ALPHA CRADLE DEVICES IN BREAST CANCER TREATMENT

Susan Hook, RTT
Jane Pardy, RTR
Boston, Massachusetts

INTRODUCTION
The treatment of breast cancer with radiation has always been a process that required a great deal of accuracy and consistency in patient set up. Today the treatment of choice for early stage breast cancer is biopsy or lumpectomy plus radiation therapy and/or chemotherapy. We are, therefore, seeing many different types of treatment volumes.
With the recognition of radiation therapy as an alternative, we are seeing those patients who are not good physical candidates for surgery. These patients are thus challenging in so far as they require an accurate daily set up.

TECHNIQUE
The simulation of the isocentric technique used in our department requires the patient to maintain her position, supine on a 21° angle board with her arm extended 90° or more from her body with her hand on her head. When this technique was first introduced, we found that few women were able to maintain this position. We then realized how much an individualized immobilization device was needed.
Our technique is very simple. Using ALPHA CRADLE® brand AC325 foam, we shape the bag to fit the patient. We then pour the foaming agents and allow them to begin to rise before lying the patient down. We explain in detail the procedure to the patient and the need for us to move quickly. The patient lies down and we adjust the bag; with two sets of hands, we can shape the bag to suit our specific needs.
Once set, the ALPHA CRADLE® device was modified to allow set up equipment to be attached to the simulator and treatment couch. The contour was taken with the device in place. The simulation time was a lengthy 1-1/2 hours. However, the patient was still comfortable at the end of this time and the technologist felt assured that she had remained still.
Patient B was a 57 year old white female with intraductal in situ carcinoma of the right breast with a complex history which made her medically inoperable. This lady had extensive cardiac disease as was status post left CVA with right hemiparesis which made her body positioning more challenging.
Using two sets of AC325 FOAM, we were able to mold the foam around her abducted right arm to give it the extra support which she needed to maintain her position. The cast also made her feel comfortable and relaxed which allowed us to proceed with the simulation and eventual daily treatment. She was treated with two tangential fields to the right breast.
SUMMARY
We have adopted the slogan “No breast patient is too difficult to immobilize using AC325 FOAMING AGENTS.” These casts have allowed the patient to be in a comfortable position for a rather long and sometimes arduous simulation process. It also makes the patient feel that we as professionals have done the most we can by providing and individualized service.
From the technologist’s point of view, the cast enables us to focus on our jobs of accurate measurements, good simulation and sets the scene for good patient interaction, which is especially important for cancer patients. The cast provides a light, easy-to-make customized immobilization device that allows the patient to be treated quickly and accurately each day.
Because the molds have become so popular with patients and technologists, it is now our policy that all patients treated for breast cancer are simulated and treated in an ALPHA CRADLE® device.