What Is a Radiotherapy Mask?

Radiotherapy mask is used during cancer treatments, particularly for head, neck, and brain cancers, to keep the patient still and ensure precise radiation delivery. Made from thermoplastic material, the mask softens when heated and molds to the patient’s head and neck.

While the mask helps improve treatment outcomes, some patients may experience discomfort or anxiety due to its tight fit and potential claustrophobia. However, the benefits of precise radiation delivery generally outweigh these challenges, and communication with healthcare teams, along with relaxation techniques, can help ease discomfort during treatment.

How Does a Radiotherapy Mask Work?

A radiotherapy mask works by securely holding the patient in place during treatment. It is made from thermoplastic material, which becomes soft when heated. Once softened, the mask is placed over the patient’s head and molded to fit perfectly around the face and neck. As it cools, the mask hardens, creating a firm but comfortable fit. This helps prevent any movement during radiation sessions, ensuring the patient stays in the exact same position each time.

The mask helps to align the area being treated, ensuring that the radiation is directed exactly where it’s needed, while minimizing exposure to surrounding healthy tissues. This improves the effectiveness of the treatment and reduces side effects.

What Are the Main Types of Radiotherapy Masks?

Thermoplastic Masks

Thermoplastic masks are commonly used for patients undergoing radiotherapy for head, neck, and brain cancers. The mask is made from a material that softens when heated and becomes pliable, allowing it to mold to the patient’s face and neck. Once it cools, the mask hardens, ensuring a secure fit. This type of mask is often preferred because it can provide a precise fit, ensuring that the patient remains in the same position during each treatment session, which is crucial for accurate radiation delivery.

Perspex mask

A Perspex mask is created by first applying cream to your face, followed by placing strips of plaster of Paris bandage on top to form a mold. The mold sets in a few minutes and is then removed to create the Perspex mask.

Foam padding

Another  component in the creation of radiotherapy thermoplastic masks is foam padding, which is positioned between the mask and the patient’s skin. This padding is intended to enhance comfort and minimize the chances of skin irritation or pressure sores, which can develop if the mask lacks adequate cushioning.

Radiotherapy Mask Side Effects: What Should You Expect?

Pressure marks are a common side effect, caused by the mask pressing against the skin, particularly on the forehead, chin, and neck. These marks are usually temporary and fade after treatment. Adjustments to the mask’s fit can help alleviate this issue. Prolonged contact with the mask can lead to skin irritation, resulting in redness or discomfort. Using padding or ensuring the mask is properly fitted can reduce irritation. If the skin irritation persists, it’s important to consult your healthcare team for advice. Some patients experience feelings of anxiety or claustrophobia due to the mask’s tight fit and the need to remain still during treatment. Relaxation techniques, breathing exercises, or even discussing your concerns with the radiotherapy team can help ease anxiety.

Managing Side Effects

To minimize pressure marks, ensure that the mask fits properly and isn’t too tight. If marks appear, they usually disappear shortly after treatment. For irritation, ask the radiotherapy team to check if the mask is causing friction, and they may recommend soothing creams or adjusted padding.  If you feel anxious or claustrophobic, communicate with your healthcare provider. They may offer strategies like deep breathing or take steps to make the experience more comfortable for you.

Pros and Cons of Radiotherapy Masks

Advantages

The primary benefit of radiotherapy masks is that they ensure the patient remains completely still during each session, leading to more accurate and consistent radiation delivery. This precision helps target the cancerous area more effectively, which improves treatment outcomes and reduces the risk of radiation affecting healthy tissues. By keeping the patient’s position fixed, the mask allows for precise targeting of radiation beams, ensuring that the intended area receives the full dose, while minimizing exposure to surrounding healthy tissue. This is particularly important for head, neck, and brain cancers.

