Patients treated with intensity-modulated radiation therapy (IMRT) for head-and-neck cancer are often positioned supine on a carbon fibre board to which a thermoplastic mask is attached to immobilise the head and shoulders. For patients unable to tolerate a supine position, we developed a tilting board that accommodates a full-scale head-and-shoulder mask.

Phantom measurements were obtained to confirm the dosimetric accuracy of our treatment planning system when using this board. A patient was simulated in the flat and tilted positions on the board. The two corresponding treatment plans were evaluated by comparing the target coverage and doses with organs at risk. The patient’s intra-fraction motion was quantified during his tilted treatments.

Phantom measurements confirmed the accuracy of the dosimetric calculations. The tilted plan met dosimetric standards for clinical acceptability. The intra-fraction motion of the patient in the tilted position was >3 mm in any direction.

The tilting board met clinical requirements for IMRT planning and delivery. Full-scale head-and-shoulder immobilisation was achieved in a more tolerable tilted position.