From the Guidelines
The most tolerated radiation therapy treatment position is with both arms above the head, as it permits a greater choice of beam access, improving target coverage and sparing of normal tissues. This position is recommended by the European Organisation for Research and Treatment of Cancer 1 as the standard positioning for patients undergoing high-dose, high-precision radiotherapy for lung cancer. However, individual patients may not be able to use this standard positioning due to various reasons such as arthritis, debility, or inability to raise arms.
For patients who are intolerant to the standard positioning, alternatives can be considered, such as:
- Using a stable arm support in combination with knee supports to improve patient comfort 1
- Personalized immobilization techniques that are reproducible and stable 1
- Positioning the patient in a prone or supine position, depending on the individual patient's needs and the specific radiation therapy being administered 1, 1, 1
It is essential to individualize the delivery of radiation therapy and consider patient positioning during administration 1, 1, 1. The goal is to achieve a stable and reproducible patient setup that minimizes discomfort and ensures the safe delivery of radiation therapy. By prioritizing patient comfort and positioning, healthcare providers can improve the overall quality of life and treatment outcomes for patients undergoing radiation therapy.
From the Research
Radiation Therapy Treatment Positions
- The most tolerated radiation therapy treatment position is not explicitly stated in the provided studies, as they primarily focus on patient positioning during surgery, non-invasive ventilation, and colonoscopy.
- However, the studies suggest that patient comfort and positioning are crucial in various medical procedures, and alternative positions or interventions can be used to improve patient tolerance and outcomes.
Alternatives for Patients Intolerant to Certain Positions
- For patients who are intolerant to certain positions, alternative positions or interventions can be considered, such as:
- Using a helmet instead of a nasal or oronasal mask for non-invasive ventilation, as it is better tolerated and results in longer use and lower failure rates 2.
- Employing sedation to improve patient tolerance to non-invasive ventilation, particularly for patients at risk of intubation due to pain, discomfort, claustrophobia, or agitation 2.
- Using prone positioning in non-intubated awake patients to improve oxygenation and reduce work of breathing, although maintaining this position can be challenging due to poor comfort 2.
- Considering sedation-free colonoscopy as a safer alternative for patients who are at high risk for anesthesia, as it can be completed successfully without compromising comfort or polyp detection rates 3.
Positioning-Related Complications
- The studies highlight the importance of proper patient positioning to prevent complications, such as:
- Peripheral nerve injuries, which can be minimized by correct positioning and preventive measures 4, 5.
- Pressure-related complications, such as pressure ulcers and alopecia, which can be avoided by using adequate padding and cushions 5.
- Injury to the brachial plexus, which can be prevented by avoiding non-neutral alignment of the head and arm abduction of ≥90° 5.