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. 2023 Apr 6;30(4):4067-4077.
doi: 10.3390/curroncol30040309.

Impact of the Extremities Positioning on the Set-Up Reproducibility for the Total Marrow Irradiation Treatment

Nicola Lambri  1   2 , Simone Leopoldo Antonetti  3 , Damiano Dei  1   2 , Luisa Bellu  1 , Stefania Bramanti  4 , Ricardo Coimbra Brioso  5 , Carmelo Carlo-Stella  2   4 , Isabella Castiglioni  6 , Elena Clerici  1 , Leonardo Crespi  5   7 , Chiara De Philippis  4 , Carmela Galdieri  1 , Daniele Loiacono  5 , Pierina Navarria  1 , Giacomo Reggiori  1   2 , Roberto Rusconi  1   2 , Stefano Tomatis  1 , Marta Scorsetti  1   2 , Pietro Mancosu  1
Affiliations

Impact of the Extremities Positioning on the Set-Up Reproducibility for the Total Marrow Irradiation Treatment

Nicola Lambri et al. Curr Oncol. .

Abstract

Total marrow (lymph node) irradiation (TMI/TMLI) delivery requires more time than standard radiotherapy treatments. The patient's extremities, through the joints, can experience large movements. The reproducibility of TMI/TMLI patients' extremities was evaluated to find the best positioning and reduce unwanted movements. Eighty TMI/TMLI patients were selected (2013-2022). During treatment, a cone-beam computed tomography (CBCT) was performed for each isocenter to reposition the patient. CBCT-CT pairs were evaluated considering: (i) online vector shift (OVS) that matched the two series; (ii) residual vector shift (RVS) to reposition the patient's extremities; (iii) qualitative agreement (range 1-5). Patients were subdivided into (i) arms either leaning on the frame or above the body; (ii) with or without a personal cushion for foot positioning. The Mann-Whitney test was considered (p < 0.05 significant). Six-hundred-twenty-nine CBCTs were analyzed. The median OVS was 4.0 mm, with only 1.6% of cases ranked < 3, and 24% of RVS > 10 mm. Arms leaning on the frame had significantly smaller RVS than above the body (median: 8.0 mm/6.0 mm, p < 0.05). Using a personal cushion for the feet significantly improved the RVS than without cushions (median: 8.5 mm/1.8 mm, p < 0.01). The role and experience of the radiotherapy team are fundamental to optimizing the TMI/TMLI patient setup.

Keywords: patient positioning; radiotherapy (RT); reproducibility; total marrow irradiation (TMI); total marrow lymph node irradiation (TMLI); volumetric modulated arc therapy (VMAT).

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Representative CBCT-CT matching was performed for the shoulders (top) and abdomen (bottom) isocenters. The RVS was measured as the maximum center distance between the bone marrow of the extremities. Large (left) and small (right) RVS values are reported. RVS = residual vector shift.
Figure 2
Figure 2
Feet positioning with (left) or without (right) a personal cushion.
Figure 3
Figure 3
Four representative CBCT-CT matchings of upper and lower extremities. Color wash was used to highlight differences >200 HU. The qualitative rating and OVS are reported. OVS = online vector shift.
See this image and copyright information in PMC

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