How would you simulate and ensure set-up reproducibility for a patient with head and neck cancer and severe claustrophobia and unable to tolerate a thermoplastic mask?  

Options: Make a mask and cut out the face area, keep the chin and forehead. Use cushion tape at the edge to make it more comfortable. Use surface imaging device (Identify, VisionRT, C-rad) with good custom vaclok of the head and neck area. Use of anti-anxiety meds and music therapy (patient's o...

I appreciate Dr. @Giap's comprehensive answer to this important question. In my practice over many years, a simple combination of having an understanding, supportive attitude toward the patient, use of a benzodiazepine (lorazepam or alprazolam), and having the therapists make sure that the mask is ...

Masking tape and larger margins

Agree with all the thoughts above. In training, we did have an integrative medicine team - and in one case, had someone trained in meditation/hypnosis speak to the patient over the intercom during treatment, which worked for the n=1... better than daily anesthesia! 

I have tried Dr. @Giap's recommendation. But in a few times, we had to sedate the patient with IV midazolam. We monitored oxygen and heart rate. 2-5 mg usually suffice. It is short acting and it easily lasts a 15-25 minute treatment.