Radiation therapy field evaluation of simulated shoulder support cushion for head-neck immobilization

¶ … Sinmed Shoulder Support Cushion for Head and Neck Immobilisation

Brown's (2010) article entitled "Evaluation of a Sinmed Shoulder Support Cushion for Head and Neck Immobilisation," published in The Radiographer, investigates the efficacy in positioning for head and neck patients, with the Sinmed shoulder support cushion, as opposed to standard protocol in place at the Princess Alexandra Hospital Radiation Oncology Department. Understanding that the ability to accurately position a patient is critical to successfully delivering radiation therapy treatment, Brown notes that the hospital has been investigating optimal immobilisation techniques. The author discovered that after trialing the Sinmed shoulder support cushion, manufactured by CIVCO Medical Solutions, no significant differences were found in the positioning accuracy, from the standard protocol.

A small group of patients were trialed for this evaluation of the Sinmed shoulder support. Electronic portal imaging was used to asses the device, as well as a collation of observations that were made from treatment and planning staff at the hospital. As noted, no major differences were found to occur between the use of the Sinmed device and standard departmental protocol, for the accuracy of positioning of the patients. In fact, Brown (2010) notes that trends indicated that the Sinmed device actually decreased the positioning accuracy the staff achieved. Staff reported that the Sinmed device was difficult to use, and when used in daily practice resulted in problematic shell fitting. For these reasons, the hospital has not implemented this device department-wide, instead it has retained it's original protocol except for those patients with anatomical restrictions that could benefit from the device.

Critique of the Article:

The author does an moderately good job discussing Princess Alexandra Hospital's small trial of the Sinmed shoulder support cushion. Brown's (2010) title allows readers to know what the general topic of the article will be; however, it is a bit misleading in the scope of the evaluation. Reading just the title, the reader may be led to believe this will be a broader evaluation. Instead, the evaluation was conducted on just six patients at the hospital. A more appropriate title would have indicated the small trial size and noted the trial was limited to Princess Alexandra Hospital.

The abstract does a better job detailing the article. Brown (2010) gives the reader a brief explanation as to why accurate and consistent patient placement is important. He then continues to note that Princess Alexandra Hospital investigated the use of the Sinmed device for their radiation department. The method is very briefly described, although Brown notes that it is a small trial size, he could've been more specific with noting that there were only six patients in the trial, so the reader can truly appreciate the small scale of the trial. Results are also briefly described in the abstract, and the conclusion notes that the hospital has not implemented the Sinmed device, due to the results, except in the cases where it may be beneficial due to anatomical restrictions of the patient. In general, Brown's abstract was representative of the article's content; however, it could've provided a few more details regarding the trial scope.

Brown's (2010) introduction provides a clear and concise demonstration of the importance accurate patient positioning in the delivery of radiation therapy, particularly with the advent of Intensity Modulated Radiation Therapy (IMRT). Due to the complexity of the anatomy, as well as the proximity of tumors to critical and radiation sensitive anatomical structures, Brown further notes that accurate and consistent patient placement for patients with head and neck cancer is even more important. The author concludes with the acknowledgment that the hospital had hypothesized that the Sinmed support could facilitate this placement, resulting in a clear indication of what the purpose of the article is.

The interpretation of Princess Alexandra Hospital's findings is not summed up as accurately as possible, by Brown (2010). Brown concludes that the hospital found that there was no major difference found between patients that were positioned with the Sinmed device and those who were positioned without it. However, his report of the true data shows there was a difference found in the displacement values. He notes,

The mean displacement value in the superior direction was 1.8 mm for patients positioned as per standard protocol and 2.7 mm for those positioned with the shoulder support. In the inferior direction, the mean displacement values was 1.9 mm and 2 mm respectively. The maximum displacement value in the superior direction was 3 mm for patients positioned as per standard protocol compared to 7 mm for those positioned with the shoulder support. In the inferior direction, the maximum displacement values were 5

mm and 6 mm respectively (p. 14).

As some of these values are a greater than 100% increase in displacement, for the use of the Sinmed device, this could have been more accurately represented in some of the broader conclusive statements Brown made in his article.

The objective of Princess Alexandra Hospital's evaluation is incredibly important to the field of radiography, in particular, and more specifically, the use of IMRT for cancer patients with tumors in the head and/or neck region. Doing all that can be done to maximize the accuracy and consistency of patient placement, during radiation treatments, is critical to the success of the treatments. This is a life-saving concern. As such, Brown's (2010) article detailing the evaluation of the potential use of the Sinmed shoulder support cushion provides useful information for other hospitals to consider.