Prostate CyberKnife Rotations
We are currently on a Gen4 CyberKnife without a Robo Couch and are seeing large pitch rotations for our prostate patients. Because we do not see this for other treatment sites e.g. lung, I'm wondering if this is a circumstance of the standard CyberKnife couch being extended too far out? Do others see large rotation adjustments? If so, what do you do to correct them?
Comments
-
When we see the rotation is consistently too much for couch correction. We may ask pt to adjust the bladder filling and the filling may impact the rotation (heads-up or heads-down). If this does not work, we may have to re-plan
-
The prostate gland pitches with bladder and rectal filling. I have personally seen pitch rotations up to 45 degrees based on bladder filling. For this reason, it is important to establish a patient protocol to be followed from before imaging and planning to after treatment is completed. I suggest the following: low fiber diet start 2 - 3 days before imaging (continue until end of treatment), fleet enema 1 - 2 hours before imaging and treatment, after enema empty bladder followed by drinking 8 ounces of water and no urination until after the procedure is finished. With this protocol, we never had an issue with prostate pitch.
