Benefits of using SGRT for Head & Neck Patients

SGRT US 2024
Lauren Conway
MS RT(T) Chief Radiation Therapist
Dana-Farber Cancer Institute / Brigham Cancer Center

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Benefits of Using SGRT for H&N Patients
Lauren Conway MS, RT(T)
Chief Radiation Therapist
Dana-Farber/Brigham and Women’s Cancer Center, Boston
June 2024

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•VisionRT is covering travel expenses for this presentation, however, this
support does not influence the content, or opinions expressed during
this presentation.
Disclosure

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•Institution- DFCI/BWH
•Background and Clinical Rationale
•Open-Face Mask + SGRT Timeline
•Workflow
•H&N Pilot Data Collection
•Data Analysis and Results
•Clinical Impacts
•Acknowledgements
Agenda

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About Dana-Farber/Brigham &
Women’s Hospital, Boston
•FY 2023
•Department treated ~50k patients
•H&N patient population was ~6k pts
•Machines:
•4 Truebeams – all with AlignRT
•2 Clinac iX- 1 machine with AlignRT
•1 Ethos/Halycon- in-bore AlignRT
•1 MR-Linac
•3 CT simulators
•1 MR Machine
•Cobalt-60
•2 HDR units

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1.Increase in staff feedback regarding H&N set up:
•RTTs felt they spent a lot of time in and out of the room manually adjusting shoulder, chin, and/or spine position
•MDs were requesting adjustments on patient films.
2.Success with open-face mask + SGRT workflow used for
C-spine SBRT treatments
3.Department push to move towards CBCT Daily for H&N
patients, needing to improve initial set up to remove kV
imaging.
Background and Clinical Rationale

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Open-Face Mask + SGRT Timeline
January 2021
April 2021
July 2021
February 2023
June 2023

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Open-Face Mask + SGRT Timeline
SBRT team started using surface
guidance prior to placing the mask
on the patient to improve initial set
up for C-spine SBRT cases.
January 2021
April 2021
July 2021
February 2023
June 2023

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Open-Face Mask + SGRT Timeline
SBRT team started using surface
guidance prior to placing the mask
on the patient to improve initial set
up for C-spine SBRT cases.
January 2021
SBRT team trialed Open-Face Mask
for C-spine patients using SGRT
April 2021
July 2021
February 2023
June 2023

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Open-Face Mask + SGRT Timeline
SBRT team started using surface
guidance prior to placing the mask
on the patient to improve initial set
up for C-spine SBRT cases.
January 2021
SBRT team trialed Open-Face Mask
for C-spine patients using SGRT
April 2021
Standard practice Open-Face Masks
for C-spine SBRT using SGRT
July 2021
February 2023
June 2023

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Open-Face Mask + SGRT Timeline
SBRT team started using surface
guidance prior to placing the mask
on the patient to improve initial set
up for C-spine SBRT cases.
January 2021
SBRT team trialed Open-Face Mask
for C-spine patients using SGRT
April 2021
Standard practice Open-Face Masks
for C-spine SBRT using SGRT
July 2021
Piloted Open-Face Masks with SGRT
for H&N patients
February 2023
June 2023

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Open-Face Mask + SGRT Timeline
SBRT team started using surface
guidance prior to placing the mask
on the patient to improve initial set
up for C-spine SBRT cases.
January 2021
SBRT team trialed Open-Face Mask
for C-spine patients using SGRT
April 2021
Standard practice Open-Face Masks
for C-spine SBRT using SGRT
July 2021
Piloted Open-Face Masks with SGRT
for H&N patients
February 2023
Standard practice Open-Face
Masks with SGRT for H&N pts
June 2023

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Workflow
1.Patient lies on couch, rests inhead-cup
2.RTTs set couch coordinates
3.Turn on AlignRT
4.Move patient head/shoulders into
position with deltas & postural video
5.Put on mask
6.Move head to align rotational deltas
(pitch, roll, rotation)
7.Shift table to get translational deltas into
tolerance (3mm/2deg)

