Background: Motion management is crucial in the safe delivery of head and neck (H&N) radiotherapy (RT). Current practice is to limit patient motion with thermoplastic masks which some patients find distressing.
Aims: The Remove the Mask project aims at improving patient experience through the development of an alternative to thermoplastic masks for H&N RT.
Methods: We developed a novel Surface Guided Radiotherapy (SGRT) system and a tumour tracking algorithm using fluoroscopic imaging which we plan to combine to create a synergistic head motion tracking system that enables safe and effective maskless H&N RT. Three human studies were opened to help with the development and testing of this system:
VISION - A healthy volunteer study that aimed at quantifying the accuracy of our SGRT system.
CHIRP - An imaging study which aimed at testing the accuracy of our tumour tracking algorithm on 2D fluoroscopic images.
SMART - A non-interventional feasibility study to assess the feasibility and acceptability of our system, quantify patient motion without the mask, and determine the impact of surface changes on the accuracy of our SGRT system.
Results: The tracking accuracy of our SGRT system was <1mm for translations and <0.5 degrees for rotations based on preliminary VISION data. The accuracy of our fluoroscopic tumour tracking algorithm was 3.1 mm. In the SMART study, patients moved by an average of 4 mm and 2 deg over a 20 min imaging period.
Conclusions: Clinical implementation of novel technology mainly occurs when it provides a clinical advantage for patients or when it eases clinical workflow. The Remove the Mask project is a good example of how development of novel technology can and should also be considered as a mean to improve patient experience. Future work will aim at evaluating the safety of our multi-modality tracking system in a prospective trial.