Positioning and immobilization of patients undergoing radiation therapy for Hodgkin's disease

The prognosis for patients with Hodgkin's disease is largely determined by the initial management, therefore, special attention must be given to the precision of the often complex treatment in these relatively young and curable patients. Positioning and immobilization is extremely important and may have a role in the final outcome of the treatment. Alpha Cradles, along with laser alignment systems, have been routinely used for these patients in our institution for approximately 10 years. Despite these efforts, difficulties are encountered in precisely reproducing the setup. A modification was therefore made to an Alpha Cradle to include an arm support with handles that fix the position of the patient's elevated arms during the treatment. This modification provides improved repositioning and alignment of the patients, which may have an impact on the final outcome of the treatment. The positioning device also offers improved patient comfort, and, as a result, reduced patient motion as evidence by the reduced number of adjustments required when port films are examined. Additionally, the described technique reduces the risks of over- or underdosage at the junction between the mantle and the para-aortic fields.