A comparative evaluation of two head and neck immobilization devices using electronic portal imaging

A study was performed to compare the positioning reproducibility and the cost efficiency for two head and neck immobilization devices: the Uvex (Uvex Safety, Smithfield, USA) plastic mask system and the Finesse Frame with Ultraplast System (PLANET Medical, Svendborg, Denmark). 20 patients treated with 3D conformal radiation therapy for head and neck cancers were randomly selected (10 for each of the two different immobilization systems) and electronic portal images acquired during their course of treatment were saved and used in this study. The anatomical landmark coordinates and their shifts in the anteroposterior (AP) and craniocaudal (CC) directions with respect to the digitized simulator films for lateral fields were analysed using an in-house developed portal image registration system. Statistically, no evidence was found to indicate that the systematic components of the displacement for the Uvex system and the Finesse Frame with Ultraplast System were different from each other or from zero. The random component of displacement was slightly smaller in the AP direction for the Uvex than the Ultraplast system (sigma = 1.9 mm and 2.9 mm, respectively, p = 0.007), but larger in the CC direction (sigma = 3.8 mm and 2.2 mm, respectively, p<10(-9)). Production time and required materials for a radiation therapy department were also quantified to assess costs for each system. The overall costs per patient were estimated at 141.50 dollars (CAD) and 82.10 dollars for the Uvex and Ultraplast systems, respectively. The Finesse Frame with Ultraplast System of immobilization for head and neck cancer treatment provides a field placement reproducibility that is equal to, or greater than, that of the Uvex plastic mask immobilization system and, while it requires more expensive materials, the workload and consequently overall cost is greatly reduced.