Chairs:
Dr Ye Zhang (Paul Scherrer Institut, Switzerland),
Dr Lennart Volz (GSI Helmholz Centre for Heavy Ion Research, Germany)
Dr Tracy Underwood (Leo Cancer Care and University College London, UK)
Dr Cristina Garibaldi (European Institute of Oncology, Italy)
Motivation
Eliminating the gantry by rotating the patient instead of the radiotherapy beam offers the opportunity to reduce 1) equipment costs, 2) radiation shielding requirements, and 3) treatment room footprints for all radiation modalities. Consequently, gantry-less treatments can potentially improve the cost-effectiveness and global accessibility of radiotherapy. Furthermore, gantry-less treatments are typically associated with both fixed beamlines and additional space around the patient, offering new possibilities for advanced/exotic treatment beams (e.g., FLASH, VHEE, or grid therapy) and onboard image guidance.
However, gantry-less radiotherapy brings new challenges that require robust research. To facilitate various beam angles, unconventional patient positioning and immoblization systems, such as revolvable patient tables or upright positioning systems, are necessary. Clinics must overhaul traditional workflows designed for supine positions. Techniques such as deformable image registration and auto-segmentation need to be reassessed due to anatomical variation between body positions (e.g. supine versus upright), which could affect accuracy. Critical assessment of the expected treatment quality for unconventional body positions, across different tumour sites and patient groups is necessary, particularly for positioning reproducibility and organ motion The industry faces challenges in designing patient positioners that can support weight and provide comfort during lengthy sessions. This pivotal moment calls for ESTRO to bridge clinical and research efforts to engage and optimise such novel techniques.
This workshop aims to create a unified understanding of the current state-of-the-art in gantry-less radiotherapy approaches and engage both existing and emerging research teams, as well as commercial vendors, in a vibrant scientific dialogue. The discussion aims to drive the development of optimal solutions for future gantry-less treatments and to bridge existing photon/particle experiences and practices. Additionally, we are committed to nurturing young researchers to spearhead gantry-less radiotherapy in academia, industry, and clinical practice.
We will focus on addressing the following critical topics:
- Identifying key technical challenges:
Exploring the intricacies of equipment design, such as beamlines and nozzles, immobilisation devices, positioning systems, imaging devices, room layout, and necessary shielding.
- Addressing clinical workflow challenges:
Including pre-treatment imaging processes, image synthesis, application of deformable image registration, organ segmentation, treatment planning, onboard imaging, and real-time monitoring. ,
- Identifying subsets of patients who should / should not be treated gantry-less:
Considering the potential clinical advantages/disadvantages of upright radiotherapy and discussing methods for assessing these through in-silico studies.
- Adapting existing techniques to ganty-less treatment:
How can current radiotherapy techniques be modified or directly applied to gantry-less treatments? Identify which elements can be seamlessly transferred and which require substantial adjustments, with priority.
- Implementing advanced treatment concepts:
Considering how advanced treatment concepts can fit within the gantry-less framework, such as proton arc therapy, onboard MR guidance, proton CT/radiography, and combined proton-photon treatment.
- Enhancing global access:
Discussing strategies for using gantry-less options to increase access to radiotherapy globally, considering both technological and economic factors.
- Patient experience:
Considering how to evaluate the patient experience for gantry-less radiotherapy, plus strategies which may improve it.
Outcomes
- Position paper on the status of gantry-less radiotherapy
- A list of research questions to be explored, with possible joint grant submissions.
- Recommendations for commercial vendors regarding which tools and functionality are most urgently needed (“Wishlist to vendors”)
- A proposed ESTRO 2025 conference session to report the workshop findings
Participants are required to list and rank their interests in the above topic (3 max) in the application letter. We will then generate sub-groups for discussion during pre-meeting and on-site meetings.