A Complete Solution for Pediatric Upright Proton Therapy: Novel Tilting Chair for Anesthesia-Induction, Integrated Audiovisual Immersion for Awake Patients, and Child Engagement Toys
Abstract
Purpose
The significant tissue-sparing advantages of upright proton therapy (UPT) make it an appealing treatment for pediatric patients, yet its widespread use is limited by the lack of a commercially available solution for upright anesthesia-assisted treatment. Additionally, while educational preparation tools and audiovisual immersion techniques have been used as anesthesia-reducing interventions in conventional radiation therapy, these approaches have not been translated to UPT. We present a comprehensive, integrated strategy that combines multiple innovations to create a safe, effective, and patient-centered workflow for pediatric UPT.
Methods
A novel pediatric tilting chair was designed and built to enable safe anesthesia induction and treatment delivery, with complete integration into the Leo Cancer Care (Sussex, UK) upright positioning system. For cooperative patients, an audiovisual distraction system (AVATAR) is integrated with the chair to provide immersive content, biofeedback, and communication, aiming to enable anesthesia-free treatment. The clinical workflow incorporates pre-treatment educational tools, such as animated videos and custom toys, to familiarize children with the process and reduce baseline anxiety. Validation of the chair system included mechanical load testing, vertical CT imaging, and end-to-end workflow simulation.
Results
Chair prototype functionality was verified with the upright positioning system; by rotating from a supine induction to an upright treatment position, this system accommodates anesthesia protocols while maintaining optimal patient positioning and beam access. Static load testing confirmed structural integrity and CT imaging demonstrated that the chair neither induced artifacts nor restricted imaging geometry. Workflow simulations validated protocols for anesthetized and awake patients.
Conclusion
We are implementing a holistic solution that addresses the multifaceted challenges of pediatric UPT. By combining a specialized anesthesia chair with advanced patient engagement and distraction technologies, this system moves beyond a single-device solution to set a new standard for compassionate, safe, and effective pediatric radiation therapy.