Abstract Introduction: SGRT can accurately monitor VMAT DIBH breast radiotherapy patients. Camera occlusion may provide difficulties for SGRT systems, such as VisionRT’s AlignRT, during rotational imaging (CBCT) and treatments (VMAT). Therefore, appropriate regions of interest (ROIs) need definition to ensure robust monitoring. Equally, operators must know where camera occlusion most likely occurs to optimise workflows. Methods: A CT scan of an anthropomorphic phantom was performed to mimic a breast patient’s DIBH treatment position. A VMAT plan was produced, and six ROIs drawn on an AlignRT terminal. An ROI sensitivity test was performed, and approximate percentage surface area of occlusion was determined for all ROIs. Postural video was also utilised to determine where camera occlusion is most likely to occur. Results: No full camera occlusion was demonstrated using the phantom. However, postural video demonstrated camera occlusion was more probable between 10 and 60 degrees for CBCT arcs due to lateral camera occlusion. Sensitivity test results showed ROIs were more sensitive to vertical and lateral translations when both lateral cameras are blocked at CBCT50. Larger ROIs may be less sensitive and more robust when cameras were occluded. Additionally, the greatest approximate percentage of occlusion occurred at the superior lateral aspects of ROIs. Conclusion: Gantry angles at higher risk of camera occlusion have been described between 10 and 60 degrees for CBCT to assist operators with troubleshooting, and a clinical workflow proposed. An ROI for VMAT DIBH breast rotational imaging and treatment has also been suggested to reduce the impact of camera occlusion.
Abstract Introduction: Governance structures in radiotherapy are central to ensuring patient safety, yet significant variation exists in how errors are reported, analysed and mitigated globally. This literature review evaluates current international approaches to radiotherapy error governance, highlighting barriers to consistent reporting and opportunities for system-wide improvement. Methods: A structured search of peer-reviewed literature and policy documents was undertaken using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. The search yielded 42 relevant articles, reviewed for themes relating to governance frameworks, safety culture, incident reporting systems and technology’s role in error reduction. Results: Findings reveal inconsistent adoption of Safety I and Safety II models, underreporting due to blame culture, and limited integration of artificial intelligence (AI) into governance frameworks. Successful strategies included pre-treatment peer review, multidisciplinary safety boards and AI-assisted risk management tools. Despite advancements, gaps persist in standardising incident definitions, fostering transparency and promoting a just culture. Conclusion: The review suggests the need for international alignment on governance practices, wider integration of AI and proactive learning from near misses. Radiographers and radiation oncology teams are urged to engage in shaping safety governance through open reporting, system design and education. Implications for practice: Improved governance not only reduces harm but also supports continuous quality improvement in radiotherapy services.
Abstract Introduction: Surface-guided radiotherapy (SGRT) allows patient prepositioning based on a 3D surface instead of conventional skin marks. The primary aim was to investigate the feasibility of SGRT using ExacTrac Dynamic (ETD) for prepositioning patients receiving breast radiotherapy in free breathing compared to conventional skin-marker setup, secondary to assess intrafraction motion using surface data. Methods: Twenty-one patients receiving whole- or partial-breast radiotherapy in free breathing were included. Each patient was set up using both skin marks and SGRT for different fractions in a non-systematic order. The setup offset was evaluated using 3D couch shifts from subsequent image guidance. Intrafraction motion was analysed for all monitor units (MU) delivered, and systematic patient movement was assessed by analysing the average surface shift per main tangential field compared to baseline. The shift between main fields represented the intrafraction movement. Results: No significant difference was found in mean population setup offset between SGRT and skin-marker setup. SGRT demonstrated reduced random errors in vertical and longitudinal direction and reduced systematic errors in lateral direction. Intrafraction motion was limited with a vector displacement of 0·9 mm. A small but significant inter-field movement of −0·3 mm was, however, detected vertically. Conclusion: Surface-guided setup using ETD is a viable alternative for prepositioning patients receiving breast radiotherapy in free breathing compared to conventional skin-marker setup. It is, however, advisable to use subsequent IGRT for final positioning. Patient motion can be tracked effectively using ETD surface monitoring.
