Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Two of 4 specialist commentators have used this technology before and 1 was familiar with it.

Level of innovation

The commentators agreed AlignRT was novel but not unique, and 1 thought it was highly innovative. One felt that this was the best system currently available. Two mentioned that the innovative aspect of AlignRT was avoiding the repeat X‑ray images and radiation exposure as well as a greatly increased accuracy of patient positioning. One commentator felt that AlignRT may not be the best device for use with stereotactic radiosurgery (SRS) for secondary brain tumours, and that it might be better used for general radiotherapy. They noted that the NHS service specification for SRS uses other X‑ray imaging.

Potential patient impact

Two commentators who had not used the device said that it would have little advantage over current methods of patient positioning for accurate radiosurgery. The 2 commentators who have used AlignRT thought it offered significant patient benefits in avoiding radiation exposure from additional X‑rays and by halting the radiation beam when a person moves. It also allowed for a rapid readjustment of the person, minimising extra X‑ray exposures and reducing anxiety. However, 1 expert noted that the radiation dose from imaging would be several orders of magnitude lower than the total radiation dose from treatment and so this would not be a particularly significant benefit from using AlignRT.

One expert (who had used the system in breast cancer treatment) noted a range of technical benefits including respiratory gating, tracking thoracic and abdominal respiratory motion and compatibility with an automated treatment couch. One expert noted it was useful for people who couldn't tolerate a full-face mask and possibly for older patients. Another noted that children may benefit as well, but that the number of children being treated for these cancers would be very small.

One expert noted that dose and fractionation is standardised in the UK and so AlignRT would not alter the number of patient visits (fractions) or the amount of treatment radiation given. However, radiation from alternative imaging sources would be reduced.

Potential system impact

Two commentators said that AlignRT could lead to cost savings by increasing patient throughput because of quicker patient set‑ups, and by using fewer time-consuming, radiation-based positioning methods. One also noted that using AlignRT would support a 'lean staffing' model, because it has the potential to allow staff of differing skill sets to set‑up complex treatments safely and efficiently. Two commentators thought any advantages would be unclear or unlikely, with 1 noting that although AlignRT interrupts treatment if the patient moves, it does not correct for it, which may prolong treatment times.

When considering the potential cost impact of AlignRT, 1 commentator noted that standard linear accelerators (LINACs) have image-guidance systems already, such as cone beam CT, and so AlignRT would present an additional equipment cost. However, 1 commentator felt that AlignRT would allow SRS treatment on machines that do not have other specialist imaging. Another commentator queried how many head rests would be included in the purchase price and whether these may add costs.