Image Guidance in Upright Radiotherapy
Description
Upright patient positioning is transitioning rapidly from concept to clinic in both photon and proton therapy, supported by compact treatment systems, innovative immobilization devices, and the development of upright imaging platforms. Early studies highlight potential advantages such as improved patient comfort, increased lung volume, and posture-related organ-motion changes that can enhance targeting accuracy. These benefits, however, introduce new challenges for image guidance that span simulation, planning, daily setup, and verification. This symposium will provide a comprehensive overview of image guidance in upright workflows, with an emphasis on how imaging protocols and emerging technologies are being adapted to seated or standing treatments. Topics will include upright simulation with fan-beam CT, registration between supine and upright anatomies, on-board imaging for patient setup and verification, motion characterization and management, and strategies for end-to-end quality assurance. Speakers will present results from international research groups and early clinical implementations, including the ultra-compact upright proton therapy system now being commissioned at Stanford. Attendees will gain practical guidance on protocol design, alignment and verification strategies, and new solutions for upright imaging. The session will conclude with a forward-looking discussion on challenges to avoid and opportunities for multi-site collaboration and data sharing.