Objective: Breast cancer is the most common malignancy among women worldwide, including Morocco. Radiotherapy plays a key role after surgery by eliminating residual disease and reducing local recurrence. This study compares the dosimetric and biological performance of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) for breast cancer treatment using the Halcyon linear accelerator.Methods: IMRT and VMAT treatment plans were retrospectively compared in 25 breast cancer patients. Dosimetric evaluation was performed using dose-volume histograms for the planning target volume and organs at risk. Biological assessment included normal tissue complication probability (NTCP), secondary cancer complication probability (SCCP), and tumour control probability (TCP) calculated with established predictive models.Results: Both techniques achieved comparable target coverage (V95%), with a slight advantage for VMAT. VMAT showed improved dose homogeneity and conformity, while IMRT required higher monitor units. IMRT provided superior sparing of organs at risk, particularly the lungs, heart, and contralateral breast. NTCP and SCCP estimates were lower with IMRT, suggesting reduced risks of radiation pneumonitis and secondary malignancies. TCP was marginally higher with VMAT, without statistical significance.Conclusion: IMRT offers better protection of healthy tissues, whereas VMAT improves target dosimetric quality and treatment efficiency.
Introduction: Rotational setup errors remain a challenge in radiotherapy centers without six-degree-of-freedom (6DoF) couch correction systems. Small angular deviations may compromise target coverage and organ-at-risk sparing. Although image-guided radiotherapy (IGRT) has improved setup verification, many centers continue to rely on three-degree-of-freedom (3DoF) couches.Innovation: This technical report evaluates an approximation in which small rotational setup deviations are represented as equivalent translational displacements using the vector cross-product formulation (Delta = theta & times; r). Head-and-neck, breast, lung, pelvis, and thorax scenarios were modeled using an Elekta Infinity linear accelerator and Monaco TPS (version 6.1.4.0) with Monte Carlo dose calculation. Simulated rotational perturbations were assessed with and without translation-based correction using dose-volume histogram endpoints Dmean, D95, and V95.Discussion: Translation-based correction improved D95 across all treatment sites. The largest improvement was observed in head-and-neck geometry (approximately 2%), while pelvic and thoracic scenarios demonstrated intermediate gains. Breast and lung cases showed measurable improvements. Dmean increased modestly, whereas V95 remained essentially unchanged, suggesting improved target coverage without compromising volumetric conformity.Recommendations: Translation-based correction is not a substitute for 6DoF couch technology but may provide a low-cost mitigation strategy for centers limited to 3DoF correction capability. Future studies should include phantom validation and automated correction approaches.
Aim: To estimate and compare the vaginal doses in terms of posterior inferior border of symphysis (PIBS) points such as PIBS, PIBS+2, PIBS-2, and vaginal reference length (VRL) for patients of cancer of cervix (CC) treated with intracavitary brachytherapy (ICBT) using Fletcher Williamson applicator (FW) and interstitial brachytherapy (ISBT) using Martinez Universal Perineal Interstitial Template (MUPIT).Material/methods: Treatment plans of a total of 36 consecutive CC patients, who underwent ICBT and ISBT with FW and MUPIT respectively, were retrospectively included in the study. The 3D treatment planning for all the patients had been performed on computed tomography (CT) images. The median prescription dose delivered by high dose rate brachytherapy was 6 Gy per fraction. PIBS point doses were estimated for each plan and analysed with OriginPro2024b graphing and analysis software.Results: The Mann Whitney test showed statistically significant differences in vaginal doses in terms of percentage of prescription dose (PD) between ICRT and ISBT. Spearman's rank correlation coefficient (rho) values indicated that vaginal wall dose and VRL were strongly correlated for FW applicator as compared to MUPIT applicator.Conclusion: Vaginal wall doses in terms of percentage of the PD with MUPIT applicator were found higher than with the FW applicator. Our results suggested that estimation of vaginal doses for each patient was necessary during planning phase in order to avoid the late toxicities.
Objectives: To evaluate the setup reproducibility of the semi-Fowler's position as a practical positioning strategy for radiotherapy patients who are unable to tolerate standard supine or prone positioning.Materials and Methods: Fifteen patients with respiratory or musculoskeletal limitations preventing standard positioning were retrospectively analysed. All patients were treated in the semi-Fowler's position using routinely available immobilisation components. Setup reproducibility was assessed using orthogonal kilovoltage (kV) imaging with two-dimensional image matching. Translational displacements along the lateral (X), longitudinal (Y) and vertical (Z) axes were evaluated using the intraclass correlation coefficient, Lin's concordance correlation coefficient and Bland-Altman analysis.Results: Median setup errors across all translational directions were close to zero, with the majority of displacements remaining within +/- 0.5 cm. Bland-Altman analysis demonstrated acceptable agreement across repeated fractions. Slightly increased variability was observed along the longitudinal and vertical axes, consistent with gravitational effects associated with semi-inclined positioning.Conclusions: The semi-Fowler's position can be implemented as a practical and reproducible positioning option for selected radiotherapy patients when standard setups are not tolerated, without compromising geometric accuracy under routine image guidance.
