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SURVEY ABOUT PATIENT POSITIONING & IMMOBILISATION

by the ESTRO Positioning & Immobilisation Focus Group

Dear ESTRO Members,
The ESTRO Positioning & Immobilisation Focus Group kindly asks for your contribution. We are launching a short survey to gather essential data on current guidelines and work instructions for setup, positioning, and immobilisation practices. Our goal is to identify existing gaps to improve patient care and radiation treatment quality across ESTRO.
In this survey we underline positioning, immobilisation and setup. To avoid misunderstanding we explain what this means:
Term / Definition
Positioning: Placing the patient in a comfortable, reproducible position by the RTT
Immobilisation: Using support tools to maintain the defined patient position
Setup: The final preparation for actual radiation treatment after positioning and immobilisation, using software and/or skin markings. This excludes position verification.
We need your contribution. By sharing information about your department, you will help us develop future recommendations and better inform the professional community. We request one response per institution where possible. If this is not feasible, we kindly ask that one representative from each profession within the institution completes the survey. Survey results will be published in scientific journals and presented at congresses.
The survey should take you approximately 15 to 25 min to complete. You can interrupt and continue filling out the survey or modify your responses at any time if you use the same computer (depending on cookie settings) until you press the submit button.
We understand the importance of confidentiality. The survey is anonymous, and the data will be stored on the password-protected Survey Monkey account belonging to ESTRO. Your responses will be used in summary form only to protect your confidentiality. Your individual responses will not be identifiable in any reports or publications. Due to the anonymity of the responses, it is not possible to withdraw from the survey after it has been completed. Only when you consent to share your protocols or state that you are willing to help with the review of guidelines you share your personal information.
Should you have any questions about the study, please feel free to contact Mirjam Mast at m.mast@haaglandenmc.nl. We are here to provide any information or clarification you may need.
Your voice is crucial for building a sustainable standard of care. Thank you for your time and expertise.
Sincerely,
IIlja Čurić and Mirjam Mast On behalf of the ESTRO Positioning & Immobilisation Focus Group
Section 1: Identification of existing work instructions
(3 questions)

1-Does your country have specific national guidelines for patient setup and positioning & immobilisation?
1a-If YES, could you specify which national guidelines exist? For setup and positioning & immobilisation separately?
1b-If YES, which tumour sites or techniques do these work instructions cover?
1c-What percentage of these national work instructions has your department implemented (or used as the basis of your own work instructions):
1d-If you do not have national work instructions, what do you use?
Please specify:
2-Do you think standardised international work instructions for setup and positioning & immobilisation are a good idea?
3-Are there barriers in your department to implement positioning & immobilisation work instructions?
3a-If YES, what are the main barriers in your department to implement positioning & immobilisation work instructions?
Section 2: specific positioning methods
A. Use of Bolus (3 questions)
1-If you use bolus, for which treatment sites or indications is bolus used?
2-Do you make use of 3D printed bolus based on the patient outline?
2a-If YES, for which treatment sites or indications
3-Does your department have specific work instructions or practices for positioning of bolus (3D printed and/or standard) during patient setup and treatment?
3a-If YES, is the positioning of the bolus (3D printed and/or standard) described in work instructions?
3b-If YES, would you be willing to share these work instructions? (please add your email address or send an email to m.mast@haaglandenmc.nl which keeps your other answers anonymous)
3c-Do you think standardised international work instructions for the use of bolus would be beneficial?
B. Use of tattoos (4 questions)
1-Do you use tattoos for positioning the patient?
1a-If YES, for which anatomical sites? How many tattoos do you use?
(open space for answer) [Example: breast: 4 tattoos, pelvic: 3 tattoos, etc.]
1b-If NOT, how do you setup the patient?
(the option “other” can be used for specifying the anatomical site-specific answers)
2-Does your department have work instructions in place for the use of tattoos?
3-Do you think standardised international work instructions for the setup of the patient using tattoos would be beneficial?
4-Do you think standardised international work instructions for the tatooless setup of the patient would be beneficial?
Section 3: Communication and patient education
(6 questions)
1-Are there work instructions within your department for the communication of positioning instructions to the patient?
2-Are there work instructions within your department for communicating preparation requirements to the patient (e.g., bladder filling or bowel preparation)?
3-How is information about positioning and immobilisation procedures communicated to patients in your department?(Select all that apply)
4-At what steps of the patient journey is the immobilisation procedure explained?
(Select all that apply)
5-I think most of my patients know that following the positioning/breathing instructions helps make their treatment more accurate
6-Do you think a standardised patient education tool should be developed to enhance cooperation during setup and Positioning & Immobilisation?
Section 4: Review of existing guidelines
(4 questions)
1-For which of the listed variables do you feel there is a lack of sufficient setup and positioning & immobilisation published work instructions or practical guidance?
(Please select all that apply and comment if possible)
2-Do you believe international published site-specific guidelines (e.g., head & neck, breast, pelvis) are necessary for setup and positioning & immobilisation?
3-In your opinion, which (inter)national work instructions require an update? Open space for answer
4-In your opinion what are the most common factors contributing to setup variability or errors in your department? (Select all that apply)

Patient-related
5-In your opinion what are the most common factors contributing to setup variability or errors in your department? (Select all that apply)

Technique/Device
6-In your opinion what are the most common factors contributing to setup variability or errors in your department? (Select all that apply)

Workflow/Staffing
7-In your opinion what are the most common factors contributing to setup variability or errors in your department? (Select all that apply)

Imaging/Technology
8-In your opinion what are the most common factors contributing to setup variability or errors in your department? (Select all that apply)

Guidance/Organisation
Section 5: Demographics
Could you please fill in this information?
Name of your National Society:
Country:
Name of your institute and city (to double check if more persons from your department have responded to this questionnaire):
What is your profession?
Would you be interested in contributing to or reviewing future guidelines or educational tools?
Thank you for your contribution on behalf of the ESTRO Positioning & Immobilisation Focus Group