Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Abstract

Prone positioning for whole-breast irradiation (WBI) reduces dose to organs at risk, but reduces set-up speed, precision, and comfort. We aimed to improve these problems by placing patients in prone crawl position on a newly developed crawl couch (CrC). A group of 10 right-sided breast cancer patients requiring WBI were randomized in this cross-over trial, comparing the CrC to a standard prone breastboard (BB). Laterolateral (LL), craniocaudal (CC) and anterioposterior (AP) set-up errors were evaluated with cone beam CT. Comfort, preference and set-up time (SUT) were assessed. Forty left and right-sided breast cancer patients served as a validation group. For BB versus CrC, AP, LL and CC mean patient shifts were − 0.8 ± 2.8, 0.2 ± 11.7 and − 0.6 ± 4.4 versus − 0.2 ± 3.3, − 0.8 ± 2.5 and − 1.9 ± 5.7 mm. LL shift spread was reduced significantly. Nine out of 10 patients preferred the CrC. SUT did not differ significantly. The validation group had mean patient shifts of 1.7 ± 2.9 (AP), 0.2 ± 3.6 (LL) and − 0.2 ± 3.3 (CC) mm. Mean SUT in the validation group was 1 min longer (P < 0.05) than the comparative group. Median SUT was 3 min in all groups. The CrC improved precision and comfort compared to BB. Set-up errors compare favourably to other prone-WBI trials and rival supine positioning.

Impact of Cold Weather on Setup Errors in Radiotherapy

“…Shen et al [20] designed a new breast vacuum bag to obtain the M PTV boundary values of 0.44 cm, 0.31 cm, and 0.38 cm required for X, Y, and Z, respectively, which were smaller than those obtained in this study. Deseyne et al [21] used a modified prone breastplate to obtain the M PTV boundary values of 1.14 cm, 1.21 cm, and 1.0 cm required for X, Y, and Z, respectively, which were greater than those obtained in this study. Cravo Sá A et al [22] employed 3D surface image guidance to achieve the expanded M PTV boundary values of 0.89 cm, 10.4 cm, and 0.93 cm required for X, Y, and Z, respectively, which were greater than the values in the usual weather group and similar to those in the cold weather group in this study.…”

A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

“…For prone positioning, there is a problem about postural repeatability. Although Deseyne et al 42 demonstrated that a newly developed crawl couch could improve precision and comfort and reduce set-up errors compared to the standard prone breast board in prone-WBI. Lakosi et al 43 analyzed respiratory motion of surgical clips, chest wall (CW) and the anterior displacement of the heart, results showed that prone position significantly reduced respiration related CW and surgical clip movements but increased anterior heart displacement.…”

Prone versus supine free-breathing for right-sided whole breast radiotherapy

“…The concept of prone radiotherapy is simple—in prone setup, the breast hangs down from the chest wall through an aperture on the support couch, facilitating avoidance of intrathoracic organs with radiation tangential fields—but the implementation is not. It requires the full radiation team to collaborate on many levels, to address the challenges of implementing prone setup that include, among other: comfort of the patient (53.4% preferred supine, Table 1 ), stability and set-up precision using the present prone devices, the need for new devices 24 , the longer set-up times. Surface-guided set-up systems reported for supine 25 are not well suited for prone breast positioning.…”