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Topic: Prone Position

Forum: Radiation Therapy - Before, During, and After —

What to expect from treatment and ways to cope with side effects.

Posted on: Feb 9, 2018 10:57PM

Veeder14 wrote:

Anyone getting radiation in the prone position? Is it like being in the MRI for a biopsy?

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Feb 9, 2018 11:51PM VLH wrote:

My biopsy wasn't done in an MRI, but I'm very claustrophobic and was still able to do prone position. The descriptions I've heard of the type of biopsy you describe, patients are positioned on a very firm surface during the biopsy. Equipment probably varies from facility to facility, but my facility had a pink foam surface with a cutout for the affected breast. If you do a Google search and look at images, you'll see some possible positioning options. If not for my badly encapsulated/frozen shoulder, the procedure would have been totally painless. Even with the shoulder pain, the procedure was quick enough after the initial mapping and rehearsal that it was definitely bearable. Good luck!

Lyn

Dx 5/20/2016, IDC, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Surgery 7/14/2016 Lumpectomy: Left Dx 7/18/2016, DCIS, Left, Stage 0, Grade 3, 0/3 nodes Surgery 7/25/2016 Lumpectomy: Left Chemotherapy 10/10/2016 AC + T (Taxol) Radiation Therapy 9/5/2017 Whole-breast: Breast
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Feb 10, 2018 12:11AM Veeder14 wrote:

Thanks VLH,

Yeah, I was wondering about cushioning because for the MRI and MRI biopsy that plastic thing just killed my ribs. I'm glad to hear that your facility had some padding available. I even brought strips of memory foam to put on the plastic edges, which the radiologists let me use. It was still a very hard surface. How long would you actually be laying down? I can deal with 15-20 minutes but the MRI's were 45-1 hour and just miserable on my back/neck.

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Feb 10, 2018 01:13PM Dauna wrote:

I was initially in the prone position. Most unfortunately, and painfully, I wound up breaking ribs three different times. I actually had to spend some 4 or 5 days in the hospital. I had been breathing so shallowly that my lungs were filling with fluid. A resperologist helped me to recover.

When my radiation resumed I was placed on my back.

Very best wishes

Dauna

Surgery 7/19/2015 Lumpectomy: Right; Lymph node removal: Sentinel
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Feb 10, 2018 01:25PM Veeder14 wrote:

Hi Duana,

I'm sorry to hear that you got cracked ribs from treatment and hope your ribs have recovered. I broke a rib after a fall once. and know how painful that is. I noticed during the 4 breast MRI's I had over 6 weeks time frame that I couldn't breathe very deep or they would say the pictures are blurry.

About how long were you on the table for each treatment?

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Feb 13, 2018 10:27AM VLH wrote:

Cracked ribs? How terrible!

Veeda, the sessions were very short, maybe 5 minutes? Once they do the tattoos during mapping and you become accustomed to the procedure so getting your positioning right becomes easier and easier, the actual radiation is fast. I should note that my treatment was only whole breast; that is, I didn't require radiation to the lymph nodes.

Lyn

Dx 5/20/2016, IDC, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Surgery 7/14/2016 Lumpectomy: Left Dx 7/18/2016, DCIS, Left, Stage 0, Grade 3, 0/3 nodes Surgery 7/25/2016 Lumpectomy: Left Chemotherapy 10/10/2016 AC + T (Taxol) Radiation Therapy 9/5/2017 Whole-breast: Breast
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Feb 13, 2018 11:15AM Veeder14 wrote:

Thanks VLH,

My lymph nodes were clear so hopefully I only have whole breast. I thought the breast tissue does go up near your arm pit. I've a seroma still and I'll see about getting that drained ahead of time.

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Apr 9, 2018 01:49PM OwMahBoob wrote:

Dauna! Same here!! I'm starting week 3 of prone breast radiation today. A week ago today, during the treatment, I had an excruciating pain in my rib (not from the radiation - from the ridiculously hard table). I couldn't move or flinch because I was in the middle of being zapped with the radiation. Afterwards, I told the technicians and they said that all the women complain about rib bruising. I said "it was not a bruise - something broke".

