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Instruction Manual

Disposable NB Board

! Supervised by:

Department of Radiology, Kyushu University Hospital

! Issued by:

Medical Systems Division

Engineering System Co., Ltd.

5652-83 Sasaga, Matsumoto

Nagano 399-0033 Japan

TEL: +81-263-29-2633

FAX: +81-263-29-2638

Date created: November, 2013 (Version 3.5.0)

Note The instructions provided in this manual are intended for reference only.

Following these instructions does not necessarily guarantee

high-precision radiotherapy.

It is essential for the institution to utilize its own mechanism for checking

and confirming the safety and precision of radiotherapy. It is at discretion

of the physician to make decisions regarding the administration of

treatment.

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Contents

¢ Read Before Use .................................................................. Page 3

¢ What Is Disposable NB Board? ............................................ Page 4

¢ Key Features of Disposable NB Board ................................. Page 4

¢ Step-by-step Guide to Using Disposable NB Board ............. Page 7

¢ Other Precautions ................................................................. Page 14

¢ Dedicated Arm Table (Optional) ........................................... Page 16

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Package contents

Read Before Use

* If there are any missing components, contact Engineering System Co., Ltd.

* The model number label is affixed on the outer surface of the package.

* For details about how to use Disposable NB Board, see Step-by-step Guide to Using Disposable NB Board on page 6

of this manual, or refer to the Treatment Procedure CD.

Base plate x 1

Anti-slip pad x 2

Hook-and-loop fastener x 20

Treatment Manual x 1

Treatment Procedure CD x 1

Package Insert x 1

ENB-16CB ENB-1600

Base plate x 1

Knee Support x 1

Anti-slip pad x 2

Hook-and-loop fastener x 20

Treatment Manual x 1

Treatment Procedure CD x 1

Package Insert x 1

Vacuum bag HN x 1 Thermo Plastic Sheet x 2

Fixation plate (small) x 1

Fixation plate (small) x 1

Fixation plate (large) x 1

Heel Support x 1 Heel Support x 1

Fixation plate (large) x 1 Knee Support x 1

1. The fixation plate (large) for fixing the side boards in place is stored inside the recessed area that is designed to hold a Knee Support.

2. Using the fixation plate (small), fix the Knee Support in place.

Place the Knee Support

inside the recessed area

with its shorter side facing

the head side.

Assembling Disposable NB Board (see also page 8.)

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What is Disposable NB Board? Disposable NB Board is a fixation device developed for use with image-guided radiotherapy (IGRT),

which is designed to immobilize the patient during treatment. Each of its components is made of

reinforced triple-layered cardboard with adequate strength and low X-ray absorption. It consists of a

section at which a vacuum bag is secured in place, side boards for securing a Thermo Plastic Sheet in

place, and a Knee Support.

Key Features of Disposable NB Board 1. You can fix the patient in three different positions to examine a lesion in the chest/upper

abdominal area or pelvic area.

By using a vacuum bag and a Thermo Plastic Sheet, you can fix the patient to the Disposable NB

Board in the following three different positions: supine position with the chest/upper abdomen area

immobilized, supine position with the pelvic area immobilized, and prone position with the pelvic area

immobilized.

1-1. Fixing the patient in supine position with the chest/upper abdomen area immobilized

A dedicated Arm Table or Arm Support is optionally available to fix the patient in supine position with

the arms positioned above the head. (For details, see Dedicated Arm Table (Optional) on page 14).

1-2 Fixing the patient in supine position with the pelvic area immobilized

* When immobilizing the chest/abdomen area of

the patient, remove the Knee Support packaged

with the NB board.

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* After the Thermo Plastic Sheet hardens, loosen it once,

and then stretch it down tightly again as the patient

exhales to ensure rigid immobilization.

* Use the Knee Support packaged with the NB

board.

Please exhale.

1-3. Fixing the patient in prone position with the pelvic area immobilized

2. You can compress and immobilize the thoracic-abdominal area.

Use the Thermo Plastic Sheet to immobilize the patient. As the patient exhales, tightly stretch and pull

down the Thermo Plastic Sheet over the thoracic-abdominal area, and fix the both ends of the Thermo

Plastic Sheet to the fixing parts on the NB board using hook-and-loop fasteners. It secures

immobilization of the thoracic-abdominal area and helps reducing respiratory displacement of internal

organs.

3. Low X-ray absorption

X-ray absorption is reduced by half compared to our conventional carbon base plate product

lines(Note).

4. Light-weight board

A Disposable NB Board weighs only 4 kg. It is lighter than carbon fixation devices, and can be

transported by a single person.

Note: Body Fixture System (SN Type) ESN-1800

Structure: CFRP board/acrylic foam/CFRP board = 1.5 mm/27 mm/1.5 mm

* When using a chest support or a leg support,

fix it in place using a hook-and-loop fastener

or the like.

