Technical Innovations and Patient Support in Radiation Oncology最新文献

{"title":"Validation of a weekly imaging protocol for tangential whole breast radiation therapy with a tattoo-less surface-guided setup","authors":"Sumie Namba ,&nbsp;Jared Steel ,&nbsp;Matthew Hoffmann ,&nbsp;Hannah Thompson ,&nbsp;Abbey Baylis ,&nbsp;Carmen Hansen ,&nbsp;Thomas Shakespeare","doi":"10.1016/j.tipsro.2025.100318","DOIUrl":"10.1016/j.tipsro.2025.100318","url":null,"abstract":"<div><div>This study explored whether tattoo-less surface guided setups with a first 4 fractions then weekly imaging schedule (F1-4&amp;W) is a suitable alternative to tattoo alignment setups for adjuvant whole breast radiotherapy (WBRT) patients.</div><div>The daily CBCT images (n = 450) of 30 patients treated using tattoo-less surface-guided radiation therapy (SGRT) were retrospectively re-matched to a WBRT protocol. The accuracy of the re-match was assessed, and a F1-4&amp;W imaging schedule applied to investigate the percentage of fractions that would have been treated to a 0.5 cm tolerance. The results were compared with the setup accuracy of 100 consecutive patients treated with WBRT using the existing practice of tattoo-based alignment.</div><div>95.8 % of the tattoo-less SGRT setup fractions were assessed to be treated within tolerance, with a maximum discrepancy from isocentre of 0.7 cm for a non-imaged fraction. When comparing imaged fractions, 98 % of these patients positioned within 0.5 cm of isocentre, while the tattoo-alignment method achieved this only 80 % of the time. The overall imaging frequency rates per patient were 51 % and 53 % for study (SGRT/CBCT) and control groups (EPI/tattoos) respectively.</div><div>We conclude that tattoo-less SGRT provides a consistently accurate method to setup supine tangential WBRT patients with a benefit to patient experience. Furthermore, a F1-4&amp;W imaging schedule is sufficient to ensure patients are treated within tolerance, while maintaining appropriate indication for when increased imaging frequency is necessary.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100318"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the proton gap: A proton therapy consultation service for Canadian radiation oncologists","authors":"Inhwa Kim ,&nbsp;Amy Parent ,&nbsp;Michael Holwell ,&nbsp;Tim Craig ,&nbsp;Patricia Lindsay ,&nbsp;Hillary Le ,&nbsp;Yat Tsang ,&nbsp;Perry B. Johnson ,&nbsp;Danny J. Indelicato ,&nbsp;Fei-Fei Liu ,&nbsp;Derek S. Tsang","doi":"10.1016/j.tipsro.2025.100320","DOIUrl":"10.1016/j.tipsro.2025.100320","url":null,"abstract":"<div><h3>Purpose</h3><div>Canada is the only G7 country without a clinical proton beam therapy (PBT) facility. Patients can access publicly funded PBT through provincial out-of-country approval programs. We created a consultation service to inform health care providers regarding the potential dosimetric benefits of PBT.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively reviewed patients referred to our proton consultation service from June 2020 to December 2024. Pencil beam scanning proton plans were generated in the RayStation treatment planning system. Key dosimetric parameters were evaluated using Wilcoxon matched-pairs signed rank test.</div></div><div><h3>Results</h3><div>A total of 55 patients were referred to our service, and 49 had evaluable plans. Patients were referred from 6 provinces and 11 institutions across Canada. The median age at referral was 36 (range, 3–74 years), and 29 % of patients were pediatric. The most common reasons for referral were young age (33 %) and proximity of tumour to OARs (37 %). Target coverage was similar in both photon and proton plans. Cranial (n = 19) and thoracic (n = 7) plans showed a statistically significant reduction in mean brain dose (p &lt; 0.001), mean brain dose minus PTV (p &lt; 0.001), brain D50% (p &lt; 0.001), mean lung dose (p = 0.02), lung V50% (p = 0.02), and lung D50% (p = 0.02) with proton therapy. Sixteen patients were approved by their provincial Ministry of Health for PBT in the United States.</div></div><div><h3>Conclusion</h3><div>Our proton consultation program provides an important service by identifying patients where PBT offers a dosimetric advantage over photon therapy. Following this personalized, data-informed approach, nearly a third of referred patients were approved to go to the US for PBT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100320"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timely integration of palliative care into oncology care for patients with bone metastases at the radiotherapy department: A pilot study on acceptability and feasibility","authors":"Anouk van Oss ,&nbsp;Arianne Stoppelenburg ,&nbsp;Ellen de Nijs ,&nbsp;Rebecca van Jaarsveld ,&nbsp;Carly S. Heipon ,&nbsp;Natasja J.H. Raijmakers ,&nbsp;Yvette M. van der Linden","doi":"10.1016/j.tipsro.2025.100317","DOIUrl":"10.1016/j.tipsro.2025.100317","url":null,"abstract":"<div><h3>Background and aim</h3><div>Patients with bone metastases may have needs that extend beyond the management of pain by radiotherapy. Concurrent palliative care leads to improved quality of life, but is often introduced late. In this pilot study, we assessed the acceptability and feasibility of an introdu0000ctory conversation with a palliative care consultant at referral for palliative radiotherapy.