Optimizing Radiation Therapy Setup Through Integrated Gantry-Based Display of Multimodal Setup Information

Abstract

Purpose/Aim

For over a decade, our institution relied on free-text setup notes within the MOSAIQ notes section to guide radiation treatment delivery. With the installation of an Elekta Harmony Linear Accelerator featuring an integrated gantry-mounted display screen, an opportunity arose to improve treatment efficiency, reduce setup errors, and better leverage integrated technology. The aim of this project was to transition from traditional word-based setup notes to a combined, site-specific, multimodal setup system that fully utilizes the integrated display screen, standardizes setup information, and supports safe, accurate treatment delivery—particularly in the context of a fast-paced clinic with increasing treatment complexity and multi-site palliative care.

Methods/Process

The transition involved redesigning setup documentation to consolidate all relevant setup information into a single, site-specific display. This included the development of a structured library of setup devices, eScribe templates generated from CT simulation, tattoo schematics with anatomical references, and site-specific setup photographs. Devices associated with a higher incidence of setup error were identified and assigned additional verification steps. Each treatment site for a patient maintains its own distinct setup information to minimize cross-site confusion. An initial working group trialed multiple iterations directly on the Elekta Harmony Linear Accelerator before standardizing the approach. This process resulted in minimizing free-text setup notes in favor of visual and structured elements. Implementation was phased, beginning with simpler and more standardized treatment sites such as lower gastrointestinal (GI) and genitourinary (GU) setups. Once these workflows were stabilized, the project expanded to sites with more complex settings, including head and neck, abdominal, and thoracic treatments involving specialized immobilization devices and multi-parameter positioning. Future sites identified for transition include spinal stereotactic body radiation therapy (SBRT) spine and four-field breast treatments.

Results or Benefits/Challenges

A primary benefit of the new system is that all setup information is presented on a single screen without scrolling, reducing cognitive load and the risk of missed details. This is particularly beneficial for complex palliative patients receiving treatment to multiple sites, as each site’s setup is clearly separated and visually distinct. The integrated display enhances workflow efficiency, consistency, and clarity for therapists at the treatment unit. Challenges included an initial learning curve for staff and determining the most effective visual presentation of setup information. Early implementation relied on one-hour formal in-service sessions and written “how-to” documents, which generated numerous questions and revealed inconsistencies in understanding and knowledge retention. For subsequent site implementations, system features were introduced more gradually using a scaffolding approach. A Plan-Do-Check-Act framework was applied to further refine both the setup information and the training process. Smaller group huddles, informal discussions, and hands-on demonstrations at the treatment unit proved more effective, allowing staff to practice with test patients and ask questions in real time.

Conclusions/Impact

Staff have successfully adapted to the new presentation of setup information and integrated it into routine clinical practice. The phased rollout, combined with unit-based, hands-on education and site-specific documentation, supported consistent adoption. This project demonstrates how integrated display technology, standardized visual setup tools, and adaptive education strategies can enhance treatment delivery and support safe, efficient radiation therapy in a modern clinical environment.