SGRT Birmingham 2022 SGRT; Going live with tattoo and mark-free treatments  Lydia Kedziorek, Therapeutic Radiographer, Royal Derby Hospital.  

1. SGRT; Going live with tattoo
and mark free treatments
Lydia Kedziorek
PrincipalTreatment Lead

2. Royal Derby Hospital
• 4 Truebeam Linear
Accelerators
• 1 Philips Big Bore CT
with Gate CT
• 1 Xstrahl superficial unit
• HDR brachytherapy
• ARIA
• SGRT on 2 linacs –
AlignRT Advance (6.3)

3. • On average - 500 breast patients referred each year
• Old technique:
- 3 tattoos (anterior and laterals)
- Voluntary DIBH
- Field borders marked in surgical marker, field light
checked against these
- DIBH marks drawn in surgical marker
Breast Treatments

4. Putting our Patient’s First
Some key findingsin the study were:
•70% had negative feelings about this
involuntary body modification
•78% of patients would choose a
treatment which avoided tattoos and/or
marks
•45 miles is the average additional
distance patients are willing to travel to
a center that is tattooless/markless

5. • All tangential breast/chestwall patients were
tattooless and markless from day 1 of
implementation, including DIBH.
• Soon after we went live with tattooless and markless
for our patients having rapid arc breast/chestwall +
nodes treatment
• How did we get there…
Breast treatments using SGRT

6. • Clinical Applications Specialist initially spent 2 days with us
– theory and practical
• Vision RT Portal – training modules
• Training package created for staff using resources from the
portal
• First treatment protocols written – clinical applications
specialist reviewed them
• Created test patients within Align RT for Region of Interest
(ROI) training
• End to end testing
Initial Training

7. Meet Colin…
• Anthropomorphicphantom
• CT Scan –plan made
• Export/Import protocol created
• Staff practical sessions using SGRT,
image and treat.
Pros:
• Test the protocol from end to end
• Allow staff to get used to the system
• Gave us confidence
• Tested new white brass bolus
Cons:
• Difficult to practice with potential set
up issues

8. End to End Testing

9. End to End Testing

10. • DIBH workflow
• Difficult set ups
Volunteers

11. • Small team chosen for the go live week
• Clinical Application specialist spent time with staff to
provide support
• Tweaked the protocols during the first few weeks
• Was challenging when problems arose
• BIG THANK YOU to all involved
Go Live

12. • DIBH much more accurate – staff members could see
the benefit
• Had to be much more stringent with those eligible to
DIBH – CT had to change process slightly
• Patients very grateful – spent time explaining to them
the new system
Initial Pros

13. • Spent time working out the best ROIs for us. Not one
fits all – assess on day 1
With experience…

14. • Gained experience with problem solving i.e. when to
use the 1 second beam delay
• Staff still building up confidence. Support with
challenging patients
• Reviewing protocols again – can drop Elbow to Elbow
distance
With experience…

15. • Pendulous breasts – challenging but found PV helps
• Palliative patients – SCFs, ribs, humerus
• Breast patients – 1 arm down
Postural Video (PV)

16. • Lung SABR – free breathing. Now Tattooless
• Oligometasases SABR – Pelvic patients.
• Lymphoma Abdomen (DIBH)
Other sites

17. • SGRT focus group
• Going live with tattooless for all thorax
• End to end testing Cat 1s – contingency plan
Moving forward

18. Any Questions?