five female patients with diagnosed rectal cancers (T3–T4, N0–N2, M0). Three hundred and seventy one images were analysed. An improvement in population systematic and random error was most notable in the superior–inferior direction (Patient Group A Σpop = 3·1 mm, σpop = 3·6 mm to Patient Group B Σpop = 2·0 mm, σpop = 2·3 mm, respectively).

Discussion/Conclusion

There is evidence that the use of the BBD is more reproducible when accompanied by a task-specific training package. Based on the results of this study, further work will be carried out on training standardisation for patient positioning with a BBD for reducing systematic and random geometric displacements.

Keywords

belly boardbelly board trainingimmobilisationlower GI radiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 3 , September 2014 , pp. 302 - 309
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kapiteijn, E, Marijnen, C, Nagtegaal, Iet al. Preperative radiotherapy combined with total mesorectal excision for respectable rectal cancer. N Engl J Med 2001; 345: 638–646.CrossRefGoogle Scholar
2.National Institute for Clinical Excellence. Improving Outcomes in Colorectal Cancers: Research Evidence for the Manual Update, NICE Good Practice Guidance for Commissioning Cancer Services, London, UK, 2004: 235.Google Scholar
3.Glimelius, B. Radiotherapy in rectal cancer. Br Med Bull 2002; 64 (1): 141–157.CrossRefGoogle ScholarPubMed
4.Dobbs, J, Barratt, A, Morris, S, Roques, T. Practical Radiotherapy Planning, 4th edition. Hodder Arnold: UK, 2009.Google Scholar
5.Koelbl, O, Vordermark, D, Flentje, M. The relationship between belly board position and patient anatomy and its influence on dose–volume histogram of small bowel for post-operative radiotherapy of rectal cancer. Radiother Oncol 2003; 67: 345–349.CrossRefGoogle Scholar
6.van Herk, M. Errors and margins in radiotherapy. Radiat Oncol 2004; 14: 52–64.CrossRefGoogle ScholarPubMed
7.The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine. On Target: Ensuring Geometric Accuracy in Radiotherapy. London: The Royal College of Radiologists, 2008: 11–14.Google Scholar
8.Valentini, V, Beets-Tan, R, Boras, Jet al. Evidence and research in rectal cancer. Radiother Oncol 2008; 97: 449–474.CrossRefGoogle Scholar
9.Brecevic, E, Leighton, C, Fisher, Bet al. Does radiation dose escalation improve outcome in stage II-III rectal cancer? Gastrointestinal Cancers Symposium 2004, Abstract No. 254.Google Scholar
10.Roels, S, Verstraete, J, Haustermans, K. Setup verification on a belly board device using electronic portal imaging. J Radiother Pract 2007; 6: 73–82.CrossRefGoogle Scholar
11.Olofsen-van Acht, M, van den Berg, H, Quint, Set al. Reduction of irradiated small bowel volume and accurate patient positioning by use of a bellyboard device in pelvic radiotherapy of gynecological cancer patients. Radiother Oncol 2001; 59: 87–93.CrossRefGoogle ScholarPubMed
12.Robertson, J, Campbell, J, Yan, D. Generic planning target margin for rectal cancer treatment setup variation. Int J Radiat Oncol Biol Phys 2009; 74 (5): 1470–1475.CrossRefGoogle ScholarPubMed
13.Kasabasic, M, Ivkovic, A, Jurkovic, S, Belaj, N. Rotation of the sacrum during bellyboard pelvic radiotherapy. Med Dosim 2009; 35: 28–30.CrossRefGoogle ScholarPubMed
14.Stewart, D, MacLure, K, George, J. Educating non-medical prescribers. Br J Clin Pharmacol 2012, http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2012.04204.x. Accessed on 15th July 2012.CrossRefGoogle Scholar
15.Routsis, D, Staffurth, J, Beardmore, C, MacKay, R. Education and training for intensity-modulated radiotherapy in the UK. Clin Oncol 2010; 22 (8): 675–680.CrossRefGoogle ScholarPubMed
16.Dean, J, Routsis, D. Training needs of radiographers for implementing tomotherapy in NHS practice. J Radiother Pract 2010; 9 (3): 129–130.CrossRefGoogle Scholar
17.Burnet, N, Adams, E, Fairfoul, Jet al. Practical aspects of implementation of helical tomotherapy for intensity-modulated image-guided radiotherapy. Clin Oncol 2010; 22: 294–312.CrossRefGoogle Scholar
18.Woollard, M, Whitfield, R, Newcombe, R, Colquhoun, M, Vetter, N, Chamberlain, D. Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial. Resuscitation 2006; 71 (2): 237–247.CrossRefGoogle ScholarPubMed
19.Stefanidis, D, Acker, C, Todd Henniford, B. Proficiency-based laparoscopic simulator training leads to improved operating room skill that is resistant to decay. Surg Innov 2008; 15 (1): 69–73.CrossRefGoogle ScholarPubMed
20.Kahol, K, Ashby, A, Smith, M, Ferarra, J. Quantitative evaluation of retention of surgical skills learned in simulation. J Surg Educ 2010; 67 (6): 421–426.CrossRefGoogle ScholarPubMed
21.Mashaud, L, Castellvi, A, Hollett, L, Hogg, D, Tesfay, S, Scott, D. Two-year skill retention and certification exam performance after fundamentals of laparoscopic skills training and proficiency maintenance. Surgery 2010; 148 (2): 194–201.CrossRefGoogle ScholarPubMed