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Precautions on using the NB board for treatment � Disposable NB Board does not have fixed external position coordinate systems.

Although you can mark the Thermo Plastic Sheet, the NB board, or other fixation devices, the markings might become misaligned when securing the Thermo Plastic Sheet in place. Note that you can only use such markings as rough indices.

� Disposable NB Board is a fixation device that is mainly intended for immobilizing the

patient. It does not guarantee precise positioning of a body part by means of external position coordinate systems. After fixing the patient in place with a Thermo Plastic Sheet, make sure to check the position of the patient using radiotherapy equipment such as a linear accelerator equipped with an image guided system.

� X-ray absorption by the base plate of Disposable NB Board is estimated at 1% to

2% when 4-10 MV X-ray is used. However the actual X-ray absorption varies depending on the X-ray incidence angle. In addition, X-ray beams passing through the tabletop or side boards result in greater X-ray absorption. It is advised that the institution using the NB board consider adjustments of X-ray absorption.

� When storing the NB board, place the NB board on a flat surface. Due to the material of the NB board, resting the NB board against the wall or other similar structure for a long time with the NB board placed in a longitudinal orientation can cause the NB board to become distorted. If you have no choice but to rest the NB board against the wall or other similar structure, place the NB board in a transverse orientation.

� Disposable NB Board is made of cardboard. Be careful not to cut your

fingers or hands on the edge of the NB board. When the patient’s skin comes in direct contact with the Knee Support, it can cause pain to the patient. To prevent this, place a towel or other cloth over the Knee Support.

Notes � Although a reinforced triple-layered cardboard offers great strength, its durability is

limited. After repeated use, the NB board can become degraded. Each NB board must therefore be used for a series of treatments administered to a specific patient.

� Before each use, always check the NB board thoroughly for damage (such as cracks)

or degradation.

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Step-by-step Guide to Using Disposable NB Board 1. Preparing a Thermo Plastic Sheet

(1) Cut a Thermo Plastic Sheet to the length enough for the patient’s body thickness.

(2) Attach the frames packaged with the NB board on the four corners of the Thermo Plastic Sheet.

* When heated, the frames stick to the plate.

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Notes Attach the hook-and-loop fasteners to the frames immediately before use.

Heating the Thermo Plastic Sheet with the hook-and-loop fasteners already attached

causes the adhesive agent to leak out from the hook-and-loop fasteners.

(3) Use a hot plate to heat the Thermo Plastic Sheet.

(4) Position the patient on the vacuum bag (for details, see 2. Assembling Disposable NB Board). After

confirming that the Thermo Plastic Sheet is sufficiently heated, attach the hook-and-loop fasteners

packaged with the NB board to the plastic frames.

Notes When you heat the Thermo Plastic Sheet using a hot plate,

place the frames with the flat side facing upward.

Later on, you will attach hook-and-loop fasteners on this

side of the frames on the hot plate.

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(5) Follow the procedure described in 4. Fixing the Thermo Plastic Sheet in place to proceed in

immobilizing the patient by fixing the Thermo Plastic Sheet in place.

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2. Assembling Disposable NB Board

This section shows an example of how to assemble A Disposable NB Board when placing a patient in

supine position with the pelvic area immobilized (see also Read Before Use on page 2).

(1) Attach the Knee Support to the NB board.

(2) Lift up the side boards, and attach the fixation plate (large) to the NB board.

(3) If necessary, attach the Heel Support to the NB board using the hook-and-loop fasteners packaged

with the NB board.

* The fixation plate (large) has two grooves to which the

vacuum bag is fixed.

* Place the Knee Support inside the recessed area on

the NB board with its shorter side facing the head

side.

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3. Placing the vacuum bag on the NB board and evacuating air from the bag to hold the

patient’s body in place

(1) Place the vacuum bag on the NB board.

(2) Lay the patient on the vacuum bag, and then evacuate air from the bag to hold the patient’s body in

place.

Notes While evacuating air from the vacuum bag to hold the patient’s body in place, make sure

that the edges of the bag do not protrude over the side boards. If they do, it will be difficult

to stretch and tighten the Thermo Plastic Sheet to immobilize the patient effectively.

In order to apply sufficient tension

The vacuum bag must not protrude over the side board.

Protrusion is acceptable beside the side board.

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4. Fixing the Thermo Plastic Sheet in place

(1) Attach the Thermo Plastic Sheet you have prepared in 1. Preparing a Thermo Plastic Sheet to the

NB board.

(2) Stretch down the Thermo Plastic Sheet over the patient’s thighs to form the shape of the patient’s

thighs.

(3) Use a cold towel or other cold object to cool the Thermo Plastic Sheet until it hardens.

