Assessment of the Offline Setup Correction Protocol and Thermoplastic Mask Use for Head and Neck Cancer Radiotherapy: A Single Institution Experience

This study assessed the efficiency of offline setup correction protocol and the use of a thermoplastic mask for head and neck cancer (HNC) patients treated with three-dimensional conformal radiotherapy at Ocean Road Cancer Institute. A prospective study was conducted from April to August 2021 to verify 62 patients’ treatment setup using an offline setup correction protocol while immobilized with a thermoplastic mask. Megavoltage images were matched with digitally reconstructed radiographs obtained during CT simulation to determine the gross set-up deviations. Box plots were used to show the deviations on three consecutive days of the first week and a successive weekly set-up verification in lateral, longitudinal, and vertical directions. The associations between thermoplastic mask types and weekly deviations were analyzed using repeated test ANOVA. A p-value ˂ 0.05 was considered statistically significant. The observed deviations after the use of correction protocol were lower in all three translational directions. There was no statistical significance between types of thermoplastic mask and setup deviations in lateral (p < 0.65), longitudinal (p = 0.19), and vertical (p = 0.12) directions. The offline correction protocol can be used in settings with limited resources and high workloads of patients. Both types of thermoplastic masks are effective in immobilizing HNC patients.