Introduction: This study aims to investigate the key characteristics of a device to support patients with hearing impairments in utilising deep inspiration breath-hold (DIBH) radiation therapy (RT).Method: A qualitative approach was adopted. Semi-structured interviews were conducted both online and in person with 11 participants, including key stakeholders from a range of backgrounds: radiation oncologists, radiation therapists, medical physicists, RT service managers, industry vendors, and deaf service users. Data were analysed using thematic analysis, following the six-step approach outlined by Braun and Clarke.Results: Participants' attitudes towards a device were explored across four key themes: Device characteristics Shape and size Interference with treatment Associated challenges Thematic analysis identified several unifying themes, including the importance of co-designing a device incorporating both vibrational and visual elements. Overall, participants expressed a preference for a small and wireless device.Results: Participants' attitudes towards a device were explored across four key themes: Device characteristics Shape and size Interference with treatment Associated challenges Thematic analysis identified several unifying themes, including the importance of co-designing a device incorporating both vibrational and visual elements. Overall, participants expressed a preference for a small and wireless device.Conclusion: This study identified potential characteristics for a device to support patients with hearing impairments in accessing DIBH during their radiation therapy treatment. A device incorporating both visual and vibrational elements may be optimal for addressing the diverse needs of patients in this cohort.
Introduction: This retrospective study addressed a literature gap by comparing set-up accuracy, dosimetric impact and user perception of carbon fibre versus foam headrests for head and neck cancer radiotherapy.Methods: One thousand image datasets from 50 patients were analysed, comparing carbon fibre (group one) and foam headrests (group two). Errors were recorded across five degrees of freedom. Evaluations included staff questionnaires on usability and Varian Eclipse dosimetric assessments for attenuation and conformity.Results: No significant differences in population systematic errors were observed. Carbon fibre showed a 0.23 degrees reduction in pitch error, while foam showed a significant 0.1 degrees reduction in yaw random error (p = 0.028). Dosimetrically, carbon fibre demonstrated superior conformity and less attenuation. While 70% of radiographers preferred carbon fibre for stability, 100% rated foam more comfortable.Conclusion: Both headrests provide equivalent set-up accuracy. Selection should prioritise patient comfort and specific dosimetric requirements where clinical results are equivocal.
Introduction: Manual contouring (MC) is time-consuming work in radiotherapy planning for rectal cancer. Artificial intelligence (AI) can reduce the time required for clinical target volume (CTV) and organs-at-risk (OARs) delineation. In this study, we evaluated the quality of auto-segmented CTVs and OARs.Methods: Dose-planning data were collected from ten patients who underwent preoperative radiotherapy for locally advanced rectal cancer in 2024. Auto-segmented structures from the AI-Rad and Contour+ software tools were added. Constructed AI-CTVs, based on Contour+ segmentations and AI-OARs, i.e., bladder, femoral heads and bowel bag, by both AI tools, were compared to their MC counterparts by use of quantitative metrics, volumetric/surface Dice similarity coefficients (vDSC/sDSC) and maximum/average Hausdorff distance (HD/aHD). The constructed AI-CTVs and MC counterparts were graded by two radiotherapists with two qualitative methods.Results: The median vDSC, sDSC, HD and aHD values of our constructed AI-CTVs compared with the MC-CTVs were 0.86, 0.61, 23.19 and 0.62 mm, respectively. For both AI tools, the agreement in the OAR metrics was overall good but less similar for the bowel bag. The qualitative evaluations of the AI-CTVs, compared to the MC-CTVs, were in clear favour of the MC-CTVs. The cranial-anterior nodal levels were anatomical areas with poorer coverage, where the contouring guidelines differed.Conclusion: The quality of our constructed AI-CTVs was inferior to the MC-CTVs. Thus, the auto-segmentation methods need further development on this aspect for use in the clinical setting. In contrast, the agreement of the quantitative metrics for the OARs was overall good, except for the bowel bag.
