09/20/2018
Sorting Through Radiotherapy Head Support Options

Radiology physicians and technicians face the constant challenge of balancing treatment effectiveness with patient comfort. Of course, many medical procedures from simple injections to surgery involve some inherent patient discomfort, but radiotherapy has unique characteristics that set it apart from other treatment regimens. For example, patients are normally completely conscious during radiology treatments yet must remain perfectly still. In another example, modern treatments such as SBRT and IMRT depend on high-accuracy positioning of the treatment area to prevent damaging surrounding healthy tissues. The combination of these two characteristics creates the challenge of immobilizing patient movement in a precise position, while they are fully conscious, for the duration of the setup and treatment – a time period that can typically last from 15 to 30 minutes, or even longer. In the past, invasive frames attached to the patient’s skull were used to provide localization and immobilization for cranial radiotherapy, an inconvenient, costly, and typically painful process.

Radiation treatment providers knew there had to be a better way. The ideal answer to this challenge would be to immobilize the treatment area while also providing for the maximum possible patient comfort. This is because physical discomfort such as pressure points will cause the patient to fidget, or try to move, to gain relief even when they know that they are supposed to remain still. Patients may not even be aware of these attempts at movement – such human movements are often triggered by unconscious drivers. 

Treatment of tumors in the head and neck area are particularly sensitive to positioning because of the close proximity of other essential organs and tissues. Healthy tissues in the brain, eyes, spine, and salivary glands are only a few of the areas that need to be protected during treatments, and achieving isolation of these areas depends on both precise positioning and prevention of movement.

Fortunately, Aktina offers two distinct families of head immobilization products that can be used for treatments in the head and neck area that offer both high accuracy positioning and patient comfort. The first is based on shape-conforming thermoplastics, and the second is based on patented vacuum fixation. Both types provide positioning without requiring any action by the patient – the patient can relax as best possible given the situation.

Thermoplastics provide cost-effective, easy-to-use head immobilization systems with good accuracy. They are flexible enough to use with nearly every patient, both face-up and face-down. And, they can be used for head-only immobilization, primarily for cranial treatments or for head-and-shoulder immobilization, also ideal for neck treatments. The only difference between these applications is the size of the thermoplastic mesh and the associated frame and clamping system. Aktina offers a full range of both head masks and head and shoulder masks to support specific needs, including models with frames to fit many popular clamping systems and models with partially open faces to further increase patient comfort if the treatment regimen allows.

The second family of head immobilization products is based on a patented fixation method called PinPoint from Aktina that uses vacuum technology to match a fitted plate to the patient’s upper palate. This method maintains an open, unrestricted view for the patient, which can be better for patients that have anxiety about being confined by a mask. And, the PinPoint system enables sub-millimeter accuracy – the most accurate patient location and fixation without the need for invasive frames. The PinPoint approach can also be used for extracranial treatments and with higher accuracy than thermoplastic masks. To provide support from below the skull, several options are available, including thermoplastic support hammocks, standard cushions, and customizable foam cushions. Because these are not used for localization or immobilization, they can be selected based on preference and comfort.

Aktina is proud to provide the latest, most advanced offerings for radiotherapy cranial and extracranial localization and immobilization. Today’s solutions provide greater positioning accuracy than ever before, while also increasing patient comfort. Increased comfort translates into increased patient confidence and cooperation, minimizing any added trauma associated with treatment and creating a win-win situation for treatment providers, patients, and better outcomes.

 
09/18/2018
Three Ways to Keep Radiosurgery Patients More Comfortable

The discussion of radiosurgery is unsettling for most people outside of the medical field, as the circumstances surrounding this procedure are typically not good. Imagine the additional stress associated with any discussion of immobilization, and the serious consequences that can result if unintentional movement occurs during radiosurgery treatment. Fortunately, there have been advancements in abdominal, body and cranial radiosurgery immobilization techniques that are non-invasive, help ensure treatment accuracy, and provide a higher degree of patient comfort.

The following is a summary of three innovative immobilization solutions available today that deliver the perfect combination of precision and patient comfort:

Abdominal radiotherapy immobilization greatly relies on the Elekta Active Breathing Coordinator™ (or “ABC”) for a repeatable patient breath hold with a consistent volume every time. This solution allows operators to collect images during a breath hold, and irradiate during an identical breath hold, removing the effects of motion for more accurate treatment. A key to the successful use of the ABC system is increased patient comfort and confidence, which is achieved via proper mouthpiece fit.