</div></div><div><h3>Material and methods</h3><div>Patients with bone metastases and their family caregivers were scheduled for an introductory conversation with a consultant from the hospital palliative care team. During this meeting, the potential benefits of integrating palliative care into their current or future care was discussed. Using statements on a 5-point Likert scale, patients and family caregivers independently evaluated the acceptability of the conversation, and consultants evaluated the feasibility.</div></div><div><h3>Results</h3><div>Between December 2022 and March 2024, 48 patients were included in the study. Median age was 73 years, 63 % were male. Most patients (89 %) and family caregivers (96 %) appreciated the introductory conversation, were unaware of the existence of a palliative care team (60 %, 67 %, respectively), and would contact the team when having questions or concerns (77 %, 82 %). Some found the conversation confronting (17 %, 11 %), or felt it was too early in the illness trajectory (31 %, 26 %). Follow-up consultations were scheduled for 8 patients (17 %). Consultants were able to conduct the conversation as instructed (91 %), though 15 % indicated insufficient time for preparation.</div></div><div><h3>Conclusion</h3><div>Introductory conversations about palliative care at referral for palliative radiotherapy appear both acceptable and feasible, and may enhance timely integration of palliative care into oncology care for patients with bone metastases.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"35 ","pages":"Article 100317"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of digital tools and the expected digital transformation in radiotherapy on Dutch radiation therapists (RTTs)","authors":"Thijs Ackermans ,&nbsp;Paul Cremers ,&nbsp;Janne Dingemans ,&nbsp;Carol Ou ,&nbsp;Marcel Verheij ,&nbsp;Maria Jacobs","doi":"10.1016/j.tipsro.2025.100319","DOIUrl":"10.1016/j.tipsro.2025.100319","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Technological advancements have the potential to mitigate RTT shortages, burnout levels, and turnover rates. However, it is unclear if RTTs currently experience technostress (stress or anxiety from being overwhelmed by technology) and how extensive digital tool usage impacts key job performance indicators (e.g., job engagement, satisfaction, and turnover intentions). This study investigates the impact of digital tools used and expected digital transformation on RTTs’ technostress and key job performance indicators.</div></div><div><h3>Materials and Methods</h3><div>A survey was distributed to RTTs across all Dutch radiotherapy centers, resulting in 265 respondents. The survey included validated questionnaires on digital tool use, technostress, job autonomy, innovative work behavior and job performance indicators. Relationships were assessed using linear regression models and paired samples T-tests (p &lt; 0.05).</div></div><div><h3>Results</h3><div>The number of digital tools used had no significant effect (p &lt; 0.05) on key job performance indicators and was not related to technostress. Technostress negatively impacted key job performance indicators, but explained less than 7 % of the variance. Other factors, such as job autonomy, had a greater influence. When presented with a description of the future perspective of their job role after the expected digital transformation, RTTs reported small declines in key job performance indicators.</div></div><div><h3>Conclusion</h3><div>Current RTT performance is not affected by the number of digital tools used, as RTTs are used to working with digital tools. RTTs showed no technostress. After the predicted digital transformation RTTs remained satisfied and engaged. Ensuring RTTs feel skilled and empowered with decision-making authority is crucial before introducing new digital tools.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of dose delivery accuracy of the lung with the respiratory technique of the Radixact Synchrony real-time tumor tracking system","authors":"Evren Ozan Göksel","doi":"10.1016/j.tipsro.2025.100316","DOIUrl":"10.1016/j.tipsro.2025.100316","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to evaluate the dosimetric accuracy of the Lung with Respiratory (LWR) technique in the Radixact Synchrony real-time tumor tracking system using data from actual patients undergoing lung SBRT.