Oncology in the Western Cape is making significant strides with the introduction of an additional improvement in delivery of radiation treatment through the first Align RT advanced marker-less patient tracking system in the province, marking an important milestone for private sector Surface Guided Radiation Therapy (SGRT).

“With growing international support for the use of SGRT in treating breast cancer, brain tumours, head and neck cancers, sarcomas, and other conditions, the recent installation of this sophisticated radiation therapy delivery system at Netcare N1 City Hospital’s radiation unit represents a major advancement in cancer care options for the Cape region,” says Cindy Aitton, head of Netcare Cancer Care.

John Sauer, a radiation oncologist practising at Netcare N1 City Hospital, emphasises the enhanced accuracy and safety of radiotherapy treatments with the province’s first Align RT advanced.

“The system uses fixed cameras in the treatment room to track patients’ skin surface in three dimensions, for both set-up and motion management during radiotherapy, ensuring precise positioning and monitoring during radiation treatment.

"This is a significant development as the radiation beams are directed exactly where they are needed, minimising exposure of surrounding healthy tissue while delivering the full therapeutic dose,” he says.

Three cameras continuously monitor the position of thousands of points on the skin surface to identify patient positioning in three dimensions and detect any tiny shift in position during treatment.

“If the person moves during radiation therapy, the system automatically cuts off the radiation beam to pause treatment to prevent accidental exposure. During the entire treatment delivery procedure, the system ensures accuracy within a millimetre to ensure the radiation is kept away from healthy tissue and nearby critical structures,” Sauer adds.

The system is particularly well suited for delivering Deep Inspiration Breath Hold (DIBH) treatment for breast cancer with submillimetre positional accuracy to spare radiation doses to the heart and lungs.

The state-of-the-art system is also geared to improve treatment times for other advanced therapies offered at Netcare N1 City Hospital’s radiation therapy unit, including stereotactic body radiotherapy (SBRT), which delivers high doses of radiation from various angles to target a lesion.

“In treatment for left breast cancer, the DIBH technique requires patients to breathe in deeply and hold their breath for a few seconds, guided by the radiation therapists, so that the heart moves away from the treatment area to ensure minimal radiation exposure,” he explains.

DIBH patient journey

Ingrid Williams is one of the first patients in the Western Cape to be treated using this new sophisticated patient tracking system recently installed at Netcare N1 City Hospital’s radiation unit. She is currently undergoing this specialised course of radiation therapy following surgery to remove a tumour in her left breast.

“With the help of this new SGRT system, the treatment intends to eliminate any cancer cells that may remain around the surgical site, and this requires great precision as it is so near to her heart,” Sauer says.

Williams says that she was pleasantly surprised that her treatment sessions last only up to 10 minutes so that she can schedule them during her lunch break from work.

“The treatment team are so friendly. They explained exactly how to do the breathing technique without arching my back. When I breathe in, I can see on the indicator screen when I am in exactly the right position. Only then does the beam of radiation start and I hold my breath like that for 30 seconds, which isn’t hard as it goes by so quickly, and then the radiation therapists tell me over a speaker when I can relax and breathe normally again,” Williams says.

Timesaving and marker-less

Marilyn Lameyer, Netcare’s regional radiation therapy manager, says that a significant amount of time in radiation therapy sessions is usually dedicated to positioning the patient for the prescribed dose of radiation to be administered.

“The convenience of this technology dramatically reduces set up and manages motion during treatment sessions, which leads to an approximately 22% reduction in set-up and treatment time, while pinpointing the areas prescribed in the radiation treatment plan in real time.

“The new system also eliminates the use of excessive daily X-ray imaging to verify skin marks, so people can spend less time on the treatment bed. Another benefit of the new system is that it is a completely non-invasive, contactless technology,” she says.

Lameyer adds that another advantage of the new marker-less system is that medical tattoos are not required to provide the reference points for treatment and treatments that previously required an enclosed mask can now be administered with an open face mask for greater patient comfort.

“The rapid advances in treatment technologies are not only important in improving outcomes, but in terms of quality of life, these developments are also helping to make the practical aspects of treatment a little easier for people living with cancer,” Aitton says.

“Netcare continues to invest in the latest cancer care services so that practitioners and their patients have world-class treatment options, supported by our caring, holistic multidisciplinary approach,” she concludes.

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