Clinical Benefits of Surface Guided Planning: Improving Safety, Efficiency and Outcomes
Abstract
Purpose
To assess the clinical feasibility, accuracy, and patient comfort benefits of a fully maskless workflow for head and neck (H&N) radiation therapy using Surface Guided Radiation Therapy (SGRT) for setup and intrafraction motion management.
Methods
Ten H&N cancer patients were treated using a dorsal shell without a thermoplastic face mask. Initial positioning was performed with SGRT and verified by cone-beam computed tomography (CBCT). SGRT provided continuous real-time monitoring during treatment. Motion thresholds were set at 2 mm translational and 2° rotational; exceeding these triggered treatment interruption and repositioning. Post-treatment CBCT was acquired to validate SGRT accuracy and compare residual shifts.
Results
Across all fractions, intrafraction motion exceeded thresholds in only 4%, requiring repositioning. Post-treatment CBCT demonstrated mean residual shifts of 0.1 mm and 0.1°, confirming high positional accuracy. SGRT recorded mean intrafraction motion of 1.0 mm and 0.9°, indicating effective motion control without rigid immobilization. Patients reported improved comfort and reduced anxiety compared to conventional mask-based setups.
Conclusion
A maskless H&N radiation therapy workflow guided by SGRT is clinically feasible, accurate, and enhances patient experience by eliminating rigid immobilization. This approach maintains treatment precision while addressing psychological and comfort concerns associated with thermoplastic masks. Future studies with larger cohorts and long-term outcomes are warranted to validate these findings and support integration into routine clinical practice.