Disadvantages

The mask, particularly when it is molded tightly to the face and neck, can cause discomfort during treatment. Some patients experience pressure on their face, especially on the forehead and chin. However, adjustments can be made to improve comfort.  The tight fit of the mask, coupled with the requirement to remain still for an extended period, can cause feelings of anxiety or claustrophobia for some individuals. Patients may feel trapped or unable to move during treatment, which can be distressing.

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What Are the Risks or Complications of Using a Radiotherapy Mask?

Potential Risks

A poorly fitted radiotherapy mask can cause discomfort or skin irritation, leading to pressure sores or excessive pressure on the face and neck. This can affect the patient’s ability to remain still during the procedure, potentially compromising treatment accuracy.  If the mask does not fit securely or adequately support the patient’s head, it can result in slight movement during the radiation treatment. Even minimal movement may lead to the misalignment of the radiation beams, reducing the precision of the treatment and possibly affecting its effectiveness. This can be a particular concern in treatments requiring high precision, such as those for head and neck cancers.

Managing Risks and Complications

It’s essential to ensure that the mask fits correctly before starting treatment. The healthcare team will assess the fit and make any necessary adjustments to ensure a secure and comfortable position. In some cases, modifications can be made to accommodate patient comfort and prevent discomfort or pressure sores. If any issues with mask alignment arise, the healthcare team can recheck the positioning to ensure that radiation is being delivered accurately. The treatment team may also use imaging techniques to verify that the mask and patient’s position remain consistent across sessions.

How to Prepare for a Radiotherapy Mask Fitting

 During the radiotherapy mask fitting, patients will be required to remain still while the mask is molded to their head and neck. The process ensures a precise fit, which is essential for immobilizing the patient during treatment. The technician will start by applying a soft, warm thermoplastic material over the patient’s head. This material is pliable when heated and will mold to the shape of the patient’s face as it cools. The fitting process typically involves applying the mold over the face, where it will harden as it cools. This can take a few minutes. A foam padding might be used to ensure comfort and reduce pressure on the skin, helping to prevent irritation or sores during treatment.

 It’s essential that patients remain calm and still throughout the fitting. The mask must fit accurately for the treatment to be effective, so any movement could result in an improper fit, affecting the treatment’s precision.

Tips for Patients with Anxiety

If feeling anxious, try focusing on slow, deep breaths to help calm nerves and maintain stillness. Let the healthcare team know if you feel uncomfortable or anxious. They may be able to make adjustments to improve comfort or offer reassurance.  Patients can practice relaxation techniques like visualization, where they imagine a peaceful setting or focus on positive thoughts during the fitting. Once the mask has been fitted and cooled, the technician will make any final adjustments to ensure it is snug but comfortable. Small holes may be added for breathing to reduce discomfort during treatments.

 The mask will be carefully removed, but it will be ready for use in future sessions. Patients will not wear the mask during the fitting, but they will wear it during every treatment session, which may last several weeks.

In 2024, Keane et al., published in the Radiotherapy and Oncology journal, conducted a single-center randomized self-controlled clinical trial comparing patient discomfort and immobilization performance between open-face and closed immobilization masks in cranial radiotherapy. The study included 30 patients with brain tumors who underwent treatment plans with identical dose prescriptions, alternating between open-face and closed masks during their course of radiotherapy. Results demonstrated that open-face masks significantly reduced discomfort, anxiety, and pain based on visual analogue scale (VAS) scores. Closed masks caused more discomfort in the infraorbital and maxillary areas. Most patients (27 out of 29) preferred the open-face masks. While interfraction positional shifts varied between mask types, intrafraction variability showed no difference. The study concluded that open-face masks enhance patient comfort without compromising immobilization accuracy.

Managing Claustrophobia and Anxiety While Wearing a Radiotherapy Mask

 It’s common for patients to feel anxious or claustrophobic while wearing a radiotherapy mask. The mask is designed to fit snugly over the face and head, which may feel restrictive or uncomfortable for some, especially during long treatment sessions. Claustrophobia is a common response to the mask’s tight fit and the fact that it covers the face. However, it’s important to recognize that the mask is essential for immobilizing the patient, ensuring the precise delivery of radiation and minimizing damage to surrounding healthy tissues.

