Upright radiotherapy: rapidly realising clinical and economic benefits
Lead Research Organisation:
Leo Cancer Care UK
Department Name: Directorate
Abstract
Currently, radiotherapy patients are treated lying on their backs. Complex machinery weighing at least six tonnes is rotated around them. As it rotates, this machinery delivers radiation beams from different angles.
Leo Cancer Care are a small British company who adopted a "design thinking" approach to re-imagine and simplify radiotherapy. Together with ergonomics experts, they developed a flexible and comfortable robotic positioning system that rotates an upright patient. The radiotherapy beam remains fixed.
This project draws upon the fellow's international clinical experience and strong scientific track-record to optimise Leo Cancer Care's simplified radiotherapy solution for clinical use. This will enable the fellow and Leo Cancer Care to deliver cancer treatments that are better, cheaper, more efficient and more accessible.
Better treatments: radiotherapy side-effects can be devastating. For certain types of cancer, treating patients upright will enable us to better target radiotherapy treatment beams, reducing normal-tissue damage. For breast cancer, sitting upright with a forward tilt moves the breast away from the heart and lungs, improving beam access. For prostate cancer, day-to-day variations in bladder filling and rectal gas will have less impact for upright patients. For lung cancer, lung volumes are greater and lung motion is reduced when patients are upright, enabling better sparing of the heart. Additionally, upright positioning will make many patients feel physically more comfortable (e.g. by enabling patients with lung cancer to breathe more easily) helping them to tolerate their treatment.
Cheaper treatments: the cost of a LCC upright X-ray treatment room is half that of a conventional, supine treatment: £2m compared to £4m.
More efficient treatments: LCC's simpler technology will lead to (1) reduced equipment maintenance costs (2) easier upgrades of beam delivery technology (3) simpler machine QA & therefore lower expertise barriers (4) substantial reductions in shielded treatment room volume (5) improved patient throughput due to upright positioning.
More accessible treatments: worldwide access to radiotherapy is unacceptably low. There is potential to save one million lives per year by 2035 through optimal access to radiotherapy. 80% of cancer patients live in low- and middle-income countries which host only around 5% of the world's RT resources. By halving the cost of an X-ray treatment room and also delivering more efficient RT, LCC solutions stand to make RT more affordable and accessible, improving cancer survival worldwide.
To conduct this research the fellow will build new partnerships between Leo Cancer Care, the NHS and universities/hospitals worldwide. Partners include: University College London NHS Foundation Trust, Clatterbridge Cancer Centre, the Royal Surrey NHS Foundation Trust, Massachusetts General Hospital, Centre Léon-Bérard, University College London, the University of Surrey, Sheffield Hallam University, Loughborough University and the University of Sydney. The shared goal is to rapidly deliver the benefits of upright radiotherapy to patients. To do this, a number of key scientific challenges will be addressed:
Challenge 1: patient immobilisation systems must be developed. These must enable the patient to sit/stand comfortably for ~20 mins for each radiotherapy treatment. Radiotherapy is delivered daily, in up to 30 treatment 'fractions', each lasting ~20 mins.
Challenge 2: upright radiotherapy workflows (for patient treatments and machine testing) must be streamlined. Streamlined workflows will reduce the expertise barrier associated with treatments, improving access.
Challenge 3: algorithms must be developed to transfer biological data from MRI/PET to upright radiotherapy.
Challenge 4: to incorporate tomorrow's imaging technologies into upright RT, bringing live MRI-guidance to our treatment rooms. This will further improve tumour targeting.
Leo Cancer Care are a small British company who adopted a "design thinking" approach to re-imagine and simplify radiotherapy. Together with ergonomics experts, they developed a flexible and comfortable robotic positioning system that rotates an upright patient. The radiotherapy beam remains fixed.
This project draws upon the fellow's international clinical experience and strong scientific track-record to optimise Leo Cancer Care's simplified radiotherapy solution for clinical use. This will enable the fellow and Leo Cancer Care to deliver cancer treatments that are better, cheaper, more efficient and more accessible.
