title: Adaptation of vacuum-assisted mouthpiece head immobilization system for precision infant brain radiation therapy.
abstract: OBJECTIVE
  Our purpose was to describe an adaptation of a commercially available mouthpiece for vacuum-assisted mouthpiece immobilization for radiation therapy in infants.
  
  
  METHODS
  An infant diagnosed with a brain tumor required radiation therapy. After reviewing dental literature about obturators, we designed a modification for the smallest commercially available mouthpiece tray.
  
  
  RESULTS
  The patient was simulated with the adapted mouthpiece tray. We achieved excellent immobilization and had small daily image guided treatment position shifts. Our patient tolerated treatment well without injury to oral cavity or mucosa.
  
  
  CONCLUSIONS
  Head immobilization with a vacuum-assisted modified mouthpiece has not been described in infants. Our modification is a novel and safe and permits effective and accurate immobilization for infants for radiation therapy. New manufacturing technologies may allow creation of individualized mouthpieces.
authors.affiliation: Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Southern California, Los Angeles, California. Electronic address: kewong@chla.usc.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wong
authors.affiliation: Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Justine
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Kristine
authors.initials: K
authors.lastname: Bowlin
authors.affiliation: Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Southern California, Los Angeles, California.
authors.forename: Arthur
authors.initials: A
authors.lastname: Olch
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000532:radiotherapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007103:Immobilization / Q000295:instrumentation* / Q000379:methods; D007223:Infant; D009064:Mouth Protectors; D019635:Neurosurgical Procedures; D056888:Patient Positioning / Q000295:instrumentation* / Q000379:methods; D036102:Peripheral Blood Stem Cell Transplantation; D018714:Radiotherapy, Adjuvant; D018335:Rhabdoid Tumor / Q000532:radiotherapy*; D013724:Teratoma / Q000532:radiotherapy*; D014618:Vacuum