 Open communication with the medical team is vital. Patients should feel comfortable expressing their concerns or feelings of anxiety before and during the treatment process. The team can offer reassurance, make adjustments to the mask, or implement strategies to improve comfort. Mental health support can also be provided by professional counselors or support groups who specialize in helping patients manage anxiety during cancer treatment. These resources can offer coping strategies and help patients address feelings of fear and stress.

 Relaxation Techniques

Breathing exercises can be effective in calming the mind. Slow, deep breaths help reduce anxiety and maintain stillness, which is critical during radiotherapy sessions. Visualization is another helpful technique. Patients can visualize a calming scene or focus on a pleasant memory to distract themselves from feelings of discomfort or panic. Progressive muscle relaxation is another option, where patients can mentally focus on relaxing each muscle group, helping to release physical tension associated with anxiety.

Practical Steps for Comfort

Before the actual radiotherapy session, patients can ask to see the mask and even try it on briefly to get accustomed to the feeling. Some patients may feel more comfortable once they have a better understanding of what to expect.  The healthcare team can make minor adjustments to the mask to improve fit or reduce pressure points. Foam padding may be used to enhance comfort and reduce irritation.  Patients can request to listen to soothing music or bring personal items, like a favorite blanket or photo, to help them feel more at ease during treatment.

 It can be helpful for patients to talk to others who have had similar experiences. Hearing from individuals who have successfully managed anxiety while wearing a radiotherapy mask can offer reassurance. The healthcare team may also provide patients with information about how the mask enhances the effectiveness of the treatment, reassuring them that the discomfort is temporary and part of the process aimed at better outcomes.

 After each session, patients should be encouraged to discuss any feelings of anxiety or discomfort. Continuous support can help identify strategies that may work best for the individual patient’s needs.

What Are the Signs Radiotherapy Mask Is Working?

One of the primary indicators of treatment effectiveness is a reduction in tumor size. Follow-up imaging, such as CT scans or MRI, is used to assess whether the tumor has shrunk after treatment. A decrease in the size of the tumor suggests that the radiotherapy is successfully targeting and damaging cancer cells, leading to tumor control.

 In many cases, radiotherapy masks are used for palliative care, particularly in head and neck cancers. Signs of improvement include reduced pain, improved swallowing, or relief from obstruction symptoms caused by the tumor. For instance, patients with throat or oral cancers may experience less difficulty swallowing or reduced bleeding, indicating that the tumor has shrunk or is less aggressive.

 As the tumor shrinks and symptoms improve, many patients report a better quality of life. This could include feeling more comfortable, having more energy, or being able to return to normal activities with fewer limitations. Patient-reported outcomes are crucial for assessing overall improvement in well-being.

Typically, follow-up evaluations are conducted a few weeks after the completion of the radiotherapy course to monitor early changes in tumor size and symptom relief. Additional imaging may be scheduled 3 to 6 months after treatment to assess longer-term effects. It’s important to understand that radiotherapy can continue to work after the last session, as tumor cells may die over time. Hence, improvements may not be immediately evident right after treatment ends.

 If progress isn’t as expected, adjustments to the treatment plan may be considered. These could include additional treatment sessions, changes in the radiation dose, or considering other therapies. The healthcare team monitors the patient’s response closely, and these adjustments are made to optimize treatment success.

Comparison: Radiotherapy Masks vs. Other Immobilization Devices

The thermoplastic material used for masks molds comfortably to the patient’s face, allowing them to remain still during treatment while minimizing discomfort. This precise immobilization is critical in ensuring the accuracy of radiation delivery, particularly for tumors near sensitive structures like the brain or spinal cord. For treatments involving the head and neck, where even slight movement can significantly affect the accuracy of radiation, radiotherapy masks provide a secure fit, ensuring that the patient remains in the correct position throughout all sessions.

