Three-dimensional motion analysis of an improved head immobilization system for simulation, CT, MRI, and PET imaging

A mask/marker immobilization system for the routine radiation therapy treatment of head and neck disease is described, utilizing a commercially available thermoplastic mesh, indexed and mounted to a rigid frame attached to the therapy couch. Designed to permit CT, MRI, and PET diagnostic scans of the patient to be performed in the simulation and treatment position employing the same mask, the system has been tested in order to demonstrate the reproducibility of immobilization throughout a radical course of irradiation. Three-dimensional analysis of patient position over an 8-week course of daily radiation treatment has been performed for nine patients from digitization of anatomic points identified on orthogonal radiographs. Studies employing weekly simulation indicate that patient treatment position movement can be restricted to 2 mm over the course of treatment. This easily constructed system permits rapid mask formation to be performed on the treatment simulator, resulting in an immobilization device comparable to masks produced with vacuum-forming techniques. Details of motion analysis and central axis CT, MRI, and PET markers are offered.