title: Impact of knee support and shape of tabletop on rectum and prostate position.
abstract: OBJECTIVE
  To evaluate the impact of different tabletops with or without a knee support on the position of the rectum, prostate, and bulb of the penis; and to evaluate the effect of these patient-positioning devices on treatment planning.
  
  
  METHODS
  For 10 male volunteers, five MRI scans were made in four different positions: on a flat tabletop with knee support, on a flat tabletop without knee support, on a rounded tabletop with knee support, and on a rounded tabletop without knee support. The fifth scan was in the same position as the first. With image registration, the position differences of the rectum, prostate, and bulb of the penis were measured at several points in a sagittal plane through the central axis of the prostate. A planning target volume was generated from the delineated prostates with a margin of 10 mm in three dimensions. A three-field treatment plan with a prescribed dose of 78 Gy to the International Commission on Radiation Units and Measurements point was automatically generated from each planning target volume. Dose-volume histograms were calculated for all rectal walls.
  
  
  RESULTS
  The shape of the tabletop did not affect the rectum and prostate position. Addition of a knee support shifted the anterior and posterior rectal walls dorsally. For the anterior rectal wall, the maximum dorsal shift was 9.9 mm (standard error of the mean [SEM] 1.7 mm) at the top of the prostate. For the posterior rectal wall, the maximum dorsal shift was 10.2 mm (SEM 1.5 mm) at the middle of the prostate. Therefore, the rectal filling was pushed caudally when a knee support was added. The knee support caused a rotation of the prostate around the left-right axis at the apex (i.e., a dorsal rotation) by 5.6 degrees (SEM 0.8 degrees ) and shifts in the caudal and dorsal directions of 2.6 mm (SEM 0.4 cm) and 1.4 mm (SEM 0.6 mm), respectively. The position of the bulb of the penis was not influenced by the use of a knee support or rounded tabletop. The volume of the rectal wall receiving the same dose range (e.g., 40-75 Gy) was reduced by 3.5% (SEM 0.9%) when a knee support was added. No significant differences were observed between the first and fifth scan (flat tabletop with knee support) for all measured points, thereby excluding time trends.
  
  
  CONCLUSIONS
  The rectum and prostate were significantly shifted dorsally by the use of a knee support. The rectum shifted more than the prostate, resulting in a dose benefit compared with irradiation without knee support. The shape of the tabletop did not influence the rectum or prostate position.
authors.affiliation: The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Roel J H M
authors.initials: RJ
authors.lastname: Steenbakkers
authors.forename: Joop C
authors.initials: JC
authors.lastname: Duppen
authors.forename: Anja
authors.initials: A
authors.lastname: Betgen
authors.forename: Heidi Th
authors.initials: HT
authors.lastname: Lotz
authors.forename: Peter
authors.initials: P
authors.lastname: Remeijer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fitton
authors.forename: Peter J C M
authors.initials: PJ
authors.lastname: Nowak
authors.forename: Marcel
authors.initials: M
authors.lastname: van Herk
authors.forename: Coen R N
authors.initials: CR
authors.lastname: Rasch
mesh_terms: D004867:Equipment Design; D004865:Equipment and Supplies, Hospital; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010413:Penis / Q000033:anatomy & histology*; D011187:Posture; D011467:Prostate / Q000033:anatomy & histology*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal; D012007:Rectum / Q000033:anatomy & histology*; D016683:Supine Position