Better treatments: radiotherapy side-effects can be devastating. For certain types of cancer, treating patients upright will enable us to better target radiotherapy treatment beams, reducing normal-tissue damage. For breast cancer, sitting upright with a forward tilt moves the breast away from the heart and lungs, improving beam access. For prostate cancer, day-to-day variations in bladder filling and rectal gas will have less impact for upright patients. For lung cancer, lung volumes are greater and lung motion is reduced when patients are upright, enabling better sparing of the heart. Additionally, upright positioning will make many patients feel physically more comfortable (e.g. by enabling patients with lung cancer to breathe more easily) helping them to tolerate their treatment.
Cheaper treatments: the cost of a LCC upright X-ray treatment room is half that of a conventional, supine treatment: £2m compared to £4m.
More efficient treatments: LCC's simpler technology will lead to (1) reduced equipment maintenance costs (2) easier upgrades of beam delivery technology (3) simpler machine QA & therefore lower expertise barriers (4) substantial reductions in shielded treatment room volume (5) improved patient throughput due to upright positioning.
More accessible treatments: worldwide access to radiotherapy is unacceptably low. There is potential to save one million lives per year by 2035 through optimal access to radiotherapy. 80% of cancer patients live in low- and middle-income countries which host only around 5% of the world's RT resources. By halving the cost of an X-ray treatment room and also delivering more efficient RT, LCC solutions stand to make RT more affordable and accessible, improving cancer survival worldwide.
To conduct this research the fellow will build new partnerships between Leo Cancer Care, the NHS and universities/hospitals worldwide. Partners include: University College London NHS Foundation Trust, Clatterbridge Cancer Centre, the Royal Surrey NHS Foundation Trust, Massachusetts General Hospital, Centre Léon-Bérard, University College London, the University of Surrey, Sheffield Hallam University, Loughborough University and the University of Sydney. The shared goal is to rapidly deliver the benefits of upright radiotherapy to patients. To do this, a number of key scientific challenges will be addressed:
Challenge 1: patient immobilisation systems must be developed. These must enable the patient to sit/stand comfortably for ~20 mins for each radiotherapy treatment. Radiotherapy is delivered daily, in up to 30 treatment 'fractions', each lasting ~20 mins.
Challenge 2: upright radiotherapy workflows (for patient treatments and machine testing) must be streamlined. Streamlined workflows will reduce the expertise barrier associated with treatments, improving access.
Challenge 3: algorithms must be developed to transfer biological data from MRI/PET to upright radiotherapy.
Challenge 4: to incorporate tomorrow's imaging technologies into upright RT, bringing live MRI-guidance to our treatment rooms. This will further improve tumour targeting.
Organisations
- Leo Cancer Care UK (Fellow, Lead Research Organisation)
- SHEFFIELD HALLAM UNIVERSITY (Collaboration)
- Paul Scherrer Institute (Collaboration)
- Léon Bérard Center (Collaboration)
- Helmholtz Association of German Research Centres (Collaboration)
- IMPERIAL COLLEGE LONDON (Collaboration)
- University of Sydney (Project Partner)
- University College London (Project Partner)
- University of Surrey (Project Partner)
- Leon Berard Cancer Centre (Project Partner)
- Massachusetts General Hospital (Project Partner)
- Royal Surrey County Hospital (Project Partner)
Publications
Boisbouvier S
(2023)
Upright patient positioning for gantry-free breast radiotherapy: feasibility tests using a robotic chair and specialised bras.
in Frontiers in oncology
Marano J
(2023)
Relative thoracic changes from supine to upright patient position: A proton collaborative group study
in Journal of Applied Clinical Medical Physics
Schreuder A
(2023)
Anatomical changes in the male pelvis between the supine and upright positions-A feasibility study for prostate treatments in the upright position
in Journal of Applied Clinical Medical Physics
Schreuder AN
(2023)
The use of image synthesis techniques in target and roi delineation in the upright position.
