Specialist commentator comments

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

Eight specialists contributed to this briefing. Six of the experts were familiar with the technology and 4 had used it in clinical practice.

Level of innovation

Two experts felt there was nothing novel about AlignRT in terms of breathing during breast cancer radiotherapy. However, another expert felt the technology offered added safety benefits because it is non-ionising and reduces the dose delivery to healthy tissues. This expert also noted that AlignRT reduces the number of repeat setups and removes the need for patient tattooing. One expert noted that AlignRT displays the whole chest which helps to avoid irradiating the heart. Another expert stated that positioning accuracy for whole-breast treatment is up to 10 mm and that smaller movements are unlikely to have any clinical significance.

Potential patient impact

One expert noted that patients felt AlignRT improves deep-inspiration breath holding, and 2 felt that it increases setup speed. Several experts noted that it improves dose delivery accuracy and 1 explained that the lack of ionising radiation was beneficial. Another expert noted that the technology will be of benefit for nodal treatment.

Potential system impact

One expert noted that changes may be needed to facilities to accommodate the new technology. Another felt that using AlignRT may reduce waiting times because of better patient throughput. This expert also noted that it could reduce long- and short-term side effects after radiation.

General comments

One expert noted that for AlignRT to work, a patient needs to be treated on the same surface used for planning. There may also be a need for a replacement linear accelerator if the machine is in use or breaks down. Another expert also noted that surface anatomy alone may not be an accurate surrogate for positioning because the tumour bed may move between treatment planning and treatment. This expert also felt that AlignRT does not remove the need for other localisation systems. Another expert highlighted the need to demonstrate long-term outcomes before AlignRT is widely adopted. One expert noted that any cost savings may depend on the clinical accuracy of the technology and the quality of the treatment plan rather than the difference between a conventional setup and an AlignRT setup.