</div></div><div><h3>Material and methods</h3><div>This retrospective study included 20 patients treated with the Synchrony LWR technique for primary lung cancer or lung metastases. Mid-ventilation breath-hold CT and 4DCT images were acquired for treatment planning and tumor motion evaluation. Gamma analysis was performed using the PTW 1500 detector. Three verification plans were generated for each patient: one for gamma analysis without motion (GAWoM), one for point dose measurement with motion (PDWM), and one for gamma analysis with motion (GAWM). Patient specific respiratory motion was simulated using a CIRS motion platform. The relationship between respiratory patterns, treatment plan parameters, and the dose delivery accuracy of the Synchrony system was evaluated using correlation analysis.</div></div><div><h3>Results</h3><div>The PDWM results demonstrated a strong agreement between the planned and measured doses, with a maximum difference of less than 2%. The gamma passing rates of 3D dose measurements for all patients’ Synchrony plans were found to be within the clinically acceptable level. While GAWM results were slightly lower than GAWoM results, correlation analysis revealed a strong positive relationship between the two. A moderate negative correlation was observed between the modulation factor and GAWM, similar to GAWoM. Additionally, a strong negative correlation was observed between beam-on time and both GAWoM and GAWM. Furthermore, no significant correlation was found between GAWM and respiratory pattern-related variables, including superior-inferior and lateral motion amplitude or respiratory rate per minute.</div></div><div><h3>Conclusion</h3><div>The results of the correlation analyses indicate that the dose delivery accuracy of the Synchrony LWR technique is comparable to that of static target irradiation, independent of the patient’s respiratory pattern or the planning parameters used.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100316"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging cultural and linguistic barriers: South Asian minority women’s experiences of radiotherapy for cervical cancer in Norway","authors":"Harvinderjit Vicky Singh ,&nbsp;Esten Nakken ,&nbsp;Lena Fauske","doi":"10.1016/j.tipsro.2025.100315","DOIUrl":"10.1016/j.tipsro.2025.100315","url":null,"abstract":"<div><h3>Introduction</h3><div>This study explored the experiences of women with South Asian ethnicity who received chemoradiotherapy for cervical cancer in Norway. Research on how they cope with radiotherapy, as well as the challenges they face in relation to cancer care, is crucial to generate new knowledge about the situation of minority women. This study sought to promote a more equitable healthcare service and provide more personalised information for minority women.</div></div><div><h3>Methods</h3><div>This study has a qualitative, exploratory design and applied a phenomenological and hermeneutical approach based on individual in-depth interviews with seven South Asian women. These women moved to Norway after the age of 18 and subsequently received chemoradiotherapy for cervical cancer. The interviews were conducted in each woman’s own language. The data were interpreted via reflexive thematic analysis.</div></div><div><h3>Results</h3><div>The data analysis revealed that a lack of cultural understanding among healthcare professionals made the treatment experience challenging for the interviewed women, while a lack of familiarity with the Norwegian language made health information less accessible to them. Linguistic and cultural barriers rendered the women vulnerable, both during their treatment and during the scheduled clinical follow-up period, which was often reported to be a lonely experience.</div></div><div><h3>Conclusion</h3><div>The experiences of minority women with cervical cancer who are treated with radiotherapy are influenced by challenges related to culture and language. This highlights a clear need for individually tailored health information and access to professional interpreters. Additionally, there is a need for support groups conducted in minority languages.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100315"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploratory health economic analyses to support decisions within the innovation process in radiotherapy: Magnetic Resonance Linear Accelerator as a case study","authors":"Marike J. Ulehake ,&nbsp;Ellen J.L. Brunenberg ,&nbsp;Marcel Verheij ,&nbsp;Janneke P.C. Grutters","doi":"10.1016/j.tipsro.2025.100314","DOIUrl":"10.1016/j.tipsro.2025.100314","url":null,"abstract":"<div><h3>Background and purpose</h3><div>There is an increasing need for understanding the added value of radiotherapeutic innovations before their widespread adoption. For multi-purpose innovations such as the Magnetic Resonance Linear Accelerator (MR-Linac), determining their value within a specific clinical context does not conclusively answer the broader question whether the innovation justifies the required investment. Exploratory analyses can be informative during early development and use of the innovation. We aim to develop and demonstrate an online, flexible tool to facilitate early economic evaluation of the MR-Linac.