Supine proton beam craniospinal radiotherapy using a novel tabletop adapter

To develop a device that allows supine craniospinal proton and photon therapy to the vast majority of proton and photon facilities currently experiencing limitations as a result of couch design issues. Plywood and carbon fiber were used for the development of a prototype unit. Once this was found to be satisfactory after all design issues were addressed, computer-assisted design (CAD) was used and carbon fiber tables were built to our specifications at a local manufacturer of military and racing car carbon fiber parts. Clinic-driven design was done using real-time team discussion for a prototype design. A local machinist was able to construct a prototype unit for us in <2 weeks after the start of our project. Once the prototype had been used successfully for several months and all development issues were addressed, a custom carbon fiber design was developed in coordination with a carbon fiber manufacturer in partnership. CAD methods were used to design the units to allow oblique fields from head to thigh on patients up to 200 cm in height. Two custom-designed carbon fiber craniospinal tabletop designs now exist: one long and one short. Four are in successful use in our facility. Their weight tolerance is greater than that of our robot table joint (164 kg). The long unit allows for working with taller patients and can be converted into a short unit as needed. An affordable, practical means of doing supine craniospinal therapy with protons or photons can be used in most locations via the use of these devices. This is important because proton therapy provides a much lower integral dose than all other therapy methods for these patients and the supine position is easier for patients to tolerate and for anesthesia delivery. These units have been successfully used for adult and pediatric supine craniospinal therapy, proton therapy using oblique beams to the low pelvis, treatment of various spine tumors, and breast-sparing Hodgkin's therapy.