Quality control of custom block making in radiation therapy

A self-correcting method for improving the precision of beam blocks

A technique for manufacturing precise custom blocks is described. Using the tracing stylus of the mold making machine, reference markers are cut into the lateral borders of the polystyrene mold after the cavities for the blocks have been made. These markers are aligned with the central ray cross hair of the shadow tray when the blocks are mounted on the tray. The ability of the technique to enhance precision has been verified in laboratory tests by intentionally introducing small imperfections into a mold making machine and checking the positional accuracy of the mounted blocks. The clinical performance has been tested by evaluating 47 check films of blocks for 16 randomly selected patients. The average positional error of individual blocks, projected to the isocenter, was less than one mm. The average time needed to cut the reference markers was 25 seconds. Implementing the technique required only minor modifications of a commercial mold making machine.

A standardized block fabrication technique

The accuracy of delivered dose is a primary goal in every radiation therapy department. Improved imaging techniques now enable the radiation therapist to define more precisely the area of interest, which helps the sparing of normal surrounding tissue. Tray-mounted customized blocks are routinely used to define this treatment portal accurately and reproducibly. However, the level of accuracy is dependent on the block fabrication technique and the skill of the block cutter. We at Moffitt Cancer Center have standardized our system in a way that minimizes some of the human errors, while keeping the procedure fast and accurate. This system uses a tray template that simulates our blocking trays. The function of this tray is to position the styrofoam (and therefore the cerrobend block) on the tray in such a way as to insure proper alignment with the treatment machine. We also feel this improves upon some common designs using random holes or hole patterns, which may interfere with the treatment area. This system is not overly sophisticated and can be easily implemented in most radiation therapy departments.