Patient reported outcomes of slow, single arc rotation: Do we need rotating gantries?

Whelan, Brendan; Welgampola, Miriam S.; McGarvie, Leigh A.; Makhija, Kuldeep; Turner, Robin; Holloway, Lois; Feain, Ilana; Jackson, Michael; Bartoň, Michael; Keall, Paul J.

doi:10.1111/1754-9485.12688

Cited by 15 publications

(28 citation statements)

References 26 publications

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“… A cancer patient's acceptance and tolerance to horizontal rotation could be a substantial barrier to fixed‐beam treatments. To better understand this issue, Whelan et al . assessed the claustrophobia, anxiety and motion sickness of 15 patients undergoing slow horizontal and vertical rotation at 12° s −1 .…”

Section: Discussionmentioning

confidence: 99%

Development and commissioning of a full‐size prototype fixed‐beam radiotherapy system with horizontal patient rotation

et al. 2019

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Purpose Compared to conventional linacs with rotating gantries, a fixed‐beam radiotherapy system could be smaller, more robust and more cost‐effective. In this work, we developed and commissioned a prototype x‐ray radiotherapy system utilizing a fixed vertical radiation beam and horizontal patient rotation. Methods The prototype system consists of an Elekta Synergy linac with gantry fixed at 0° and a custom‐built patient rotation system (PRS). The PRS was designed to immobilize patients and safely rotate them about the horizontal axis. The interlocks and emergency stops of the linac and PRS were connected. Custom software was developed to monitor the system status, control the motion of the PRS and modify treatment plans for the fixed‐beam configuration. Following installation, the prototype system was commissioned for three‐dimensional (3D) conformal therapy based on guidelines specified in AAPM TG‐45 and TG‐142, with modifications for the fixed‐beam geometry made where necessary. Results The system and control software was tested in a variety of machine states and executed motion, stop and beam gating commands as expected. Interlocks and emergency stops of the linac and PRS were found to correctly stop PRS motion and both kV and MV radiation beams when triggered. For 3D conformal treatments, the prototype system met all AAPM TG‐45 and TG‐142 specifications for geometric and dosimetric accuracy. Motion of the PRS was within 0.6 ± 0.3 mm and 0.10° ± 0.07° of input values for translation and rotation respectively. The axis of rotation of the PRS was coincident with the radiation beam axis to less than 1 mm. End‐to‐end treatment verification for 6 MV conformal treatments showed less than 2% difference between planned and delivered dose for all fields. Conclusion In this work, we have developed and commissioned a radiotherapy system that utilizes a fixed vertical radiation beam and horizontal patient rotation. This system is a proof‐of‐concept prototype for a fixed‐beam treatment system without a rotating gantry. Fixed‐beam systems that are smaller and more cost‐effective could help in improving global access to radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Development and commissioning of a full‐size prototype fixed‐beam radiotherapy system with horizontal patient rotation

et al. 2019

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“…1 Members of the same research group who produced the article in this issue of Journal of Medical Imaging and Radiation Oncology 1 have also reported on the development of a rotating couch and immobilisation system 2 as well as a static-gantry linear accelerator 3 for use in photon-beam radiotherapy. Their study investigated the acceptability of rotating the radiotherapy patient instead of the linear accelerator (linac) gantry, by evaluating levels of patient discomfort caused by anxiety or motion sickness.…”

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“…Specifically, several members of this same research group have made important contributions to the Australian MRI-linac programme. 1 A patient support system that rotates a lying patient around the craniocaudal axis can be expected to produce a dramatic effect on the shape of the patient's external contour, as anyone who has ever compared prone and supine patient images will attest (e.g. However, the development of an alternative 'inline' arrangement, where the patient is placed between the MRI magnets and the radiation beam is delivered through the bore of the magnets (as shown in fig.…”

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“…37 The practise of using deformable image registration for dose warping and dose accumulation is, however, currently questionable enough to justify a whole other editorial. 1 The publication of Whelan et al's 1 article in Journal of Medical Imaging and Radiation Oncology should inspire discussions and debates about the use of unconventional external beam radiotherapy simulation and treatment geometries, which may ultimately motivate the design of alternative patient imaging and immobilisation systems, the completion of comprehensive anatomical deformation studies or the development of advanced organ motion monitoring and compensation systems. Furthermore, as in so many areas of radiation oncology, the need for greater automation means a need for greater numbers of radiation oncologists, radiation therapists, dosimetrists and medical physicists to critically evaluate, investigate, monitor, test, and verify the automatically generated results.…”