I spoke to the doctor, who sent me for rib x-rays - which didn't show anything. But rib fractures don't always show up on x-rays. The doctor said that since there is no treatment for fractured ribs (they don't tape it up or anything), they would continue to do the radiation sessions the same way whether the rib was broken or not. So I have, indeed, continued lying on the rib for my radiation sessions all this past week. I was in agony this weekend. But the alternative would be having them re-simulate my therapy in a supine position and doing the radiation on my back. Since I'm large-breasted and the tumor was in my left breast, close to the chest, there is no way that I want to do supine radiation. So I'm forced to "tough it out". I hate this.

I'm not 100% sure that it's the bone itself that is broken or the cartilage surrounding the rib. Apparently, they are both excruciating and take a while to heal.

I googled pictures of prone breast radiation and saw some beautiful comfortable-looking tables (including cushioned face cradles - mine is just a flat board and I have to turn my poor neck all the way to the side). I showed the pictures to the doctor and she said that a number of the manufacturers have been demonstrating those types of tables to the hospital staff but the staff members don't feel that these tables would work appropriately. Of course they could simply explain the shortcomings to the manufacturers and have them re-design the tables. In the meantime, they will not allow me to use any sort of cushioning on the table. Oh, and by the way, I'm having my cancer treatment at one of the world's top cancer hospitals: Sloan Kettering. You would think they'd have a better setup, no?

I'm so sorry for what you're going through, Dauna. This really hurts and I hope we both feel better soon. In the meantime, ice packs feel good but you have to make sure you don't put them on your breast - just your rib (we're not supposed to use ice packs on our radiated ribs because it affects the blood flow).



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Apr 9, 2018 01:59PM OwMahBoob wrote:

Veeder, I know you asked this question two months ago but I hope this helps. The prone breast table is NOTHING LIKE AN MRI. It's completely open. I'm also claustrophobic so I can tell you that's not an issue. For the prone breast MRI and the MRI-guided needle biopsy, I had to take Atavan because I was going to be inside the MRI tube. That said, though, the breast MRI bothered me less than a normal one when you're on your back. With the breast MRI, you're facing down with your face in a cradle so if you open your eyes, you see a lot more space between you and the machine than you do when you're lying face-up.

Anyway, the prone breast table is just a hard table with an open space for your breast to hang down. The machine that radiates you stays to the side of the machine and zaps your breast underneath the table.

The table itself is hard and it's very uncomfortable on your ribs (see my last post about breaking my rib). So THAT sucks, but you won't be claustrophobic!

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Apr 9, 2018 02:34PM Veeder14 wrote:

Hi OwMahboob & Duana,

I can totally relate to what your experiencing with the rib pain. After the first day of Radiation and being on that hard table for xrays, and positioning and the treatment, I was ready to quit. I have existing back/neck problems anyways and that just made it worse. I believe that I got some sort of bruise (I thought I had a rib fracture but didn't get it checked out) from the first day which got worse each day I was on the table. Over the weekends, it started to not hurt as much but then 5 more days in a row of being on the table and more excruciating pain.

I was given long acting injectable pain medication twice during the 21 rads which definitely helped with the pain. Otherwise, I wouldn't of been able to continue with treatment. I think my rib is starting to heal now since I finished last Friday. It seems like the breast that didn't hang down was smashed against the table and that created pain along with resting right on my rib and breast bone. Can you get your doctor to order pain medication?

The table I was on at least had once of those cushion face cradles that massage tables have so my head is straight down. I worried that I would need to turn my neck to one side or the other and knew I'd never survive that position. Being on my back would have caused tons of pain for my back/neck and shoulders also. Just glad to be finished. Good luck with your treatments and I hope you really don't have a rib fracture.

