Addenbrooke’s: first UK hospital to offer advanced patient positioning and surface guided technology for radiotherapy patients

17 August 2020
Addenbrooke’s has become the first hospital in the UK to install a new technology to enable delivery of precision radiosurgery and radiotherapy to patients with cancer and other conditions.

The radiotherapy team with June Dean (centre) and Tara Djanani from BrainLab (left).Addenbrooke’s has become the first hospital in the UK to install a new technology to enable delivery of precision radiosurgery and radiotherapy to patients with cancer and other conditions using an advanced form of Surface Guided RadioTherapy (SGRT) and x-ray monitoring.

The £500,000 system from the medical technology company, BrainLab, based in Munich, combines 4D thermal-surface camera technology with real-time x-ray tracking, resulting in submillimetre accuracy in treatment delivery.

The more precisely the radiotherapy treatment delivery is targeted, the greater the chance of success in avoiding any inadvertent damage to neighbouring soft tissue or vital organs sensitive to radiation, whilst the target receives the high dose radiotherapy treatment as planned.

The system comprises of an optical surface scanner with 300,000 surface points and a thermal camera which acquires a unique thermal heat signature of the patient. This is the first global application of thermal imaging in the field of radiotherapy, specifically focusing on patient accuracy and delivery of radiation. The camera is used in conjunction with x-rays for initial patient positioning and to monitor movement throughout the treatment.  Automatic x-ray imaging is used to ensure accurate targeting of the radiation therapy.

Every set of x-rays acquired generates a new reference surface including updated thermal information, which in turn creates another dimension to consistently track the patient’s position. This minimises any delay between any movement of the patient’s  body and the treatment unit’s response.

This additional accuracy enables advanced treatments to be delivered on a daily basis, including Stereotactic Radiosurgery and Stereotactic Ablative Radiation (SABR). SABR requires fewer doses than standard radiotherapy, cutting the number of hospital visits that potentially vulnerable cancer patients need to make from 20-30 to around 5.

The installation of the system coincides with the Government’s recent announcement that SABR will be available across the NHS by the end of this financial year, rather than 2022 as originally planned.

It means Addenbrooke’s will be able to offer SABR treatment to patients not only with non-small cell lung cancer but also those with lung, lymph nodes and non-spine bone oligometastatic disease.

A further future enhancement coming soon by BrainLab, will enable staff  to track and treat tumours, or lesions, that move or change size and shape over and during a course of treatment.

June Dean, associate radiotherapy manager and head of technical operations for the radiotherapy centre at Addenbrooke’s said: “Our focus is on making sure patients have access to high quality treatment that meets their needs.

“This system uses surface guidance for patient positioning with high quality imaging that enables us to reduce the use of high dose x-rays and ultimately to treat patients with far greater precision. Eventually, it will also allow us to successfully treat a broader range of patients, including patients with breast cancer who struggle to achieve deep inspiration breath hold; a technique that enables us to avoid treating the heart.

“We are really lucky to have it. Radiotherapy is a highly targeted treatment and anything we can do to spare healthy tissue is ultimately going to benefit the patient.”

Tara Djanani, clinical marketing manager for BrainLab, said: “The ExacTrac Dynamic launch has begun a new era of radiotherapy with the hybrid technology of 3D surface tracking and thermal acquisition with the assurance of configurable x-ray monitoring. The combination of tracking the patient’s external surface and correlating this to the internal anatomy enables healthcare professionals to deliver accurate treatment. We are very excited for Addenbrooke’s Hospital to be the first adopters of this technology. The combination of BrainLab’s Elements Treatment Planning Software which is already being used in the department and now ExacTrac Dynamic would enable a smooth workflow for the team and high quality treatments, including SRS and SABR to patients in the region. ”