Surface-guided radiation therapy

Short description: 3D imaging used during radiation therapy

Surface-guided radiation therapy

Other names| SGRT / Surface-image guided radiation therapy
Specialty| interventional radiology/oncology

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Surface-guided radiation therapy (SGRT) (sometimes referred to as Surface-image Guided Radiation Therapy) is the process of using 3D imaging to position and track movement of radiation therapy patients during treatment.

## Contents

* 1 Goals and clinical benefits
* 2 Clinical applications
* 3 See also
* 4 References
* 5 External links

## Goals and clinical benefits

SGRT can help to improve the safety, effectiveness and efficiency of radiation therapy treatments, by offering guidance across every step of the radiation therapy workflow, including simulation, planning, treatment and dose visualisation.

Developed as an advancement to image-guided radiation therapy, SGRT relies on 3D imaging as opposed to an x-ray.[1] SGRT uses cameras to feed data into a software program linked to the linear accelerator delivering the radiation.[2] Each camera uses a projector and image sensors to create a 3D surface model of a patient, by projecting a red light containing a pseudo-random speckle pattern on their skin.[3] The pattern allows the SGRT system to reference thousands of points on the skin, acting as virtual medical tattoos.[4] This imaging information is fed into the software to allow real-time tracking and sub-millimetric accuracy during radiotherapy treatments. Information on movements is fed back to the radiation therapist, who is alerted if the patient moves from the optimal position (as determined by their treatment plan). SGRT systems can be set to automatically stop the delivery of radiation if a patient moves outside of a certain tolerance level.[5]

SGRT can help to reduce errors in set-up and positioning, allow the margins around target tissue when planning to be reduced, and enable treatment to be adapted during its course, with the aim of overall improving outcomes.[6]

## Clinical applications

For breast cancer treatment, SGRT increases the patient setup information compared to laser‐based setup (LBS), by using the entire patient skin surface instead of only three skin marks.[7] SGRT also enables clinicians to monitor a patient in real-time to replicate the same position during the CT scan for sarcoma patients.[8]

When used with deep inspiratory breath-hold, SGRT supports initial positioning, both in free breathing (at mid-patient reference point) and in DIBH (at treatment isocenter).[9] This process has been found to help reduce errors in set-up, positioning and improve overall outcomes for patients. It has also been used with Stereotactic Body Radiation Therapy to assist with the initial set-up and detect intrafraction patient motion throughout treatment.[3] For stereotactic surgery, SGRT allows a frameless system to be used to monitor the surface of the patient within an open-face immobilization mask.[10]

## See also

* Radiography
* Treatment of cancer

## References

1. ↑ Hombrink, Gerrit; Promberger, Claus (26 July 2021). "How and Why Surface Guided Radiation Therapy Developed". Brainlab. https://www.brainlab.com/journal/how-and-why-surface-guided-radiation-therapy-developed-sgrt/.
2. ↑ Freislederer, P.; Batista, V.; Ollers, M.; Nguyen, D.; Bert, C.; Lehmann, J. (30 May 2022). "ESTRO-ACROP guideline on surface guided radiation therapy". Radiotherapy & Oncology 173: 188–196. doi:10.1016/j.radonc.2022.05.026. PMID 35661677. https://www.thegreenjournal.com/article/S0167-8140(22)04132-9/fulltext.
3. ↑ 3.0 3.1 Lawler, Gavin (19 January 2022). "A review of surface guidance in extracranial stereotactic body radiotherapy (SBRT/SABR) for set-up and intra-fraction motion management". Technical Innovations & Patient Support in Radiation Oncology 21: 23–26. doi:10.1016/j.tipsro.2022.01.001. PMID 35079644.
4. ↑ Batista, Vania; Meyer, Juergen; Kugele, Malin; Al-Hallaq, Hania (2020). "Clinical paradigms and challenges in surface guided radiation therapy: Where do we go from here?". Radiotherapy and Oncology 153: 34–42. doi:10.1016/j.radonc.2020.09.041. PMID 32987044.
5. ↑ Sarudis, Sebastian; Karlsson, Anna; Back, Anna (2021). "Surface guided frameless positioning for lung stereotactic body radiation therapy". Journal of Applied Clinical Medical Physics 22 (9): 215–226. doi:10.1002/acm2.13370. PMID 34406710.
6. ↑ Paxton, Adam Brent; Waghorn, Benjamin James; Hoisak, Jeremy David; Pawlicki, Todd (2020). Surface Guided Radiation Therapy. CRC Press. ISBN 9780429951800.
7. ↑ Mast, Mirjam (15 April 2022). "Introduction to: Surface Guided Radiotherapy (SGRT)". Technical Innovations & Patient Support in Radiation Oncology 22: 37–38. doi:10.1016/j.tipsro.2022.04.004. PMID 35464887.
8. ↑ Saito, Masahide; Ueda, Koji; Suzuki, Hidekazu; Komiyama, Takafumi; Marino, Kan; Aoki, Shinichi; Sano, Naoki; Onishi, Hiroshi (3 May 2022). "Evaluation of the detection accuracy of set-up for various treatment sites using surface-guided radiotherapy system, VOXELAN: a phantom study". Journal of Radiation Research 63 (3): 435–442. doi:10.1093/jrr/rrac015. PMID 35467750. PMC 9124621. https://academic.oup.com/jrr/article/63/3/435/6573755.
9. ↑ Freislederer, P.; Kugele, M.; Ollers, M.; Swinnen, A.; Sauer, T-O.; Bert, C.; Giantsoudi, D.; Corradini, S. et al. (31 July 2020). "Recent advances in Surface Guided Radiation Therapy". Radiation Oncology 187 (15): 187. doi:10.1186/s13014-020-01629-w. PMID 32736570.
10. ↑ Heinzerling, John H.; Hampton, Carnell J.; Robinson, Myra; bright, Megan; Moeller, Benjamin J.; Ruiz, Justin; Prabhu, Roshan; Burri, Stuart H. et al. (20 March 2020). "Use of surface-guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen". Journal of Applied Clinical Medical Physics 21 (5): 48–55. doi:10.1002/acm2.12852. PMID 32196944.

## External links

* Google Scholar articles on surface-guided radiation therapy

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