# Open-face immobilisation masks for brain and head and neck radiotherapy where surface guidance can check the position

Source: https://onco.cc/ideas/idea-pu-open-face-masks/  
OnCo record `idea-pu-open-face-masks` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy to the head usually means a moulded plastic mask clipped to the table over the whole face. In a randomised comparison in 29 people with brain tumours, a mask with the face cut out caused much less discomfort and anxiety with the same accuracy, and 27 of them preferred it.

## Summary

What changes. A closed thermoplastic mask covers the face and is fixed to the couch. An open-face mask leaves the eyes, nose and mouth uncovered; because the radiographers can no longer use the mask alone to confirm the position, a surface camera watches the exposed face during treatment.

The randomised evidence. In a single-centre self-controlled trial, 30 people having fractionated brain radiotherapy had both masks made and switched halfway through treatment. Mean discomfort on a 10-point scale was 0.5 with the open mask against 3.3 with the closed one (p below 0.0001), anxiety and pain were also lower, 27 of 29 preferred the open mask, and movement during treatment did not differ. In a randomised trial of 106 people with head and neck cancer, open-face masks with foam support gave set-up errors no different from closed masks in most directions, with the trial also measuring comfort, anxiety and depression. A 2024 scoping review of 19 studies, most published since 2020, found sub-millimetre reproducibility with open masks and surface guidance.

Limits. Most evidence is in brain treatment, where the target moves little; head and neck radiotherapy, where the neck and jaw move and the mask often extends to the shoulders, has less. Open masks depend on surface guidance being available. Adoption is not measured.

## Fields

- Kind: Idea
- Last checked: 2026-10-20
- Tags: protocol-upgrade; upgrade:promising; evidence:moderate
- Hypothesis: Offering open-face masks with surface guidance to people having brain or head and neck radiotherapy reduces mask-related anxiety and treatment interruptions without increasing set-up error beyond the margin used for closed masks.
- Rationale: One randomised crossover trial and one parallel randomised trial show equal accuracy and markedly lower discomfort, and a quarter or more of people having head and neck radiotherapy report anxiety about the mask.
- Proposed test: A multi-centre randomised trial in head and neck radiotherapy comparing open-face with closed masks, with set-up error on daily imaging as a non-inferiority primary endpoint and patient-reported anxiety, sedation use and missed sessions as secondary endpoints.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Keane et al., Randomized self-controlled study comparing open-face vs. closed immobilization masks in fractionated cranial radiotherapy (Radiotherapy and Oncology 2024): https://doi.org/10.1016/j.radonc.2024.110314
- Yang et al., Effectiveness of personalized open-face mask combined with styrofoam fixation in radiotherapy treatment of head and neck cancers: a prospective randomized controlled trial (Radiation Oncology 2025): https://doi.org/10.1186/s13014-025-02609-8
- Lastrucci et al., Open-face masks in radiotherapy: a comprehensive scoping review (Cancers 2024): https://doi.org/10.3390/cancers16162899
- Nixon et al., Exploring the prevalence and experience of mask anxiety for the person with head and neck cancer undergoing radiotherapy (Journal of Medical Radiation Sciences 2018): https://doi.org/10.1002/jmrs.308

## Connected records

- 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/), [Radiotherapy set-up without permanent ink tattoos, using surface guidance or invisible ink](https://onco.cc/ideas/idea-pu-tattoo-free-set-up/)
- cancers: [Brain and spinal cord tumours (all types)](https://onco.cc/cancers/brain-tumours/), [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)
- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Patient positioning and surface guidance systems (AlignRT, Catalyst, ExacTrac Dynamic)](https://onco.cc/technologies/patient-positioning-surface-guidance-systems/), [Surface-guided radiotherapy (SGRT)](https://onco.cc/technologies/surface-guided-radiotherapy/)
- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)

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