As far as claustrophobia, when the machine was over me sometimes I felt claustrophobic but then when I saw what the machine looked like when I wasn't on the table, it eased my concerns. Yes, the MRI's are totally different; the MRI techs let me bring strips of memory foam that they placed along the edges of the plastic thing which helped a lot. Plus having both sides hanging down makes it more even. Since I was going in face down I wasn't really claustrophobic and tried to think about something different than being in the machine!

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Apr 10, 2018 02:49PM FrozeninAlaska wrote:

Hello, I am about to have prone radiation -- in a few more weeks. Wondering where you had this done? I am currently traveling to Houston, but looking to see if there are locations closer to home that would do radiation in prone position. It sounds very uncomfortable. How does your rib get cracked or bruised? Is there pressure or is it only body weight on the table? Many thanks.

Dx 11/27/2017, DCIS, Right, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 12/22/2017 Lumpectomy: Right Surgery 1/5/2018 Lumpectomy: Right Surgery 1/12/2018 Lumpectomy: Right Surgery 3/22/2018 Lumpectomy: Right; Reconstruction (left); Reconstruction (right) Radiation Therapy 4/26/2018 Whole-breast: Breast
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Apr 10, 2018 03:10PM ctmbsikia wrote:

I am outside of Philly also about to do the prone position.  My 1st simulation failed in the supine and doing breath holds.

For prone, this hospital has your head turned to treated side, unlike an MRI being completely face down.  There is padding on the table so belly was comfortable enough through the mapping process-just a little rough on neck.  Sternum and right breast is flat on metal but not bad at all, not worried about cracking a rib, geez that's terrible!!!  Get better soon.  Wish me luck, I'm off to simulation tonight hope I can get started.

Dx 12/14/2017, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 1/16/2018, LCIS, Right Surgery 1/31/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/11/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Apr 10, 2018 09:58PM VLH wrote:

My facility had foam to add to the table. I have a badly encapsulated shoulder and discovered on my own that I could tolerate having my elbows out a bit above shoulder height with my face cradled on my hands facing downward. The mapping was done with me in that position and they took photos to ensure I assumed the same position during treatments. A head cradle was offered, but I was more comfortable just using my hands. If my RO hadn't been flexible on a position that babied my shoulder, I wouldn't have had radiation at all.

Dx 5/20/2016, IDC, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Surgery 7/14/2016 Lumpectomy: Left Dx 7/18/2016, DCIS, Left, Stage 0, Grade 3, 0/3 nodes Surgery 7/25/2016 Lumpectomy: Left Chemotherapy 10/10/2016 AC + T (Taxol) Radiation Therapy 9/5/2017 Whole-breast: Breast
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Apr 11, 2018 12:48AM Veeder14 wrote:

VLH,

I'm glad that your RO accommodated your needs so you could get this done.

ctmbsikia,

Good luck with your simulation, let us know how it went.

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Apr 11, 2018 06:45PM - edited Apr 11, 2018 06:48PM by OwMahBoob

Hiya...

I am having mine done at Memorial Sloan Kettering in NY. No face cradle and my head is turned to the right and flat on the table, which is really uncomfortable on my neck because I have a herniated disk. It's the worst the first day because they have you in that position much longer getting you set up. And then once a week, they take X-rays, and you have to stay still in that position longer again. The rest of the time is tolerable.

3 more sessions and then they will flip me onto my back for the boosts.

Frozen, the reason for the bruising/fracturing is because your body weight is pretty much concentrated in your rib area which is pressing against the hard table as well as the edge of the hard table, which, in my case, pressed between two ribs.

Dauna, where did you have yours done when you broke your ribs?

VLH, you're smart to keep your arm like that. Yesterday I was favoring my rib and had my right arm up over my head and pressed down on it to try to take weight off of my rib. I also have capsulitis history in that shoulder and when we finished, my shoulder was in agony. : ( I came home and held ice on it for 3 hours and then my wonderful hubby gave me a neck/shoulder massage and I love him forever because it helped so much!!