Introduction: Cone Beam CT (CBCT) imaging is used for accurate patient positioning in radiotherapy; however, excess frame acquisition increases the patient dose from the imaging procedure unnecessarily. Previous investigations identified that breast imaging was most affected by excessive frames.Methods: Comparing all protocols, a modification was introduced to adjust the gantry start angle +/- 5 degrees to ensure acquisitions commenced after acceleration, which aimed to reduce static frames and minimise unnecessary dose.Results: The protocol optimisation reduced the acquired frames by an average of 7 across Left and Right Breast Fast protocols and lowered delivered mAs by up to 4%. Using PCXMC simulation, the effective dose decreased from 3 & centerdot;0 to 2 & centerdot;8 mSv for the Left Breast protocol and from 2 & centerdot;9 to 2 & centerdot;8 mSv for the Right Breast, which is equivalent to 14 and 7 chest X-rays, respectively. Image quality metrics from the Catphan 503 phantom showed minimal changes in uniformity and contrast.Conclusion: The optimisation technique reduced excess CBCT frame acquisition and dose while maintaining image quality. The maximum deviations above tolerance reduced substantially from 16 & centerdot;1 to 8 & centerdot;5% for the Left Breast Fast S20 protocol and from18 & centerdot;6% to 12 & centerdot;1% for the Right Breast Fast S20 protocol.
Introduction: Direct-to-unit (DTU) radiotherapy is an increasingly popular treatment paradigm in which a traditional computed tomography simulation (CT-sim) is foregone, and a patient's diagnostic imaging (DI) is used for treatment planning. DTU can be delivered with (ART-DTU) or without online adaptation (non-ART-DTU). Herein, we describe considerations for the implementation of both non-ART and ART DTU.Innovation: DI selection criteria are dependent on the technique in use, as ART DTU image criteria may be less strict due to the capability to adapt to the anatomy of the day. Patient-related selection criteria for DTU include the ability to tolerate increased time on the table as well as the target location. Clinic needs and billing considerations must be addressed prior to formally installing a DTU programme.Discussion: DTU workflows will increase in complexity with the advent of new and intriguing technology. It is also anticipated that DTU will increase in popularity as efficient workflows for oligometastatic patients become more in vogue. Evaluation of this technique in prospective clinical trials is critical.Recommendations: DTU can be beneficial to patients, but great care must be taken when installing these workflows into the clinic. Close coordination between physicians and physicists and careful assessment of clinic demands are essential to success.
Background: Geographical inequalities in cancer care, often termed the 'postcode lottery', have long affected patient access and outcomes across the UK. In Wales, radiotherapy services are concentrated within three specialist centres, meaning many patients must travel considerable distances for treatment, potentially extending the time between key steps in the pathway. This study examined whether distance from the South-West Wales Cancer Centre (SWWCC) influenced access to, or timing of, breast cancer radiotherapy and explored whether and how service developments have mitigated geographic inequity. Methods: A retrospective cohort analysis was performed on 2,286 breast cancer patients treated at SWWCC between January 2018 and December 2023. Patients were grouped by travel time (<= 60 min vs >60 min), transport type and treatment prescription. Statistical analyses, including Fisher's exact and Kruskal-Wallis tests, assessed associations between travel distance, transport modality and treatment timing. Results: 31% of patients lived more than 60 minutes away and were significantly more likely to require ambulance transport (16.8% vs 4.4%) or hostel accommodation (11.3% vs 0%) (p < .001). There was no statistically significant difference in time from booking to first treatment fraction (p = .676). Mean CT-to-plan-check intervals fell from 27 to <10 days, and the wait between booking and start of treatment fell from similar to 60 to 25 days, reflecting efficiency gains linked to capacity release from adoption of hypofractionated regimens. Conclusions: Treatment timeliness is equitable across South-West Wales. Five-fraction regimens have alleviated many postcode-related disparities, though differences in transport dependence and access to supportive services remain areas for improvement.
Purpose: This study investigates the effect of sagging correction errors on image quality and geometric coordinate accuracy.Methods: This study utilised the Elekta radiotherapy system, ball bearing (BB), Catphan phantom and MultiMet-WL phantom. Ten distinct flex maps (FMs) were acquired by positioning the BB at the accuracy isocentre and introducing shifts of 0.2, 0.4 and 0.6 mm in the left, table and up directions, respectively. Cone-beam computed tomography images of the Catphan phantom were acquired using 10 FMs. The images were analysed for modulation transfer function (MTF) values and geometric coordinates. Additionally, the Winston-Lutz (W-L) test was conducted under reference couch positions and with a 0.3 mm couch shift.Results: For the Catphan phantom analysis, the standard deviations of MTF10% across FMs were 0.19. The centre-of-gravity coordinates of the insert exhibited shifts of approximately 0.2, 0.4 and 0.6 mm when comparing reference images to those acquired with the shifted FMs. The results of the W-L test with a 0.3 mm couch shift showed radiation isocentre deviations exceeding 1 mm compared to the reference couch positions.Conclusions: Minor sagging correction calibration errors did not remarkably impact image quality; however, they altered the geometric coordinates of the image isocentre. These calibration errors decreased the accuracy of off-isocentre positioning.
