ALPHA CRADLE® DEVICES FOR INTACT BREAST PATIENTS

Janet Protesto, RTT
Bethesda Memorial Hospital
Boynton Beach, Florida

With the advent of lumpectomy and the preservation of patient’s breast, a variety of treatment techniques have arisen. Most radiation therapists have worked with the breast ramp, a cumbersome device to say the least. Securing the ramp to the treatment table is of great concern.
Patient positioning on the ramp can also be quite exasperating. Frequently patients will slide down the ramp to where they are most comfortable. This technique also involves using a heavy half-beam block.

With the introduction of the ALPHA CRADLE® devices to our department, we have achieved the following:

Elimination of SSD and introduction of SAD technique
Elimination of the breast ramp
Elimination of the half beam block
Assurance of accurate and reproducible set ups
Cat Scan localization films taken with the patient in the treatment position

Simulation procedures are simple and consist of two parts. The making of the ALPHA CRADLE® device and the CT scan localization make up the first part of the simulation procedure. The second simulation is the taking of films.
Since patients vary in age, differences in breast tissue also occur. To compensate for these differences, angle sponges and Styrofoam® are used to assist in making the cradle.
While patients with small breasts appear to need a slight angle to elevate the chest, a small angled piece of Styrofoam® may be placed on the cradle board under the ALPHA CRADLE® device. The patient is then positioned on the board for proper alignment. While the form is being made, careful attention is given to cover all the Styrofoam®. This allows removal of the Styrofoam® and still achieves the necessary angle of the chest for daily treatment. At this time attention should also be given to the affected arm. This ALPHA CRADLE® device must give proper support to this arm to keep it secure during treatment.
Large breasts present a few problems. If a patient with a large breast lies flat on the ALPHA CRADLE® board, the superior aspect of the breast may rise into the supraclavicular region. Steep
angled Styrofoam® blocks will be added to elevate the chest. Positioning is extremely important before the ALPHA CRADLE® device is made. If the breast sags laterally an angle sponge may be used to rotate the patient slightly. These problems should all be addressed before the ALPHA CRADLE® device is made. The physician, dosimetrist and the therapist must decide on the proper placement to the Styrofoam® and angled sponges before the ALPHA CRADLE® device is made. Only after these factors have been attended to can construction of the ALPHA CRADLE® device begin. If an angle sponge and Styrofoam® blocks are being used in the positioning of a large patient then an adult and pediatric foaming agent set are mixed together. This allows more support to the back, neck and affected arm of the large patient. As an extra measure, lateral laser marks may be placed on either side of the abdomen.
Patients are then escorted to the CT scan department. The localization films are taken while the patient lies in the ALPHA CRADLE® device in the treatment position. The dosimetrist then plans the treatment planning will give the therapist the field size and gantry angles that will be used during the second simulation.
The second simulation procedure will go very smoothly. Patients will find it very uncomfortable if they do not fit into the ALPHA CRADLE® device properly. Rarely is there a case when a simulation film or gantry angle must be changed. Initial films on the treatment table as well as weekly port films are accurate and the therapists are very confident with the daily set ups.
Quality of the treatment is most important to achieve the desired effect and the ALPHA CRADLE® devices are an important contributing factor. Preparation for breast patients using ALPHA CRADLE® devices is time consuming but the rewards are well worth the time. Accuracy, speed and reproducibility are the key factors for using the ALPHA CRADLE® devices.