SU-C-19A-06: A Robust and Affordable Table Indexing Approach for Total Lymphoid Irradiation Treatment




Total lymphoid irradiation (TLI) is conventionally delivered through the dosimetric matching of mantle, spleen, and pelvis fields, necessitating multiple isocenters delivered through a combination of couch shifts and sliding of patients relative to the couch rendering the technique susceptible to shifting errors. To address this challenge, a novel technique for the couch indexing of TLI treatments is developed and evaluated through a multi-patient pilot trial.


An immobilization device was designed consisting of a movable indexed slide board with an Exact Lok-Bar drilled into it. A Timo headrests were used fixate the head of the patient relative to the slide board. For the Varian Exact Couch™, the immobilization board was connected to the H3 notch to avoid the metal infrastructure of the couch for the delivery of the mantle and spleen fields. For tall patients the required shift for the pelvis isocenter reaches the shifting limit and the board was slid from H3 to H4 (a fixed distance of 14 cm). A total 22 patients were stratified in two groups of 11, one consisting of the conventional setup, and one group with the proposed immobilization technique.


The standard deviations (SD) of the couch positions in lateral, longitudinal, and vertical directions for 10 fractions for each patient in both groups were calculated. In the non-indexed group, the positioning SD ranged from 0.9 to 4.7 cm. Using our device, the positioning SD was reduced to a range of 0.2 to 0.9 cm, with the longitudinal direction showing the largest improvement.


Matched field TLI remains error prone to geometrical misses. The feasibility of full indexing TLI treatments was validated and shown to result in a significant reduction of positioning errors.