The Treatment Adapts so the Patient Doesn’t Have To: Ethos at Queen’s Hospital, Romford, UK | Varian

The Treatment Adapts so the Patient Doesn’t Have To: Ethos at Queen’s Hospital, Romford, UK

The Treatment Adapts so the Patient Doesn’t Have To: Ethos at Queen’s Hospital, Romford, UK

Queens Hospital treats around 1,200 patients a year and was the first facility in the UK to deploy and start using an Ethos™ therapy system in August 2020, despite being in the midst of the COVID pandemic. 

“Our goal is to provide treatments that don’t require our patients to adapt to us but use technology to make the experience as convenient and simple as possible,” said Siobhan Graham, head of radiotherapy at Queen’s Hospital. “Minimum fuss, maximum dignity from carpark to treatment couch without having to worry about tattoos or markers or bowel and bladder preparation.”

So far, the radiotherapy team has treated mainly prostate and bladder cancer with Ethos therapy, but it also has addressed a few pancreatic and esophageal tumors. With Ethos deployed, the team has stopped the use of fiducial markers for prostate treatments, eliminating one patient procedure. It’s currently moving toward reducing the need for patient bladder and bowel preparation by taking advantage of the daily contouring tool and scanning at treatment.

“We recently moved an esophageal patient from a regular machine to Ethos because he had an NG tube inserted between the CT scan and treatment, and the stomach changed from being full of contents to being full of air,” explained Dr. Amy Ward, radiation oncologist at Queen’s Hospital. “We were able to replan him using Ethos daily adaptation and avoid treatment gaps as well as the additional radiation exposure from a replanning CT scan.”

Although workflow reduction was not a primary goal, the team has noticed that there are fewer steps and Ethos has improved their cross-functional collaboration processes.
    
“All three groups—clinicians, radiographers, and radiotherapy physicists—can sit down together and work more collaboratively,” said Dom Withers, head of clinical dosimetry at Queen’s Hospital. “Ethos has enhanced those relationships and keeps us all at least partially involved up until the very last day of treatment. We see a reconstructed plan dose every day as well as the effect of the plan on the position of the patient: it’s challenging the way we think about how we’re doing radiotherapy in many ways.”

Another big advantage for the team is that adaptive treatments can be performed in standard treatment slots of half an hour.

“We book half an hour for patients having an adaptive treatment, but usually treat in under 20 minutes,” Withers said. “I believe we’re just at the beginning of our journey with adaptive, and all of us have at the backs of our minds the hope that as techniques evolve, we’ll be getting ever-better doses to targets.”

In addition, the streamlined automated planning tools in Ethos when used in non-adaptive mode for IGRT treatments, are helping the team’s workload and been particularly helpful for urgent pain treatment in palliative cases.

“In these cases, we were able to get a good quality IMRT plan in essentially the time it would take normally just to put on a conformal field,” Dr. Ward said. “But it wasn’t just for time and workflow purposes, we also wanted to raise the quality of our palliative treatments, too.”

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