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“…Their study investigated the acceptability of rotating the radiotherapy patient instead of the linear accelerator (linac) gantry, by evaluating levels of patient discomfort caused by anxiety or motion sickness. 1 A support structure conventionally used for balance disorder therapy was adapted to deliver slow rotations to 15 previous and current cancer patients, who provided survey responses that allowed the authors to conclude that substantial rotations in a seated or lying position can be 'well tolerated' by the radiotherapy patient. 1 Members of the same research group who produced the article in this issue of Journal of Medical Imaging and Radiation Oncology 1 have also reported on the development of a rotating couch and immobilisation system 2 as well as a static-gantry linear accelerator 3 for use in photon-beam radiotherapy.…”

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Patient rotation during linac‐based photon electron radiotherapy

Kairn

2018

J Med Imag Rad Onc

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Pelvic organ motion and dosimetric implications during horizontal patient rotation for prostate radiation therapy

et al. 2020

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Purpose Gantry‐free radiation therapy systems utilizing patient rotation would be simpler and more cost effective than the conventional gantry‐based systems. Such a system could enable the expansion of radiation therapy to meet global demand and reduce capital costs. Recent advances in adaptive radiation therapy could potentially be applied to correct for gravitational deformation during horizontal patient rotation. This study aims to quantify the pelvic organ motion and the dosimetric implications of horizontal rotation for prostate intensity‐modulated radiation therapy (IMRT) treatments. Methods Eight human participants who previously received prostate radiation therapy were imaged in a clinical magnetic resonance imaging (MRI) scanner using a bespoke patient rotation system (PRS). The patients were imaged every 45 degrees during a full roll rotation (0–360 degrees). Whole pelvic bone, prostate, rectum, and bladder motion were compared to the supine position using dice similarity coefficient (DSC) and mean absolute surface distance (MASD). Prostate centroid motion was compared in the left–right (LR), superior–inferior (SI), and anterior–posterior (AP) direction prior to and following pelvic bone‐guided rigid registration. Seven‐field prostate IMRT treatment plans were generated for each patient rotation angles under three adaption scenarios: No plan adaption, rigid planning target volume (PTV)‐guided alignment to the prostate, and plan re‐optimization. Prostate, rectum, and bladder doses were compared for each adaption scenario. Results Pelvic bone motion within the PRS of up to 53 mm relative to the supine position was observed for some participants. Internal organ motion was greatest at the 180‐degree PRS couch angle (prone), with prostate centroid motion range < 2 mm LR, 0 mm to 14 mm SI, and −11 mm to 4 mm AP. Rotation with no adaption of the treatment plan resulted in an underdose to the PTV –– in some instances up to 75% (D95%: 78 ± 0.3 Gy at supine to 20 ± 15.0 Gy at the 225‐degree PRS couch angle). Bladder dose was reduced during the rotation by up to 98% (V60 Gy: 15.0 ± 9.4% supine to 0.3 ± 0.5% at the 225‐degree PRS couch angle). In some instances, the rectum dose increased during rotation (V60Gy: 20.0 ± 4.5% supine to 25.0 ± 15.0% at the 135‐degree PRS couch angle). Rigid PTV‐guided alignment resulted in PTV coverage which, though statistically lower (P < 0.05 for all D95% values), was within 1 Gy of the supine plans. Plan re‐optimization resulted in a statistically equivalent PTV coverage compared to the supine plans (P > 0.05 for all D95% metrics and all within ±0.4 Gy). For both rigid PTV‐guided alignment and plan re‐optimization, rectum dose volume metrics were reduced compared to the supine position between the 90‐ and 225‐degree PRS couch angles (P < 0.05). Bladder dose volume metrics were not impacted by rotation. Conclusion Pelvic bone and internal organ motion are present during patient rotation. Rigid PTV‐guided alignment to the prostate will be a requirement if prostate IMRT is to be safel...

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Patient reported outcomes of slow, single arc rotation: Do we need rotating gantries?

Abstract: Slow, single arc rotation in upright and lying orientations was well tolerated in this study. These results support the need for further studies into the clinical implementation of patient rotation, which could have a major impact on the practice and cost of radiotherapy.

Cited by 15 publications

References 26 publications

Development and commissioning of a full‐size prototype fixed‐beam radiotherapy system with horizontal patient rotation

Development and commissioning of a full‐size prototype fixed‐beam radiotherapy system with horizontal patient rotation

Patient rotation during linac‐based photon electron radiotherapy

Pelvic organ motion and dosimetric implications during horizontal patient rotation for prostate radiation therapy

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