IMMOBILIZATION OF THE PROSTATE PATIENT WITH ALPHA CRADLE DEVICES

Jeffrey Vincent Kostich, President
Smithers Medical Products, Inc.
North Canton, Ohio

ALPHA CRADLE® DEVICES:
PF1, PFM, BB
Two of the three shells offered for treatment of prostate cancer have recently been developed. These new devices allow the patient to be treated in the supine (Pelvic Form Modified) and the prone (Belly Board) position. The belly board makes allowance for a cutout section which allows the bowels to drop, minimizing the amount of small bowel in the treatment field. The new modified pelvic form immobilizes the patient from the base of the ribs to the bottoms of the feet. Triangular supports fit under the knees while the base end controls flexion of the feet. These new forms allow the medical professional to use a customized repositioning tool whether they treat their patients in the prone or supine position.
All of the customized devices developed for use in treating patients with cancer of the prostate have unattached pieces that must be attached by the medical professional before the fabrication of the form can begin. It is important to measure the width of the patient and attach the side piece allowing no more than one inch between the side of the mold and the patient. This is the secret for creating tight fitting forms. By placing the side rails too far from the patient, the foam will not rise sufficiently to provide the immobilization needed for this larger device.
If using the modified pelvic form, you must use 2-3 people to create the device. The extra sets of hands are necessary to shake all of the sets of foam at one time and to keep the rising foam tight against the patient’s skin. If possible, you need to have the patient lay in the empty shell so you can accurately mark on the base where the side rails, knee supports and base piece should be connected with double-sticky tape, already attached. If you cannot have the patient lay inside of the empty shell, you can measure the patient and approximate the positions of the pieces. To get good formation around the patient’s legs, pour the foam slowly over the knee supports and then the rest of the form. Save some foam so that you can reapply a second coat of foam on top of the first coat. This double coating will provide you with ample foam once it begins to rise around the patient’s legs. The empty bottles and lids can be place inside of the form between the two knee supports. This will displace more foam that can be better utilized foaming around the patient’s anatomy. If you do not want to place the empty bottles inside of the form, pieces of cut polystyrene can also be used to displace the foam between the knee supports. As the foam starts to expand, pull the bag of sheeting up between the patient’s legs. This will allow ample foam to form between the patient’s legs. As the foam begins to feel spongy, place the foaming agents as firmly against the patient as you can.
This will make a firm guide for future use of the device. As extremities tend to rise out of the forms, remember to apply pressure to the feet.
When using the belly board for prone positioning, you will need to measure the distance that the patient is raised from their pubic bone to the treatment couch when their belly is allowed to just touch the treatment couch. This will determine the height of the center pieces that are affixed to the base with tape. Be sure that when you attach the side rails, you only allow one inch of space between the rail and the patient. Allowing more space reduces the height of the foam needed to make an effective form. After completion of the form, cut a port through the base, further allowing the belly to drop from the treatment field. Remember to wipe the form clean with a damp cloth removing any particles of foam that may have accumulated. Next, cover the exposed areas of foam with a paper of cloth tape. This will prevent the patient’s skin from becoming irritated from contact with exposed foam.
ACMMII
The ACMMII allows you to create prone or supine forms for your patient. The most beneficial tip when making effective prostate forms is to make sure the base is strong and durable. Due to the nature of the form, this form seems to receive more abuse from patients getting in and out of the form than most others. To increase the stability of the base, take a 1” thick piece of extruded polystyrene (the blue boards) and cut a piece 10”x 12”. Place this piece inside of the bag of foaming agents, pouring the foam around the inserted piece. As the foam rises and expands, it will bond to the inserted base piece creating a very strong and durable foam.
When making the form on your patient, take the recapped bottle marked #1, and carefully place it underneath the bag of foam between the patient’s legs and slide it up until it makes soft contact with the patient’s groin. This will assist the bag of rising foam make a good impression of the patient’s inner leg. This will also allow you to keep the bag of foam high in relative position to the patient’s legs. Don’t be afraid to grab the bag and pull it up if you’re not getting enough foam between the patient’s legs. As the foam begins to harden, place the remaining dividers between the dividers that are in place and the bag of foam. This process will keep the foam tight against the patient as it hardens.
Ports are easily cut into the base of sides as needed. Remember to clean the form of debris when cutting ports, and cover the area completely with cloth or paper tape. The forms should be indexed with a marker in conjunction to the relationship of the form with the lasers. This will allow you to return the form to its original position for each successive treatment. If your patient is obese, a small series of tattoos can be placed on the patient’s skin where they meet the cradle. This will allow you to rotate the patient’s skin back to the original position.