 Other immobilization devices used in radiation therapy include vacuum cushions, plaster casts, and body molds. These devices are used for various parts of the body but may not offer the same level of precision for head and neck areas. For example:

Vacuum cushions

These are used to immobilize larger parts of the body, such as the torso or pelvis. While effective in other body areas, they lack the fine control required for head or neck positioning.

Plaster casts and body molds

These can be used for immobilizing parts of the body but tend to be less comfortable than thermoplastic masks. They are also less adjustable and may not provide the same level of comfort or precision for head and neck tumors.

To read more about who is radiation oncologist read special article by OncoDaily.

Innovations in Radiotherapy Masks

 Recent advancements in the design of radiotherapy masks have led to the use of more breathable materials. These innovations aim to enhance patient comfort during the treatment process. New thermoplastic composites and ventilated masks allow for better airflow, which helps reduce discomfort and the feeling of suffocation that some patients experience when wearing traditional masks. The use of lighter, more flexible materials has also improved the fit of the masks, making them more adaptable to different facial structures and reducing pressure on sensitive areas of the face, which can lead to discomfort or irritation.

 To improve patient comfort and manage anxiety during treatment, newer mask designs incorporate features such as softer edges and more ergonomic shapes. These are designed to minimize discomfort and prevent pressure sores, especially during longer sessions. Innovations also focus on reducing claustrophobia, with modifications such as clear, transparent mask materials that allow the patient to see out more easily, and lightweight designs that create a less restrictive feeling during the procedure.

Pham et al. (2018) in SAGE Journals evaluated the accuracy of 3D-printed head models for radiotherapy immobilization. Using CT scans of 11 brain tumor patients, they created and assessed 3D-printed head and neck rests. Comparisons with original CT volumes showed high similarity (Dice coefficient: 0.985, Hausdorff distance: 0.9 mm). Mean angular deviations for Pitch, Yaw, and Roll were 1.1°, 0.59°, and 0.79°, respectively. Dosimetric differences were minimal. The study suggests that 3D-printed models could help frail patients avoid CT-simulation and mask molding for palliative whole-brain radiotherapy.

How Much Does a Radiotherapy Mask Cost?

: The type of cancer being treated can influence the cost of the mask. For example, cancers in areas requiring more precise immobilization, such as head and neck cancers, may lead to the use of more advanced, custom masks that increase the cost. Pediatric patients, who may require specially designed masks to accommodate their smaller facial structures, could also incur higher costs.  The complexity of the treatment can affect the mask’s cost. Treatments involving sensitive areas, such as the brain or spine, may necessitate more advanced mask designs that further raise the price.

Insurance coverage for radiotherapy masks varies by provider and plan. In most cases, health insurance covers the cost of radiotherapy masks as part of the overall treatment for cancer. However, the coverage may depend on the specific plan, the type of cancer, and whether the mask is considered medically necessary for the treatment. It’s advisable for patients to check with their insurance provider to confirm coverage details before proceeding with the fitting. Patients with private insurance are more likely to have the cost of the mask covered, but those with government-funded healthcare plans may need to consult with their healthcare provider to determine if the cost is included.

For patients facing high out-of-pocket expenses, there are several financial assistance programs available. Many cancer centers offer financial counseling to help patients navigate the costs of their treatment, including the cost of radiotherapy masks. Some hospitals or cancer treatment centers may have payment plans to spread the cost over time or provide discounts for patients with financial hardships.  Additionally, there are non-profit organizations that assist with cancer-related expenses, including mask costs, through grants or fundraising efforts. For patients who are uninsured or underinsured, it’s important to inquire about hospital-based programs that could potentially offer reduced pricing or additional support.

Written by Aren Karapetyan, MD