1. Physics and Imaging in Radiation Oncology
Customized mouthpieces designed to reduce tongue mucositis in carbon-ion radiotherapy for tumors of the nasal and paranasal sinuses 
Atsushi Musha, Jun-ichi Saitoh, Katsuyuki Shirai, Yoshiki Kubota, Hirofumi Shimada, Takanori Abe, Yuka Komatsu, Shuichiro Komatsu, Tatsuya Ohno, Takashi Nakano, Satoshi Yokoo 
Physics and Imaging in Radiation Oncology 
Volume 3, Pages 1-4 (July 2017)
DOI: /j.phro
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2. Fig. 1
The use of a customized mouthpiece can decrease the radiation dose. The carbon ion radiotherapy (C-ion RT) treatment plan for a nasal melanoma representative case is shown, including the dose distribution. A total dose of 64.0Gy (relative biological effectiveness [RBE]) was administered in 16 fractions. The gross tumor volume (GTV) is shown in red. (a) When we did not use a mouthpiece, the dose to the tongue was measured at 58.0Gy (RBE) using the OMDS-model. (b) A zoomed-in view of the tongue region (not using a mouthpiece). (c) The setting of the mouthpiece. (d) We again performed a computed tomography scan, which showed that the mouthpiece displaced the tongue to the lower side and moved it outside of the high-irradiation area. When we used an improved mouthpiece, the dose to the tongue was 31.0Gy (RBE) as measured using OMDS-model. (e) A zoomed-in view of the tongue region (using a mouthpiece). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Physics and Imaging in Radiation Oncology 2017 3, 1-4DOI: ( /j.phro )
Copyright © 2017 The Authors Terms and Conditions

3. Fig. 2
Temporal patterns of mucositis of the palate and tongue for 18 patients. The mean Radiation Therapy Oncology group (RTOG) grade of mucositis was significantly lower for the tongue than for the palate. fr, fraction; 1W, 1week; 1M, 1month.
Physics and Imaging in Radiation Oncology 2017 3, 1-4DOI: ( /j.phro )
Copyright © 2017 The Authors Terms and Conditions