Note After the Thermo Plastic Sheet hardens, you have to re-tighten the sheet further as the

patient exhales. To do this, be sure to leave some margin from the bottom when affixing the

frames (to which hook-and-loop fasteners are attached) of the Thermo Plastic Sheet to the

side boards.

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(4) When the Thermo Plastic Sheet hardens, slightly loosen it, and then re-tighten it over the patient’s

body as the patient exhales.

(5) Mark the isocenter or other reference point for CT on the Thermo Plastic Sheet, vacuum bag, or NB

board.

(6) Perform a CT scan or other imaging procedure to establish a treatment plan.

(7) After a CT scan, remove the Thermo Plastic Sheet, and then mark the patient’s body surface or the

NB board as necessary.

* As reference points for radiotherapy, mark the

hook-and-loop fasteners to facilitate easy setup.

Please exhale.

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Other Precautions 1. Preventing the side boards from bending inward

Attaching the Thermo Plastic Sheet to the side boards may cause the side boards to bend inward (in

the direction indicated by the arrow in the below photo). To prevent this, take the steps described below.

Place the fixation plate (small) for the Knee Support on top of the fixation plate (large).

Because you will be stacking two fixation plates on top of one another, carefully select where to place

the fixation plate (small) taking into account (1) the posture as well as the position of the lumbar region of

the patient and (2) the irradiation direction and the dose of radiation.

Finally, attach the Knee Support to the NB board.

Applying pressure to the thoracic-abdominal area can affect respiration in patients with

impaired lung function. Carefully observe the status of the patient after immobilization. If

the patient tells about or shows a difficulty in breathing, relieve some pressure, put a

respiration monitor on the patient, or take other necessary measures.

Notes

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2. Using anti-slip pads

To prevent Disposable NB Board from slipping on the couch top, make sure to place the anti-slip pads

packaged with the NB board between the couch top and the NB board.

The institution using the NB board must carefully select where to place the anti-slip pads to avoid

interference with X-ray irradiation, and not to prevent the operator from effectively fine-tuning the X-ray

beam position.

3. Using an index bar

The base plate has a groove that accepts an index bar that comes with a therapy unit or other

treatment apparatus. You can use the index bar to securely position the NB board over the couch top.

The groove is provided only at the head side of the NB board. To secure the foot side of the NB board in

place, use the anti-slip pads.

Notes Because the base plate is made of reinforced cardboard, use an index bar only

as a reference when positioning Disposable NB Board over the couch top.

Be sure to confirm that the NB board is properly positioned before starting the

treatment.

Notes

注意 Although the steps described above can help prevent the side boards from bending

inward to some degree, it will allow more pressure to be applied to the

thoracic-abdominal area.

Carefully observe the respiratory status of the patient and be careful not to apply too

much pressure to the patient.

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4. Precautions on performing treatment using Disposable NB Board

As mentioned earlier in this manual, Disposable NB Board does

not have fixed external position coordinate systems. Although

marking the isocenter on the base plate or other part of the NB

board as a reference may be significantly useful in determining the

position of the target, the markings might become misaligned due

to the way the base plate is mounted. Before starting the treatment,

always check the position of the target using a therapy unit

equipped with an image-guided system.

Dedicated Arm Table (Optional) We offer an optional Arm Table that can be used with Disposable NB

Board. It is made of the same reinforced cardboard material as the

base plate, which is reasonably priced, has low X-ray absorption, and

offers great strength.

Use the hook-and-loop fasteners packaged with the Arm Table to

attach the Arm Table to the base plate.

1. Using the Arm Table

Check the location for mounting the Arm Table, and then attach the hook-and-loop fasteners

packaged with the Arm Table to the NB board.

Adjust the position of the hand grips to ensure that the patient’s arms are

properly positioned above the head.

You can use a treatment pillow or towel to support the patient’s head.

Use of a vacuum bag to support the patient’s head helps immobilizing the

patient more effectively (see the left photo).

* Use of an optional vacuum bag HN (length: 1500 mm) helps forming the bag to fit the contour of the

patient’s body from head to toe.

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2. Using Arm Support

You can use an Arm Support (model number: ESF-18, optional)

instead of an Arm Table.

Fix the Arm Support to the base plate using hook-and-loop fasteners

(see the photograph to the left) or anti-slip pads.

Notes � Like the NB board, the Arm Table can also become degraded after repeated use. Each Arm

Table must therefore be used for a series of treatments administered to a specific patient.

� Before each use, always check the Arm Table thoroughly for damage (such as cracks) or

degradation.

� The Arm Table is made of cardboard. Be careful not to cut your fingers or hands on the edge of

the Arm Table. When the patient’s skin comes in direct contact with the Arm Table, it can cause

pain to the patient. To prevent this, place a towel or other cloth over the Arm Table.