in Journal of applied clinical medical physics
Title | Smizz's live drawing from patient advocate workshop on breast radiotherapy |
Description | A series of "live-drawings" created by artist and therapeutic radiographer Sarah Smith (Smizz) during an 8 hour workshop. The drawings document patient experiences of radiotherapy and patient thoughts on upright radiotherapy |
Type Of Art | Artwork |
Year Produced | 2023 |
Impact | Amplification of patient voice within Leo Cancer Care and within the wider radiotherapy community. |
Description | Optical guidance |
Organisation | Imperial College London |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Co-supervision of 3 MRes students looking into 3D photogrammetry for upright radiotherapy |
Collaborator Contribution | Co-supervision of 3 MRes students looking into 3D photogrammetry for upright radiotherapy |
Impact | MRes theses will result |
Start Year | 2022 |
Description | Patient experience |
Organisation | Sheffield Hallam University |
Department | Centre for Health and Social Care Research |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Working jointly on patient engagement activities to understand and improve the radiotherapy experience Working jointly on co-design projects to improve our products at Leo Cancer Care |
Collaborator Contribution | Working jointly on patient engagement activities to understand and improve the radiotherapy experience Working jointly on co-design projects to improve our products at Leo Cancer Care |
Impact | Outcomes: increased knowledge regarding the patient experience which will be shared at a later date via a publication / input to a national committee. Increased knowledge which will shape our co-design process. |
Start Year | 2022 |
Description | Upright Radiotherapy Research Consortium |
Organisation | Helmholtz Association of German Research Centres |
Department | GSI Helmholtz Centre for Heavy Ion Research |
Country | Germany |
Sector | Public |
PI Contribution | We established an international research consortium of clinicians and academics interested in upright radiotherapy. Consortium aims: to build a community of researchers interested in upright radiotherapy; to update each other on findings, data and expertise; to spark collaborations and to co-ordinate research efforts; to shape best practices internationally. We have had multiple online meetings and will have our first in-person meeting in May 2023. |
Collaborator Contribution | Contributed presentations and ideas to meetings. |
Impact | In-person collaborative meeting scheduled for May 2023 |
Start Year | 2022 |
Description | Upright Radiotherapy Research Consortium |
Organisation | Léon Bérard Center |
Country | France |
Sector | Public |
PI Contribution | We established an international research consortium of clinicians and academics interested in upright radiotherapy. Consortium aims: to build a community of researchers interested in upright radiotherapy; to update each other on findings, data and expertise; to spark collaborations and to co-ordinate research efforts; to shape best practices internationally. We have had multiple online meetings and will have our first in-person meeting in May 2023. |
Collaborator Contribution | Contributed presentations and ideas to meetings. |
Impact | In-person collaborative meeting scheduled for May 2023 |
Start Year | 2022 |
Description | Upright Radiotherapy Research Consortium |
Organisation | Paul Scherrer Institute |
Department | Center for Proton Therapy CPT |
Country | Switzerland |
Sector | Academic/University |
PI Contribution | We established an international research consortium of clinicians and academics interested in upright radiotherapy. Consortium aims: to build a community of researchers interested in upright radiotherapy; to update each other on findings, data and expertise; to spark collaborations and to co-ordinate research efforts; to shape best practices internationally. We have had multiple online meetings and will have our first in-person meeting in May 2023. |
Collaborator Contribution | Contributed presentations and ideas to meetings. |
Impact | In-person collaborative meeting scheduled for May 2023 |
Start Year | 2022 |
Description | Patient advocate workshop on breast radiotherapy |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Patients, carers and/or patient groups |
Results and Impact | 10 women who received breast radiotherapy attended a day long workshop at Sheffield Hallam University. The workshop was organised jointly by Leo Cancer Care and Sheffield Hallam University (funded by the UKRI FLF scheme). The morning session focussed on the attendees' general experience of radiotherapy and their care pathway. In the afternoon session, the focus shifted to upright radiotherapy. The participants tried out prototype equipment, giving their thoughts on it and suggestions for improvement in a co-design approach. |
Year(s) Of Engagement Activity | 2023 |