Introduction: Radiotherapy (RT) is a crucial part of the multidisciplinary treatment for various oncology sites. Clinical placement is mandatory on pre-registration RT programmes, where students spend 50% of their learning time. Recent research demonstrates that Culturally and Linguistically Diverse (CALD) students experience unique challenges during clinical placements. Limited research was found to evaluate the experience of CALD students during RT clinical placements. This study aimed to evaluate the placement experiences of RT CALD students enrolled in pre-registration RT programmes at UK universities.Method: An online Likert-scale survey was developed and sent to all BSc Radiotherapy Professional/Programme Leads at UK Universities via the Society of Radiographers Heads of Radiography Education Group. The programme leads were asked to disseminate the email to all undergraduate students in the programme; it was clearly stated that only international students should respond. Quantitative data were collected and analysed using descriptive statistics.Results: 17 CALD students completed the survey. The most common challenges identified were language barriers, cultural differences, isolation and unfamiliarity with the NHS. Some students reported that they had felt discriminated against on placement and typically received support from other CALD students or clinical tutors.Conclusion: Several challenges were observed in this study regarding CALD students enrolled in UK RT programmes. The results indicated the need to develop the cultural competence of clinical staff and educators. However, the small, all-female sample (n = 17) limits generalisability; further qualitative research is needed to gain a comprehensive understanding of how CALD students are supported during RT clinical placements.
Introduction: Radiation oncology (RO) plays a central role in modern cancer treatment. However, in Italy, this specialty remains under-represented in medical education, with limited awareness among students and many residency positions going unfilled. The gap between the importance of the discipline and student interest suggests a need to better integrate RO into medical training. Innovation: To assess the impact of early exposure, we conducted a pilot educational intervention involving 54th-year medical students. Participants completed a questionnaire before and after a six-hour clinical rotation in an RO department. The rotation included ward shadowing and introductory sessions on the role of the radiation oncologist. Discussion: At baseline, only 50% of students could describe the role of a radiation oncologist, and fewer than 10% were considering the specialty. Post-rotation, all students demonstrated an understanding of the profession. Positive perceptions of workload, safety and career prospects increased significantly (p < 0.01). The proportion of students expressing interest in pursuing RO rose modestly from 8% to 12%, while those definitively excluding it dropped from 40% to 36%. These findings suggest that even brief exposure can correct misconceptions and enhance receptiveness towards the field. Recommendations: While a single half-day experience can meaningfully improve awareness and perceptions of RO, it is unlikely to drive major changes in career choices on its own. To translate greater understanding into actual recruitment, medical schools should implement more sustained and structured RO experiences throughout the curriculum.
Purpose: This study aims to compare the dosimetric accuracy between the enhanced leaf model (ELM) in Eclipse V18.0 and the traditional multileaf collimators (MLCs) modelling in Eclipse V16.1 for volumetric modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT) treatments. The objective is to evaluate whether the ELM improves dose calculation accuracy and agreement with measurements in clinical practice. Methods: A retrospective analysis of 30 patients was conducted, categorized into Head-and-Neck (H&N), pelvic and lung SBRT groups. Treatment plans were created using the Acuros XB algorithm in both Eclipse versions. Gamma index pass rates for 1%/1 mm, 2%/2 mm and 3%/3 mm criteria were calculated using portal dosimetry for patient-specific quality assurance. Validation of MLC modelling was performed using closed leaf fields, sweeping gap fields, and the Picket Fence (PF) test across 6MV, 10MV, 6FFF and 10FFF photon energies. Results: Eclipse V18.0 demonstrated statistically significant improvements (p < 005) in dosimetric accuracy and gamma index pass rates across all photon energies and test conditions. In fully blocked fields, dose discrepancies reduced from 1.1% in V16.1 to 0.49% in V18 for 6MV. For the 6 mm sweeping gap test, discrepancies reduced from 1.19% to 0.31% for 6MV. The 1%/1mm gamma pass rates improved from 70% to 91.8% for H&N cases and from 82.4% to 87.3% for SBRT cases. Conclusion: The ELM in Eclipse V18.0 significantly improves dose calculation accuracy and treatment deliverability, supporting its adoption in clinical practice for VMAT and SBRT to achieve better treatment accuracy and outcome.
