Clinical Implementation of a 6D Treatment Chair for Fixed Ion Beam Lines

Sun, Jingsong; Kong, Lin; Chen, Zhi; You, Dan; Mao, Jingfang; Guan, Xiyin; Wu, Xiaodong; Sheng, Yinxiangzi

doi:10.3389/fonc.2021.694749

Cited by 6 publications

(14 citation statements)

References 33 publications

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“…Most recently, Sun et al (31) presented results from clinical implementation of a chair positioning system targeted for head&neck cancers at the Shanghai Proton and Heavy Ion Center (SPHIC). Of 320 patients treated for head&neck, 15 showed a clear dosimetric benefit compared to a treatment with couch and fixed horizontal or 45°inclined beam line.…”

Section: Clinical Argumentsmentioning

confidence: 99%

“…In their work, detailed stress simulations and experimental validations were performed to ensure highest safety of the components and accuracy of the treatment chair motion under patient load. Clinical implementation of the device with dedicated quality assurance protocol is reported in (46) and first experience with patient treatments is presented in (31).…”

Section: Brief Overview Over Existing Solutionsmentioning

confidence: 99%

“…Sun et al (31) report patient discomfort for a head&neck chair system, where the patients are positioned in a straight upright position (i.e., a 90°angle between seat and backrest). Patients reportedly tended to sag their heads within the thermoplastic immobilization masks.…”

Section: Considerations On Posturementioning

confidence: 99%

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Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

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Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.

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Section: Clinical Argumentsmentioning

confidence: 99%

Section: Brief Overview Over Existing Solutionsmentioning

confidence: 99%

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Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

et al. 2022

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“…Clinical tests of this chair were performed by Sun et al. ( 111 ) to verify treatment and workflow feasibility. As optimal plans are possible with only a few fields, it is suggested that beam selection is more significant to the achievable dose distribution than the available number of fields or angles.…”

Section: Limitations and Avenues For Improvementsmentioning

confidence: 99%

“…A study by Sheng et al (110) report that rotational and translational positioning with a 6D treatment chair is comparable in alignment precision and reproducibility to a standard robotic treatment couch. Clinical tests of this chair were performed by Sun et al (111) to verify treatment and workflow feasibility. As optimal plans are possible with only a few fields, it is suggested that beam selection is more significant to the achievable dose distribution than the available number of fields or angles.…”

Section: Beam Delivery Systems Gantries and Fixed Beamlinesmentioning

confidence: 99%

Future Developments in Charged Particle Therapy: Improving Beam Delivery for Efficiency and Efficacy

2021

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The physical and clinical benefits of charged particle therapy (CPT) are well recognized. However, the availability of CPT and complete exploitation of dosimetric advantages are still limited by high facility costs and technological challenges. There are extensive ongoing efforts to improve upon these, which will lead to greater accessibility, superior delivery, and therefore better treatment outcomes. Yet, the issue of cost remains a primary hurdle as utility of CPT is largely driven by the affordability, complexity and performance of current technology. Modern delivery techniques are necessary but limited by extended treatment times. Several of these aspects can be addressed by developments in the beam delivery system (BDS) which determines the overall shaping and timing capabilities enabling high quality treatments. The energy layer switching time (ELST) is a limiting constraint of the BDS and a determinant of the beam delivery time (BDT), along with the accelerator and other factors. This review evaluates the delivery process in detail, presenting the limitations and developments for the BDS and related accelerator technology, toward decreasing the BDT. As extended BDT impacts motion and has dosimetric implications for treatment, we discuss avenues to minimize the ELST and overview the clinical benefits and feasibility of a large energy acceptance BDS. These developments support the possibility of advanced modalities and faster delivery for a greater range of treatment indications which could also further reduce costs. Further work to realize methodologies such as volumetric rescanning, FLASH, arc, multi-ion and online image guided therapies are discussed. In this review we examine how increased treatment efficiency and efficacy could be achieved with improvements in beam delivery and how this could lead to faster and higher quality treatments for the future of CPT.

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A radiation therapy platform to enable upright cone beam computed tomography and future upright treatment on existing photon therapy machines

Korte,

Wright,

Krishnan

et al. 2024

Medical Physics

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BackgroundThe conventional lying down position for radiation therapy can be challenging for patients due to pain, swallowing or breathing issues. To provide an alternative upright treatment position for these patients, we have developed a portable rotating radiation therapy platform which integrates with conventional photon treatment machines. The device enables cone‐beam computed tomography (CBCT) imaging of patients in an upright position, and the future delivery of therapeutic radiation.PurposeTo design, manufacture, and test a device for upright radiation therapy. A collaborative partnership between physicists, engineers, radiation therapists, radiation oncologists, implementation researchers and consumers was established, to create a device that meets both the clinical and technical requirements of upright radiation therapy. The device is central to a clinical trial (ACTRN12623000498695) which will evaluate upright image quality in the context of future image guided radiation therapy for patients with lung cancer or head and neck cancer.MethodsThe weight and physical constraints of the device were assessed with respect to the American civilian population. The final design was evaluated with a series of tests to characterize the angular accuracy of the platform rotation and the reproducibility of the platform setup position in a radiation treatment room. To acquire an upright CBCT, the platform movement system was synchronized to the kilo‐voltage fluoroscopic imaging on an existing treatment machine. The accuracy of the synchronization was evaluated by assessing the positional reproducibility of upright CBCT imaging of a chest phantom.ResultsThe platform has a weight limit of up to 125 kg which is suitable for approximately 90% of males and 95% of females. The platform has physical constraints that accommodate approximately 95.6% of males and 99.6% of females: a maximum seated height of 97.5 cm, a maximum hip breadth of 63.0 cm, and maximum elbow to knuckle length of 46.5 cm. The angular accuracy of the motion system is within ±0.15° over a full rotation, which is within the guidelines for machine movement accuracy in radiation therapy (1 mm/1°). The platform is a portable device and can be reproducibly positioned in a radiation therapy treatment room with a translational range within ±0.04 mm and a rotational range within ±0.025°. The CBCT imaging can reproducibly detect the position of a chest phantom with a translational uncertainty of ±0.07 mm and a rotational uncertainly of ±0.22°, when imaging is acquired following a strict procedure.ConclusionThe upright radiation therapy platform is suitable for the evaluation of CBCT imaging in the context of image guided radiation therapy. The platform will allow the investigation of open questions in upright radiation therapy in the areas of patient experience, positional stability, anatomical changes, and treatment delivery. Improvements to the materials in the radiation beam line, synchronization with the existing treatment machine, and increasing the device weight limit are suggested prior to delivery of future upright treatments.

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Clinical Implementation of a 6D Treatment Chair for Fixed Ion Beam Lines

Cited by 6 publications

References 33 publications

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance

Future Developments in Charged Particle Therapy: Improving Beam Delivery for Efficiency and Efficacy

A radiation therapy platform to enable upright cone beam computed tomography and future upright treatment on existing photon therapy machines

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