# Immobilisation mask for head and neck and brain radiotherapy, including mask anxiety

Source: https://onco.cc/protocols/head-and-neck-radiotherapy-immobilisation-mask/  
OnCo record `head-and-neck-radiotherapy-immobilisation-mask` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For radiotherapy to the head or neck you wear a close-fitting plastic mesh mask, moulded to your face while it is warm and clipped to the table, so you are in exactly the same place every day. About a quarter of people feel anxious in the mask. Tell the team early: they can explain each step, give breaks, let you play music, and in some departments use a mask with the face left open.

## Summary

The ESTRO ACROP guideline (2017) sets out the radiation therapist's procedure: a full explanation beforehand, including the mask's temperature and how to signal for help; removal of dentures, hearing aids and piercings in the field; a straight, comfortable and reproducible position with every device indexed to the couch; any mouth bite or stent in place before moulding; a mask of three or more fixation points (five points when the low neck is treated, or a shoulder retractor with a three-point mask); a check of the material's temperature before it touches the skin; moulding within one to two minutes and hardening for five to fifteen; reassurance during hardening; removal and refitting before the CT scan; and labelling of the mask. It advises against cutting out the mask except for a bite block or tracheostomy.

Mask anxiety affected 26% of 100 consecutive patients in one Australian cohort and 27.3% of 410 in a validation study of a four-item screen (R-MAQ); in a prospective cohort it fell during treatment in 72% of those affected. Both Australian studies recommend routine screening, which no guideline yet requires. One randomised trial (216 patients, India, 2025) found music with guided relaxation in the first five sessions lowered mask anxiety. The OPEN phase 3 trial (230 non-claustrophobic patients, 2026) found open-face masks with surface-guided radiotherapy as accurate as a closed five-point mask and better tolerated, which departs from the ESTRO advice against cutting the mask; claustrophobic patients were excluded.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: radiotherapy mask; thermoplastic mask; shell; head and neck mask; mask anxiety; claustrophobia during radiotherapy; mould room; open-face mask; five-point mask

## Connected records

- protocols: [Dental assessment before head and neck radiotherapy and osteoradionecrosis prevention](https://onco.cc/protocols/head-and-neck-radiotherapy-dental-assessment-osteoradionecrosis/), [Mouth care and oral mucositis prevention during head and neck radiotherapy](https://onco.cc/protocols/head-and-neck-radiotherapy-oral-mucositis/), [Patient identification and pre-treatment time-out in radiotherapy](https://onco.cc/protocols/radiotherapy-patient-identification-and-time-out/), [Radiotherapy planning scan (CT simulation): positioning, skin marks and what the patient does](https://onco.cc/protocols/radiotherapy-planning-ct-simulation/), [Stereotactic radiosurgery and SBRT: planning and delivery safeguards](https://onco.cc/protocols/stereotactic-radiosurgery-and-sbrt-delivery-safeguards/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Music therapy and music medicine](https://onco.cc/technologies/music-therapy-cancer/), [Patient positioning and surface guidance systems (AlignRT, Catalyst, ExacTrac Dynamic)](https://onco.cc/technologies/patient-positioning-surface-guidance-systems/), [Relaxation training and guided imagery](https://onco.cc/technologies/relaxation-guided-imagery/), [Surface-guided radiotherapy (SGRT)](https://onco.cc/technologies/surface-guided-radiotherapy/)
- terms: [Radiotherapy](https://onco.cc/terms/radiotherapy/)
- ideas: [Ask about mask anxiety at every head and neck radiotherapy visit, and offer music and guided relaxation](https://onco.cc/ideas/idea-pu-mask-anxiety-screening/), [Open-face immobilisation masks for brain and head and neck radiotherapy where surface guidance can check the position](https://onco.cc/ideas/idea-pu-open-face-masks/)

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