Purpose: This study compared dosimetric outcomes of craniospinal irradiation (CSI) using volumetric-modulated arc therapy (VMAT) from TrueBeam (TB) and Halcyon, and intensity-modulated proton therapy from ProBeam.Methods: Fifteen CSI cases prescribed 2340 cGy in 13 fractions were optimized. Dose coverage of the clinical target volume (CTV), organs at risk (OARs), conformity index (CI), homogeneity index (HI), total normal tissue volume (%TNTV), and beam-on time were evaluated.Results: Significant differences in D95% were observed among the three techniques. ProBeam plans achieved the best CI, while Halcyon plans demonstrated superior HI. ProBeam resulted in the lowest %TNTV dose, followed by Halcyon and TB. Among 16 evaluated OARs, 10 received significantly lower doses with ProBeam compared to photon techniques. ProBeam also showed the shortest beam-on time (4.2 +/- 0.1 minutes) but required the highest total monitor units due to its delivery method. Compared with Halcyon, TB delivered lower doses to 11 OARs, with significant differences in seven. However, Halcyon reduced beam-on time by approximately half (6.1 +/- 0.8 vs. 12.1 +/- 0.5 minutes).Conclusion: Although ProBeam provided the best overall dosimetric performance, Halcyon represents an effective alternative for CSI, offering good plan quality, acceptable OAR sparing, improved %TNTV dose, and shorter treatment times compared to TrueBeam, potentially enhancing clinical efficiency.
Purpose: Head and neck (HN) radiotherapy contour quality directly impacts local control (LC) and survival; however, few departments peer review (PR) contours prior to radiotherapy planning (RTP). This study reports outcomes of a single institution's formal HN contour PR process.Methods: A formal HN contour PR process was implemented. Prior to RTP, HN radiation oncologists reviewed contours, provided feedback and assigned contour grades as follows: R0 (no change), R1 (minor revision, not high risk) or R2 (major revision; high risk). The PR task was completed and the contour grade was recorded. Cochran-Armitage trend test was performed.Results: Pilot PR process was performed over a 7-month period for 88 patients, followed by a maintenance phase. Contours were graded as follows: R0 (N = 51), R1 (N = 20) and R2 (N = 17). Over time, the number of R2 revisions decreased (p = 0.0001); month 1 (N = 7), month 2 (N = 3), month 3 (N = 5), month 4 (N = 2) and months 5-7 (N = 0). Conversely, the number of R0 revisions improved over time (p = 0.0203); month 1 (N = 5), months 2-3 (N = 9), month 4 (N = 5), month 5 (N = 8), month 6 (N = 12) and month 7 (N = 3). Each radiation oncologist demonstrated reduction in R2 revisions during the pilot. During maintenance, all 3 radiation oncologists demonstrated low rates of R2 revisions of less than 3 cases per year.Conclusion: Incorporation of HN contour PR into routine clinical workflow is feasible. The collective experience of multiple high-volume HN radiation oncologists led to improved contour quality in the pilot for each radiation oncologist and continued to ensure high quality in the maintenance phase.
Accurate delivery of radiotherapy to head, neck and brain cancer relies on the use of sophisticated immobilisation devices, usually using a restrictive thermoplastic mask. These masks can cause anxiety and can make treatment difficult for many patients. Open-face or maskless techniques are alternatives which can improve the patient experience. This systematic review aimed to compare the effectiveness of open-face (OF) masks and maskless surface guided radiotherapy (SGRT) with conventional masks. Primary research papers from the last 10 years were gathered from Scopus, PUBMED, Web of Science and OVID databases. Quantitative data reporting interfractional set-up errors and intrafractional patient motion were extracted from included studies and subjected to descriptive statistical analysis. Additional qualitative data relating to patient tolerance were also extracted to inform discussion. Ten studies were identified for inclusion. The data identified that OF masks can reproduce patient set-up with an accuracy of <2 mm and <1° and can restrict movement to <1 mm and 0·4°, while maskless SGRT can achieve accuracy to within 0·05 mm and 0·1°. This review indicates comparable reduction of intrafractional motion between conventional masks, Open-Face masks and maskless SGRT techniques. More research is needed into the impact of maskless SGRT techniques on translational and rotational motions compared to traditional masks.