Aktina Medical recently updated the design of its ABC mouthpieces to provide even greater patient comfort and flexibility. The materials and design of the mouthpiece provide a comfortable seal that minimizes patient effort and stress, making the process easier for both the patient and the technician. This combination of comfort and flexibility built into Aktina ABC mouthpieces conveys high quality and instills confidence in patients, minimizing any added trauma associated with radiotherapy. And because the comfortable mouthpiece also forms a reliable seal, the accuracy of the breathing volume measurement is improved. Accurate volume measurement also improves correlation between the imaging and treatment positions, which in turn improves overall treatment accuracy.

Stereotactic Body Radiation Therapy (SBRT) immobilization solutions improve treatment accuracy and patient comfort, while also reducing overall costs. Traditionally SBRT required technicians to employ restrictive components to immobilize patients. Aside from causing patient discomfort and added anxiety, these immobilization components are typically quite bulky making them difficult to manipulate, take longer to set-up, and require substantial storage space.

Aktina Medical took a unique approach to SBRT immobilization with the introduction of its Memorial Cradle 2 Lateral Support System. Developed in conjunction with Memorial Sloan Kettering Cancer Center, the Memorial Cradle 2 features a unique modular design that increases clinicians’ flexibility and streamlines workflow processes, while causing less stress to patients undergoing treatment. The system’s lateral support paddles mount directly to the treatment couch eliminating the need to mount and adjust additional accessories or hardware. This unique method for patient immobilization provides excellent flexibility in SBRT positioning with a direct index to table crossbar and paddle sets. The Memorial Cradle 2 Lateral Support System provides numerous benefits including: active patient support by applying lateral side pressure to increase treatment setup accuracy and reproducibility; modularity of design that improves cost-effectiveness with fewer components that require less storage space; the elimination of bulky overlays to minimize attenuation and increase treatment options and flexibility; and universal compatibility with virtually any treatment or CT couch top.

Cranial radiosurgery immobilization has been greatly enhanced with the application of new vacuum fixation technology employed in solutions such as Aktina PinPoint. A unique frameless localization and fixation system, Aktina PinPoint’s non-invasive approach provides patient-friendly immobilization with sub-millimeter positioning accuracy. PinPoint’s non-invasive approach reduces stress on the patient and makes procedures easier for the entire radiation oncology department. With PinPoint, the patient does not have to be simulated, planned and treated on the same day, allowing more flexibility for single-fraction and multi-fraction SRS. With two large treatment and imaging areas, PinPoint is fully IGRT compatible, providing the required flexibility for today’s demanding treatment modalities.

At Aktina Medical, we continually seek input from technicians in the field to see how we can further improve our current immobilization solutions, and develop new and more efficient solutions to improve overall patient treatment, comfort, and recovery.

 
06/28/2018
Advanced SBRT Immobilization Solutions Improve Patient Treatment and Comfort with Higher Cost-Efficiencies

Stereotactic Body Radiation Therapy (SBRT) has advanced on many levels in recent years with significant developments in new radiotherapy technologies and the manner in which these treatments are administered – producing better overall results. An important component in this equation involves new immobilization solutions that improve patient comfort as well as treatment accuracy while actually reducing overall costs.

As with all radiotherapy treatments, the effectiveness of SBRT is largely dependent on locational accuracy, yet the slightest patient movement can cause the radiation to miss the essential treatment location and possibly harm unaffected areas. Traditionally this meant that clinicians needed to employ bulky and restrictive components to immobilize patients. Aside from causing patient discomfort and added anxiety, these immobilization components are typically quite bulky making them difficult for clinicians to manipulate and increasing set-up time, in addition to requiring substantial storage space. 

Aktina Medical took a unique approach to SBRT immobilization with the introduction of its Memorial Cradle 2 Lateral Support System. Developed in conjunction with Memorial Sloan Kettering Cancer Center, the Memorial Cradle 2 features a unique modular design that increases clinicians’ flexibility and streamlines workflow processes, while causing less stress to patients undergoing treatment. The system’s lateral support paddles mount directly to the treatment couch eliminating the need to mount and adjust additional accessories or hardware. This unique method for patient allows for excellent flexibility in SBRT positioning with a direct index to table crossbar and paddle sets.

There are numerous benefits to this approach including: Active patient support by applying lateral side pressure to increase treatment setup accuracy and reproducibility; modularity of design that improves cost-effectiveness by requiring fewer components and reduces storage space requirements; the elimination of bulky overlays minimizes attenuation and increases treatment options and flexibility; universal compatibility with virtually any treatment or CT couch top.

Based on direct input from clinicians in the field, we will continue to enhance the Memorial Cradle 2 SBRT immobilization solution with the addition of new and even more efficient modular components further improving the prospect for better overall patient treatment and recovery.

For more information visit: http://www.aktina.com/product-category/body-radiosurgery/sbrt/

Download our catalog here.