</div></div><div><h3>Materials and methods</h3><div>We developed a tool that enables users to compare the total costs and incremental effects needed of MRI-guided radiotherapy (MRIgRT) with conventional treatment by inputting data specific to their context. Costs included in the tool are both medical technology and personnel-related expenses. The effects, required to justify potential additional costs, are expressed in Quality Adjusted Life Years (QALYs). By default, input values are used tailored to the Dutch clinical context.</div></div><div><h3>Results</h3><div>When users input data specific to their context or situation, the tool generates figures that display the (additional) costs and effects of MRIgRT compared to conventional treatment. These figures enable users to explore the impact of key variables on the (additional) costs and QALYs required to justify any potential extra costs associated with MRIgRT.</div></div><div><h3>Conclusion</h3><div>The tool and accompanying example allow for exploratory early HTA analyses, which can offer insights into the cost-effectiveness of MRIgRT. These insights can be valuable for guiding decisions regarding the purchase and utilization of innovative radiotherapeutic technologies.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100314"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time gated proton therapy: Introducing clinical workflow and failure modes and effects analysis (FMEA)","authors":"Wei Yang Calvin Koh ,&nbsp;Hong Qi Tan ,&nbsp;Kah Seng Lew ,&nbsp;Wan Ting Alice Kor ,&nbsp;Nur Atiqah Binte Samsuri ,&nbsp;Jason Wei Siang Chan ,&nbsp;Clifford Ghee Ann Chua ,&nbsp;James Kuan Huei Lee ,&nbsp;Andrew Wibawa ,&nbsp;Zubin Master ,&nbsp;Sung Yong Park","doi":"10.1016/j.tipsro.2025.100311","DOIUrl":"10.1016/j.tipsro.2025.100311","url":null,"abstract":"<div><h3>Introduction</h3><div>Real-Time Gated Proton Therapy (RGPT) has been used in proton therapy to mitigate respiratory motion challenges. This study presents the first comprehensive description of the RGPT clinical workflow at the National Cancer Centre Singapore (NCCS) and introduces a novel Failure Modes and Effects Analysis (FMEA) for RGPT.</div></div><div><h3>Methods</h3><div>We detail the workflow for prostate and liver/lung proton treatments. The FMEA, following AAPM TG-100 guidelines, evaluated potential failure modes based on occurrence, detectability, and severity. This comprehensive risk assessment approach allows for the establishment of robust Quality Assurance (QA) protocols, enhancing treatment safety and efficacy. The FMEA was performed by two disciplinary groups, namely the medical physicists and radiation therapists. Intraclass Correlation Coefficient (ICC) is used as the metric to assess the consistency of ratings among participants.</div></div><div><h3>Results</h3><div>Since implementation, 15 patients (13 prostate, 2 liver) have been treated with RGPT. The study identified 96 potential failure modes, with 47 evaluated by two disciplines. Inter-rater concordance analysis revealed strong agreement within one group, while combined groups showed lower consistency, highlighting potential differences in risk perception between disciplines. Notably, severity ratings demonstrated better correlations among raters compared to other categories, suggesting a shared understanding of the potential impact of failures.</div></div><div><h3>Conclusion</h3><div>This study provides valuable insights for institutions implementing RGPT, potentially enhancing treatment workflow, patient safety, and QA procedures. The detailed workflow description and FMEA results offer a foundation for standardizing RGPT practices and prioritizing risk mitigation strategies. Future research should focus on multi-institutional collaborations to further refine RGPT protocols and risk assessments.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiography students wishing to work in the field of radiation therapy: A French experience","authors":"S. Boisbouvier ,&nbsp;F. Hermant ,&nbsp;A. Béasse","doi":"10.1016/j.tipsro.2025.100313","DOIUrl":"10.1016/j.tipsro.2025.100313","url":null,"abstract":"<div><div>Radiation therapy (RT) is one of the main treatment modalities for cancer. In France, radiation therapists (RTTs) undergo a combined training program in radiography, nuclear medicine, and RT. In the context of rising cancer cases and greater utilisation of RT, RT departments face a workforce shortage. This study investigates the interest of final-year radiography students in working in RT and explores deterrents to their career choice.