title: Positioning accuracy in stereotactic radiotherapy using a mask system with added vacuum mouth piece and stereoscopic X-ray positioning.
abstract: OBJECTIVE
  For cranial patients receiving stereotactic radiotherapy, we use the Exactrac stereoscopic X-ray system to optimize patient positioning. Patients are immobilized with the BrainLAB Mask System (BrainLAB, Feldkirchen, Germany). We have developed an adapter to this system that accommodates a vacuum mouth piece (VMP). Measurements with the Exactrac system have been performed to study the positioning accuracy after corrections with this system and to evaluate the accuracy of the VMP vs. the standard available upper jaw support (UJS).
  
  
  METHODS
  Positioning results were collected for 20 patients with the UJS and 20 patients with the VMP, before treatment (1,122 fractions) and after treatment (400 fractions). For all 6 degrees of freedom the average, the random error and systematic error were calculated.
  
  
  RESULTS
  The average vector length before and after correction with the Exactrac system was 2.1 +/- 1.2 mm and 0.7 +/- 0.6 mm respectively for UJS and 1.7 +/- 0.7 mm and 0.4 +/- 0.4 mm for VMP. Interfraction positioning for translations was greatly improved after correction with the Exactrac system (p < 0.0005) and is better with VMP than with UJS (p = 0.005). Outliers were greatly reduced. Interfraction rotations were significantly smaller for VMP. Intrafraction errors for vertical and longitudinal translations and for rotations were smaller for the VMP.
  
  
  CONCLUSIONS
  Positioning correction using the Exactrac X-ray system greatly improves accuracy. Adding the VMP results in even better patient fixation and smaller rotations, making it a useful addition to the Mask System. Combined, this is a convenient and accurate alternative to invasive fixation methods.
authors: Department of Medical Physics, Medical Centre Haaglanden, The Hague, The Netherlands. j.van.santvoort@mchaaglanden.nl
authors: Jan
authors: J
authors: van Santvoort
authors: Ruud
authors: R
authors: Wiggenraad
authors: Petra
authors: P
authors: Bos
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy*; D004867:Equipment Design; D006801:Humans; D007568:Jaw; D008397:Masks; D008875:Middle Aged; D009064:Mouth Protectors; D009068:Movement; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D012149:Restraint, Physical / Q000295:instrumentation* / Q000379:methods; D014618:Vacuum