 
06/20/2018
The Elekta ABC System Benefits from the Latest Aktina Medical Mouthpiece

Respiratory motion in image-guided radiotherapy remains a challenge to the safe and effective delivery of these treatment regimens. Movement of internal organs in the abdomen due to patient breathing negatively affects imaging accuracy, particularly for the lungs and nearby organs, and can even make dose-calculations difficult in some cases. Motion during treatment also reduces the effective dosage on the tumor while exposing surrounding normal tissue to unwanted exposure to radiation.

To alleviate movement during abdominal radiotherapy, much of the radiation oncology community rely on the Elekta Active Breathing Coordinator™ (or “ABC”) which provides a consistent, repeatable patient breath hold, taken with the same volume every time. The solution allows operators to collect images during a breath hold, and irradiate during an identical breath hold, removing the effects of motion for more accurate treatment. 

One key to the successful use of the ABC system is increased patient comfort and confidence, which is achieved via proper mouthpiece fit. Aktina Medical has recently updated the design of its ABC mouthpieces to provide even greater patient comfort and flexibility. These new devices are of the highest quality, and individually packaged for one-time use after every radiotherapy session. Each ABC mouthpiece kit includes a mouthpiece itself, an air filter, nose clips and connective tubing.

The materials and design of the mouthpiece provide a comfortable seal that minimizes patient effort and stress, making its use easier for both the patient and the technician. The connection tubing includes a new swivel elbow arrangement designed to allow for optimal positioning, which again minimizes effort and stress during imaging and treatment.

The combination of comfort and flexibility built into the design of Aktina ABC mouthpieces also convey high quality and confidence to patients, minimizing any added trauma associated with radiotherapy. And because the comfortable mouthpiece also forms a reliable seal, the accuracy of the breathing volume measurement is improved. Accurate volume measurements also improves correlation between the imaging and treatment positions, which in turn improves overall treatment accuracy.

The new Aktina ABC mouthpieces are a win-win for patients and for treatment providers. Greater comfort and confidence, supporting higher imaging and treatment accuracy, has the potential to lead to better outcomes.

 
04/13/2018
Quality Control Ensures Precise Readings and Performance in Critical Radiotherapy Planning and Treatment

According to a New England Journal of Medicine article titled Recent Developments in Radiotherapy, it is estimated that 470,000 patients receive radiotherapy each year in the United States1.  As many as half of those will receive radiotherapy for cancer. Radiation is a common treatment for some cancers by using high-energy particles or waves, such as x-rays, gamma rays, electron beams or protons to destroy or damage cancer cells.

Defining the extent of a tumor is a critical first step in defining and planning radiation treatments since accurate location reduces the chance of unintentional radiation exclusion or inclusion. Various internal body parts including lungs, esophagus, liver and so on move with breathing, and respiratory motion varies daily, affecting the defining of the treatment field. The amount a tumor can move during breathing can vary widely as well. Simply adding treatment margins to cover the limits of motion or increasing irradiated volume is neither safe nor recommended as this results in an increase in the volume of normal tissues being exposed to high dose treatment.

One method to overcome the problem of tumor movement in patients treated with radiotherapy is to restrict tumor motion with the Active Breathing Coordinator™ (ABC) device. The Active Breathing Coordinator device increases the accuracy of the treatment by reducing the amount the organs in your chest and abdomen move by holding your breath for you. It’s a non-invasive device designed with a mouthpiece that is attached to a digital spirometer to measure the respiratory trace. The patient’s nose is pegged as well to prevent nasal respiration.

The technique requires comprehensive quality assurance procedures to ensure precise readings and treatment delivery. Until recently, the accuracy of the Active Breathing Coordinator and quality of results had to be assessed and manually verified. Manual testing typically involves checking the flow-sensors for holes, clogging, channel plugging, or excess moisture. The use of hand-held syringes to complete these tests had several drawbacks, including the inability to test the balloon valve functionality, difficulty in replicating the patient’s breathing and operator error such as pushing too fast or too slow and causing false readings. Constant or heavy use meant more frequent checks and testing which had the potential to decrease the number of patients that could be seen.

Now, performance accuracy and functionality of the Active Breathing Coordinator’s spirometry and balloon valve can be tested in under two minutes with the RoHS compliant Aktina SpiroCheck Duo® quality control device. The extremely accurate system features a precision machined piston with a 1.3-liter calibrated volume connected to a linear actuator, creating sinusoidal tidal volume. The completely automated front panel LCD displays clear results. PC connectivity allows for creating and printing of QC reports and retrospective analyses.

While QA/QC policies and procedures for ABC usage may differ from medical facility to medical facility, the quality control procedures enabled by the Aktina SpiroCheck Duo device ensures the facility knows exactly how the ABC is performing each and every time.

Sources:
1http://www.nejm.org/doi/full/10.1056/NEJMra1608986?af=R&rss=currentIssue&