How to Set Up Your AIO Solution for Maximum Efficiency: Therapist Q&A

Wijnegem, May 29, 2024 – Kelli Gilliland, Lead Radiation Therapist and Clinical Coordinator at Good Samaritan Regional Medical Center (Corvallis, OR), discusses how the team is using the new Orfit All-in-One Solution® at her center. Good Samaritan is a network of hospitals, clinics and health services caring for nearly 300,000 residents in the mid-Willamette Valley and central Oregon Coast. The clinic has two linear accelerators – a VitalBeam and a TrueBeam – and is staffed by a team of three physicians. The cancer program is accredited by the Commission on Cancer (CoC) and the National Accreditation Program for Breast Centers (NAPBC). The radiation oncology department is ACR accredited and working toward APEx accreditation.

What types of cases and treatments are best suited for the Orfit AIO Solution?

We currently use our AIO positioning and immobilization solution for head-and-neck cancers, SRS/SRT whole and partial brain cancer, as well as lung, breast and abdominal cancers. For most abdominal treatments and lower lobe lung nodules, we will use the AIO solution with a pelvic mask to create a compression setup. We also use AIO for any bone cancer treatments above the lumbar spine where we need the patient’s arms up. We prefer the AIO cushions in this setup because there are a lot of configurations and the cushions are very soft to keep the patient comfortable. It’s very easy for our therapists to position our patients using AIO and easily reproduce the position for each fraction.

Can you briefly describe some of your setups?

Before using Orfit, we would use a wingboard for all of our chest and abdomen setups. Now we are using the AIO for these, which provides much greater patient comfort and reproducibility. When the patient is lying flat, the AIO Solution has many customizable options for the handlebars and headrests to make it more accessible for patients as well.

When the patient needs to be elevated we have the option of a 5-degree elevation, 10-degree elevation, or a 15-degree elevation (a 5-degree wedge plus a 10-degree wedge). Elevation helps when patients are unable to lay flat or we need breast tissue to fall more inferiorly.

We used to use the VersaBoard for all of our head-and-neck and brain setups, and the Ultra VersaBoard for our SRS/SRT setups, but now we use the AIO Solution exclusively for these cases.

The AIO Solution also is used for head-and-neck cases, with the neck extended using a 9-degree wedge under the headrest with a 5 Pt hybrid mask with no nose holes. The 5 Pt hybrid masks have a double layer around the chin and forehead, which helps keep the patient’s pitch and roll to a minimum.

For brain cases, we use the 3 Pt hybrid mask. For SRS’s, we add Orfit’s Thermofit custom head support behind the patient’s head.

We did not have the capability to perform compression before we had the AIO Solution and would often have these patients attempt a deep inspiration breath hold treatment, which was not feasible for all patients.

Our setups for compression look like the photos below using a 4 Pt Pelvic mask. We used to put CT markers on the mask just as extra information for Dosi but we no longer use those. This setup allows the patient to breathe, but only with shallow breaths to minimize tumor movement.

Can you highlight some of the benefits of the Orfit AIO Solution you like best?

What we like best about the AIO Solution is that we can keep it on the table for most of our patients and don’t have to switch equipment all the time. Our patients prefer the Orfit masks instead of the other masks we have used. The Orfit masks provide great immobilization while feeling less restricting and claustrophobic.

What about some tips and tricks you would like to pass along to others getting started with the Orfit AIO Solution?

Make sure you are aware of your table longitudinal limit while using the AIO Solution for treating abdomens or upper lumbar spines. The reason is the handlebars tend to push the patient down the table a bit. We will often times index our AIO board up higher than we usually do for these cases so that we are able to access the patient more inferiorly without hitting our table limit.

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