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June – Dec
2022
Retrospective Closed Mask Data Collection
Sample size: 52 patients
•Average acquiring image to Beam on Time
•Average Shoulder Pulls
•Average MD Image Change Requests
•Total Fractions
March – May
2023
Open Face Mask with AlignRT Data Collection
Sample size: 39 patients
•Average acquiring image to Beam on Time
•Average Shoulder Pulls
•Manual Adjustments
•Shifts
•Average MD Image Change Requests
•6DoF capabilities
•Total Fractions
H&N Pilot Data Collection

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Comparing average time between first image and beam on time we saw
a decrease from 3.5 min to 2.6 min
Data Analysis and Results
UCL
6.1
4.4
CL 3.5
2.6
LCL 0.8 0.7
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
6/1/20226/6/20226/6/20226/8/20226/13/20226/21/20226/27/20227/5/20227/21/20227/25/20228/15/20228/22/20228/29/20228/30/20229/12/20229/15/20229/20/20229/26/202210/4/202211/7/202211/15/202211/29/202212/13/202212/27/2022
3/2/20233/13/20233/20/20233/20/20233/23/20233/27/20233/28/20233/29/20234/3/20234/3/20234/10/20234/10/20234/12/20234/17/20234/17/20234/18/20234/24/20235/3/20235/8/20235/15/2023
Average Image to Beam on Time
June 2022-May 2023
Average Image to Beam on Time- XmR
Start Open-Face Mask with
SGRT

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Shoulder pulls decreased by 50%
Data Analysis and Results
UCL 1.0449
0.64508
CL 0.4586
0.20128
LCL -0.1278
-0.24252
-0.5000
0.0000
0.5000
1.0000
1.5000
2.0000
24681012141618202224262830323436384042444648505254565860626466687072747678808284868890
Average Shoulder Pull
Sample
Average Shoulder Pull (Green Mask vs. Open Face Mask)- XmR
Start Open-Face
Mask with SGRT

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Comparing average image change requests per patient course, we can see the
requests became less frequent from 1.0 to 0.3 per pt course.
Data Analysis and Results
UCL 3.5
1.8
CL 1.0
0.3
LCL -1.5 -1.3
-2.0
-1.0
0.0
1.0
2.0
3.0
4.0
5.0
135791113151719212325272931333537394143454749515355575961636567697173757779818385878991
Average Image Change Request
Sample
Average Image Change Request (Green Mask vs. Open Face Mask) XmR
Start Open-Face Mask
with SGRT

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Clinical Impacts

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Clinical Impacts
REDUCTION IN
IMAGE TO
BEAM ON TIME
Less Repositioning &
Less Repeat Imaging

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Clinical Impacts
REDUCTION IN
IMAGE TO
BEAM ON TIME
Less Repositioning &
Less Repeat Imaging
REDUCTION IN
MANUAL
SHOULDER
PULLS
Less Repeat Imaging

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Clinical Impacts
REDUCTION IN
IMAGE TO
BEAM ON TIME
Less Repositioning &
Less Repeat Imaging
REDUCTION IN
MANUAL
SHOULDER
PULLS
Less Repeat Imaging
REDUCTION IN
MD CHANGE
REQUESTS
Reproducible set ups

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Clinical Impacts
REDUCTION IN
IMAGE TO
BEAM ON TIME
Less Repositioning &
Less Repeat Imaging
REDUCTION IN
MANUAL
SHOULDER
PULLS
Less Repeat Imaging
REDUCTION IN
MD CHANGE
REQUESTS
Reproducible set ups
INTRAFRACTION
MOTION
MONITORING
Observing patient
motion in real-time

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•Tianna Carangelo RT(T)
•Holly O’Connor RT(T)
•Katie MacDonald RT(T)
•Brenda Ferone RT(T)
•Daniela Gioioso RT(T)
•Allison Gochnaur RT(T)
•Michelle Miranda RT(T)
•Andrew Germain RT(T)
•Lauren Driscoll RT(T)
•Rose Roa Ramirez RT(T)
•Julie O’Neil-Smith RT(T)
•Michelle Physic RT(T)
•Meghan Kearney MS, RT(T)
•Joe Killoran PhD
Acknowledgments

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Thank you!
[email protected]

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