How do you simulate and treat a prostate cancer patient with a persistently full rectum?  

Simulation should lead to reproducible and desirable treatment positioning of the patient and their anatomical orientation. For prostate cancer, the state of bladder and rectal filling need to be considered. I think that a "comfortably" full bladder is widely used for simulation and treatment, but r...

As to rectum vault issues.....we were experiencing issues with putting patients on the table, then imaging them, and noticing we had to get too many off the table for various reasons, and/or relieve rectal gas pockets "manually." So we implemented QI program late last year t...

I agree with @Howard M. Sandler. For patients with regular bowel movements at an approximately consistent time each day, I encourage them to schedule their radiation treatment appointments after their usual movement time.It's reassuring to know that image-guidance methods have been shown to effectiv...

For patients who have "difficult" cases, where the rectum is persistently "full" with contents or air, then one might try to aggressively empty the rectum, but my practice is to use daily IGRT to treat the planning target volume and just accept the rectal filling, relying on the IGRT to treat the in...

Nice response by @Howard M. Sandler. IGRT in these matters......we have that capability as well. We found that our patient through-put was better if we attempted to empty the rectum to the extent possible with simple dietary changes - upfront - including anti-gas medications, if the latter is an iss...