This document summarizes Todd Pawlicki's presentation on the history and future of surface guided radiation therapy (SGRT) at the 2021 SGRT USA Annual Meeting. It describes Pawlicki's role and disclosures. It then outlines the history of SGRT at the University of California San Diego, including early cranial SRS using frames in 2005-2007 and transitioning to a SGRT system in 2008-2009. Applications of SGRT like DIBH and its increasing use are discussed. The future of SGRT is predicted to include real-time adaptive radiation therapy, collision avoidance, patient identification, and using SGRT for every patient and fraction by 2030.

1. Todd Pawlicki, PhD, FAAPM, FASTRO
Professor and Vice-Chair
Department of Radiation Medicine & Applied Sciences
The Next Chapter: SGRT Supporting
the Evolving RT Space

2. • Founding partner
• TreatSafely Foundation
• Image Owl, LLC
• Textbook Royalties
• Quality and Safety in Radiotherapy
• Hendee’s Radiation Therapy Physics, 4th Ed
• Surface Guided Radiation Therapy
Disclosures
SGRT USA Annual Meeting (Virtual) / April 2021

3. The UCSD SGRT Journey
SGRT USA Annual Meeting (Virtual) / April 2021
2005

4. The UCSD SGRT Journey
SGRT USA Annual Meeting (Virtual) / April 2021
2007

5. The UCSD SGRT Journey
http://thesocialdiary.com/ucsdcancercentergala2007.html
2007

6. The UCSD SGRT Journey
SGRT USA Annual Meeting (Virtual) / April 2021

7. The UCSD SGRT Journey
SGRT USA Annual Meeting (Virtual) / April 2021
Cranial
SRS
Frame-based Zmed-system

8. The UCSD SGRT Journey
SGRT USA Annual Meeting (Virtual) / April 2021
Use similar workflow
as with the Zmed
bite-block system.

9. The UCSD SGRT Journey 2008 – 2009
SGRT USA Annual Meeting (Virtual) / April 2021

10. The UCSD SGRT Journey 2009

11. The UCSD SGRT Journey 2009 – Present
Courtesy of Grace Kim
SGRT USA Annual Meeting (Virtual) / April 2021

12. The UCSD SGRT Journey
DIBH
Ad-hoc for extremities and challenging setups
SGRT USA Annual Meeting (Virtual) / April 2021

13. • Estimated to be on about 25% of the linacs in the U.S.
• Used for many treatment sites:
• SRS, DIBH, Breast, Head and Neck, Pediatrics, Extremities, SBRT w/wo gating
• Tattoo-less setups
SGRT Today
SGRT USA Annual Meeting (Virtual) / April 2021

14. The Future of SGRT – Real-Time Adaptive RT
SGRT USA Annual Meeting (Virtual) / April 2021

15. The Future of SGRT – Collision Avoidance
Enabling technology for non-coplanar non-isocentric treatments
SGRT USA Annual Meeting (Virtual) / April 2021

16. The Future of SGRT – Patient Identification
Wiant, D. Future Directions for SGRT.
Chapter 26, In: Surface Guided Radiation Therapy
SGRT USA Annual Meeting (Virtual) / April 2021

17. The Future of SGRT – Every Pt, Every Fx
SGRT USA Annual Meeting (Virtual) / April 2021
IAEA slide set prepared in 2006 by G.H. Hartmann (DKFZ, Heidelberg)

18. The Future of SGRT – Every Pt, Every Fx
SGRT USA Annual Meeting (Virtual) / April 2021
CT Sim
Treatment

19. Image-Guided Radiation Therapy
2002
2003 2012
2011
SGRT USA Annual Meeting (Virtual) / April 2021

20. A Prediction
2005
2005 TBD
2020

21. • By 2030, all new conventional-type linacs will be delivered with
some form of SGRT
• Hedging my bet…
• More likely if SGRT takes the place of tattoos/lasers for initial patient setup
• Less likely if tattoos/lasers continue to be used for some patients
A Prediction
SGRT USA Annual Meeting (Virtual) / April 2021

22. Fantastic Annual SGRT Meeting
• Day 1 – SGRT: Addressing Today’s Challenges
• Friday, 9th April, 1 pm EDT
• Day 2 – Deep Inspiration Breath Hold (DIBH)
• Friday, 16th April, 1 pm EDT
• Day 3 – Stereotactic Treatments
• Friday, 23rd April, 1 pm EDT
• Day 4 – Increasing Efficiency and Throughput
• Friday, 30th April, 1 pm EDT
SGRT USA Annual Meeting (Virtual) / April 2021