Evaluation of the Position Error of Wearing Surgical Masks During Radiotherapy in Head and Neck Cancer Patients

Purpose: Wearing a mask during the coronavirus disease 2019 epidemic (COVID-19) is a preventive way to reduce droplet and aerosol transmission. The purpose of this study was to evaluate the position error of wearing a surgical mask during radiotherapy in head and neck cancer patients.Patients and Methods: We collected and analyzed 2351 kV X-ray image records of 81 patients with head and neck cancer who underwent image-guided radiotherapy (IGRT). Patients with/without a surgical mask were divided into the head-neck (HN) mask group and head-neck-shoulder (HNS) mask group. The position error in the X (left-right), Y (superior-inferior), Z (anterior-posterior), 3D (three dimensional) vectors, as well as the pitch and yaw axes were compared between the four groups.Results: We found that patients wearing surgical masks in the HN mask group showed no significant differences in the mean position error of the different types of headrest (p>0.05). In the HNS mask group, only the type C headrest group showed significant differences (P < 0.05). The X axis values were -0.05 +/- 0.07 and -0.11 +/- 0.01 cm (P = 0.04), and the pitch axis values were 0.34 +/- 0.29 degrees and 0.83 +/- 0.08 degrees (P = 0.01).Conclusion: The mean position error of most patients wearing surgical masks was not greater than patients without a surgical mask. Patients wearing while receiving treatment is a low-cost and easy-to-implement prevention method.