</div><div>A survey was conducted in January 2024 among French radiography students who had completed at least 3 weeks of RT clinical placement. The survey included closed and open-ended questions on career preferences and highlighted barriers to working in RT. Data analysis included absolute number, frequency of students wishing to work in RT according to the age range of the students. A Chi square test was used to assess the influence of the age range on the desire to work in RT field. A thematic analysis of free-text responses was also performed.</div><div>The results indicated a low interest in a career in RT among students, with the main reasons being psychological and educational barriers. Enhancing RT-specific education, improving clinical placements, addressing emotional resilience, and modernising training programmes are crucial to attract future RTTs and address workforce shortages in this critical field.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100313"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tattoo-less chest wall and regional nodal irradiation using surface imaging","authors":"Boris Mueller ,&nbsp;Yulin Song ,&nbsp;Xingchen Zhai ,&nbsp;Yubei Liang ,&nbsp;Paul Tamas ,&nbsp;Simon Powell ,&nbsp;David M Guttmann ,&nbsp;Diana Roth O’Brien ,&nbsp;Beryl McCormick ,&nbsp;Atif Khan ,&nbsp;Laura Cervino-Arriba ,&nbsp;Bo Zhao ,&nbsp;Linda Hong ,&nbsp;Lior Z. Braunstein","doi":"10.1016/j.tipsro.2025.100310","DOIUrl":"10.1016/j.tipsro.2025.100310","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Objective&lt;/h3&gt;&lt;div&gt;Skin tattoos represent the standard for surface alignment and setup of breast cancer radiotherapy yet contribute to adverse cosmesis and patient dissatisfaction. With the advent of contemporary surface imaging technology, we evaluated setup accuracy, time, and dosimetric parameters between traditional tattoo-based setup techniques and a “tattoo-less” approach for lymph node positive and high-risk breast cancer patients requiring chest wall and regional nodal radiation.&lt;/div&gt;&lt;div&gt;Material/Methods&lt;/div&gt;&lt;div&gt;Patients receiving chest wall radiation for breast cancer underwent a traditional tattoo-based setup (TTB), alternating daily with a tattoo-less setup via surface imaging using AlignRT (ART) to serve as an internal control. Following initial setup (using tattoos or AlignRT), target position was verified by daily kV imaging, with matching on the chest wall bony anatomy representing ground truth. Translational (TS) and rotational shifts (RS) were ascertained, as were setup time and total in-room time. Delivered dosimetry was calculated using the reverse isocenter shift technique. Statistical analyses used the Wilcoxon Signed Rank test and Pitman-Morgan variance test.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 49 breast cancer patients receiving a total of 1118 fractions (n = 560 for ART and 558 for TTB) of chest wall radiation were analyzed. For tattoo-less setup via ART, the median absolute TS was 0.28 cm vertical (range: 0.14–––0.48), 0.24 cm lateral (0.10–––0.40), and 0.26 cm longitudinal (0.13––0.44). For TTB setup, the corresponding median TS were 0.34 cm (0.15–––0.52), 0.29 (0.13–––0.46), and 0.34 cm (0.14–––0.59), respectively. ART was significantly more accurate than TTB with regard to TS (p = 0.038, 0.007, &lt;0.001, respectively). Variance testing also showed increased precision with ART in the vertical (p &lt; 0.001) and longitudinal (p &lt; 0.001) axes.&lt;/div&gt;&lt;div&gt;The median absolute RS for ART was 0.80° rotational (range:0.40–1.50), 0.60° roll (0.20–1.20), and 0.50° pitch (0.10–1.00). The corresponding median RS for TTB was 1.00° (0.40–1.70), 0.60° (0.20–1.20), and 0.50° (0.10–1.00). ART was significantly more accurate for RS than TTB (p = 0.023). ART setup was otherwise not statistically different from TTB regarding roll and pitch (p = 0.558, 0.929, respectively). ART showed no difference in precision versus TTB regarding RS, pitch, and roll (p = 0.181, p = 0.544, p = 0.858).&lt;/div&gt;&lt;div&gt;The median total in-room time for ART was 18.77 min (range: 16.04–20.77) and 18.70 min (17.58–20.67) for TTB (p = 0.38). The median setup time was 12.75 min (11.43–14.80) for ART and 13.78 min (12.42–15.09) for TTB (p = 0.054). There was no significant difference between the AlignRT and the tattoo-based methods for both setup and in-room time.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;These findings indicate that utilizing the tattoo-less setup method with AlignRT provides sufficient accuracy and speed to potential","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"34 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}