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Apr 12, 2018 01:59AM Veeder14 wrote:

Yes, the weight is on your ribs and the set up I had raised my whole chest up on a platform so it seems like even more pressure on my ribs. UGH. One day I was called back to the machine room but staff wasn't ready for me so I watched them put the set up together on the table and saw it from the side view. I can't see any reason that these hospitals/clinics don't have padded face cradles. Turning your head to one side is very bad body mechanics and causes so much pain.

ctmbsikia,

How did your simulation go?

Dx 1/2/2018, ILC, Left, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2- Surgery 1/25/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 3/7/2018 Hormonal Therapy 6/30/2018
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Apr 12, 2018 10:05AM ctmbsikia wrote:

Hi.  It went well Veeder, got my 1st treatment.  I posted in the APR thread, thank you for asking!  Hope you are doing well today.

Dx 12/14/2017, DCIS/IDC, Left, 4cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Dx 1/16/2018, LCIS, Right Surgery 1/31/2018 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/11/2018 Whole-breast: Breast Hormonal Therapy 6/25/2018 Arimidex (anastrozole)
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Apr 14, 2018 12:56AM - edited Apr 14, 2018 12:57AM by VLH

OwMahBoob, I'm sorry your treatment hurt so much, but am glad that the spousal care helped the pain. ☺️ The first day, the technician asked me to move my elbow higher than I'd done during the simulation. I left the room in tears from the pain. It was crazy how much difference a few inches made. Luckily, they were able to do the subsequent sessions with me feeling uncomfortable, but not in severe pain. I took a prescription strength Ibuprofen an hour before each session and confirmed with my RO that it was alright to use Voltaren topical gel on the top of my shoulder.


Dx 5/20/2016, IDC, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Surgery 7/14/2016 Lumpectomy: Left Dx 7/18/2016, DCIS, Left, Stage 0, Grade 3, 0/3 nodes Surgery 7/25/2016 Lumpectomy: Left Chemotherapy 10/10/2016 AC + T (Taxol) Radiation Therapy 9/5/2017 Whole-breast: Breast
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Apr 16, 2018 09:26PM OwMahBoob wrote:

VLH, I've been doing the same - Ibruprofen about an hour before each session. Voltaren would have been a good idea. I didn't think of that. Nevertheless, today was my last prone day! Tomorrow I start my "boosts" for four days. At least I'll be on my back so I can stop worrying about my ribs. Now I'm just back to worrying about my boob!

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Apr 16, 2018 10:48PM VLH wrote:

I hope all goes smoothly with the boosts, OwMahBoob!

Dx 5/20/2016, IDC, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- (FISH) Surgery 7/14/2016 Lumpectomy: Left Dx 7/18/2016, DCIS, Left, Stage 0, Grade 3, 0/3 nodes Surgery 7/25/2016 Lumpectomy: Left Chemotherapy 10/10/2016 AC + T (Taxol) Radiation Therapy 9/5/2017 Whole-breast: Breast
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Apr 19, 2018 08:11PM cats922 wrote:

I had the similar problem on prone theory cracked one than they turned on my back .

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Apr 21, 2018 01:47PM OwMahBoob wrote:

Thank you, VLH, all went well!

So I finished my 4 "boost" sessions yesterday and I'm all done with radiation! Yay! I have to say that it was a lot more comfortable being on my back for the boosts. Nevertheless, if I had to do it over, I'd still do the full-breast radiation prone. Yes, my rib still hurts (well, not nearly as bad as it did a few weeks ago). But I had zero skin damage and I'm not worried about having had exposure to my heart and/or lungs.

So for anyone considering doing the prone, just make sure that when you're lying on the table you try to arrange yourself so that your rib isn't taking the brunt of your body weight. Press with your stomach or leg muscles to have them take more of the weight. It's not easy to do that - it's subtle but it does help.

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