title: [Which factors modify the reproducibility of patient positioning in the daily irradiation routine?].
abstract: OBJECTIVE
  Factors which influence the accuracy of the field application during daily irradiation routine are not well known. The aim of this prospective analysis was to determine the significance of these factors on the occurrence of field misadjustments in irradiation without immobilization and to evaluate their clinical relevance.
  
  
  METHODS
  Fifty-three patients received external cobalt-60 beam irradiation without fixation. Once weekly portal images of all treatment fields were carried out. In addition to objective patient data (age, weight, height, general condition, irradiation indication), the psychological situation of the patient during treatment (anxiety, restlessness, pain) and work circumstances of the medical staff during treatment were evaluated once weekly. The distance of clearly visible anatomic structures to the field borders of the portal images were measured and the deviation to the corresponding simulator images was calculated. Patient data were correlated to the number of field misadjustments (deviation larger than 1 cm).
  
  
  RESULTS
  Patients whose condition is generally poor and patients being treated palliatively, patients with feeling of anxiety, restlessness or pain during simulation or irradiation and heavy patients (90 kg and more) were more often misadjusted. The number of field misadjustments increased with the stress of the medical staff.
  
  
  CONCLUSIONS
  The problem of reproducibility of external beam irradiation without fixation in palliative treatment is of clinical relevance. Effective analgesic therapy and a comfortable and painfree patient set-up reduce misadjustments. In curative treatment, immobilization techniques should be used.
authors.affiliation: Klinik für Strahlentherapie und Onkologie, Johann-Wolfgang-Goethe-Universität, Frankfurt a. M.
authors.forename: C
authors.initials: C
authors.lastname: Thilmann
authors.forename: I A
authors.initials: IA
authors.lastname: Adamietz
authors.forename: S
authors.initials: S
authors.lastname: Mose
authors.forename: F
authors.initials: F
authors.lastname: Saran
authors.forename: A
authors.initials: A
authors.lastname: Buchner
authors.forename: H D
authors.initials: HD
authors.lastname: Böttcher
mesh_terms: D000368:Aged; D001007:Anxiety; D016009:Chi-Square Distribution; D003037:Cobalt Radioisotopes / Q000627:therapeutic use*; D006801:Humans; D019300:Medical Errors; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000532:radiotherapy; D010166:Palliative Care / Q000523:psychology; D011187:Posture; D011446:Prospective Studies; D011867:Radioisotope Teletherapy / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000523:psychology; D015203:Reproducibility of Results
chemical_list: D003037:Cobalt Radioisotopes