Head & Neck Radiotherapy without Traditional Face Masks
Radiotherapy masks are designed to immobilise patients, but they don’t eliminate movement. Studies have reported 3D displacement of up to 3 mm during treatment, while full-face masks can also cause discomfort and anxiety, creating a need for solutions that are both precise and patient-friendly1.
AlignRT provides 0.5 mm setup and treatment accuracy through continuous surface monitoring. The Postural Video module gives clinicians a clear visual reference of patient anatomy throughout setup and treatment, supporting precise positioning and enabling confident transition to open-face or even completely maskless treatments2.
In the OPEN Phase Ill trial, AlignRT detected transient patient movement not captured by CBCT3, demonstrating the value of continuous monitoring throughout treatment. Fully integrated into the treatment workflow, AlignRT can automatically pause the beam if significant movement is detected, helping support safe, accurate, and efficient treatment delivery.
Research on Head and Neck Treatments with SGRT:
Studies have shown that patients have reported mask immobilizations, using closed-face masks, to be among the ‘worst’ parts of their Radiation Therapy experiences3. Nearly half (43%) of patients reported clinically significant anxiety before their mask-making session4. Improving patient comfort while minimizing session disruption are key elements in improving treatment outcomes.
The results of a randomised trial concluded that a fully open 3-point mask used in conjunction with AlignRT improved patient experience, provided equivalent setup accuracy (to closed masks), and reduced replanning rates, supporting a new standard of care5.
The accuracy of AlignRT enables it to reduce the need for patient immobilizations, resulting in a superior patient experience, while still maintaining and improving the accuracy of setups2.
AlignRT, combined with the powerful combination of the Postural Video module, shows the outline of body parts to help ensure head, shoulders, and neck are all positioned correctly and has been shown in a study to ensure efficiency to reduce time per fraction by 90 seconds6.
Non-coplanar plans have been shown in multiple studies to deliver increased target dose or reduced organ-at-risk dose (including 19% mean and maximum dose reduction in one study for nasopharyngeal cancer7). One study shows both increased target coverage and simultaneously reduced dose to some organs at risk.
Read more about the advantages of non-coplanar treatment, which can be facilitated by the use of MapRT.
Head & Neck Workflow with SGRT:
Plan
MapRT provides the freedom to explore a greater variety of non-coplanar beams, optimizing target conformality while decreasing the dose to organs at risk (OAR). It enhances patient positioning on the treatment bed by allowing for a quick check to ensure there are no collisions when offsetting the patient. Removing the necessity for dry runs, it further reduces the number of patient visits, improving overall treatment efficiency.
Treat
AlignRT is designed to deliver high positional accuracy at all couch angles, in line with ESTRO and AAPM guidance. Advanced tools such as Postural Video provide clear visualisation and real-time guidance throughout setup and treatment, helping reduce setup time by 29% compared with standard SGRT⁸, whilst Beam Guide has the potential to help detect and prevent errors before radiation is delivered.
Dose
Hear from users on their clinical experiences:
“Minimal mask immobilisation allows for improved accuracy, improved reproducibility and certainly improved patient comfort…Making SGRT in the head and neck setting a primary safety tool for every fraction of every treatment.”
Daniel Bailey, Director of Physics and Dosimetry, Sarah Cannon, USA.
FAQ's
Studies have shown that patients have reported face masks for radiation treatment to be among the ‘worst’ parts of their Radiation Therapy experiences13 and anxiety is prevalent in head and neck patients using mask immobilizations14. SGRT is an effective alternative to a head mask for radiation therapy as it has been shown to improve patient comfort, shorten setup time, and maintain high positioning accuracy15.
Yes, research confirms that head and neck radiotherapy can be delivered safely without a full radiotherapy face mask when SGRT is used.11,12. AlignRT provides continuous motion monitoring and immediate alerts if patient movement occurs.
Clinical studies have shown that for radiation head and neck treatments, AlignRT with an open-faced mask provides greater patient comfort, with comparable outcomes to a full-face mask for radiation treatment9,10.
- Amelio D, Winter M, Habermehl D, Jäkel O, Debus J, Combs SE. Analysis of inter- and intrafraction accuracy of a commercial thermoplastic mask system used for image-guided particle radiation therapy. J Radiat Res. 2013 Jul;54 Suppl 1(Suppl 1):i69-76.
- Burns, M., Campbell, R., French, S., Dhillon, H.M., Butow, P.N., Pritchard, A. and Sundaresan, P. (2022). Trajectory of anxiety related to radiation therapy mask immobilization and treatment delivery in head and neck cancer and radiation therapists’ ability to detect this anxiety. ‘Anxiety during radiation therapy with mask’. Advances in Radiation Oncology, p.100967.
- Malone C, Ryan S, Nicholson J, ‘Maolalai RO, O’Donovan R, McArdle O, Duane F, Armstrong J, Keenan L, Glynn A, Woods R, McClean B, Brennan S. Intrafraction motion stability of open vs. closed facemasks in head and neck radiotherapy: Insights from the OPEN phase III trial. Radiother Oncol. 2025 May 21;209:110941.
- “Large Network Approach: Streamlining Workflows and Increasing Efficiency” SGRT Community Meeting 2022 Presentation by Kira-Lee Oliver, Genesis Care Florida, June 2022.
- Subramanian VS, Subramani V, Chilukuri S, Kathirvel M, Arun G, Swamy ST, Subramanian K, Fogliata A, Cozzi L. Multi-isocentric 4π volumetric-modulated arc therapy approach for head and neck cancer. J Appl Clin Med Phys. 2017 Sep;18(5):293-300.
- Oliver K, Subick N, Moser T. A prospective, comparative evaluation of an augmented reality tool (Postural Video™) vs. standard SGRT for efficient patient setup. Rep Pract Oncol Radiother. 2025 Feb 19;29(6):740-745.
- Malone et al., (2025). Intrafraction motion stability of open vs. closed facemasks in head and neck radiotherapy: Insights from the OPEN phase III trial. Radiother Oncol.
- Pan et al., (2012). Frameless, Real-Time, Surface Imaging-Guided Radiosurgery. Neurosurgery, 71(4), pp.844–852.
- Wei et al., (2020). Quantifying the impact of optical surface guidance in the treatment of cancers of the head and neck. Journal of Applied Clinical Medical Physics, 21(6), pp.73–82.
- Malone et al., (2025). Intrafraction motion stability of open vs. closed facemasks in head and neck radiotherapy: Insights from the OPEN phase III trial. Radiother Oncol.
- Olausson et al., (2017). Development and psychometric testing of an instrument to measure the patient’s experience of external radiotherapy: The Radiotherapy Experience Questionnaire (RTEQ). Technical Innovations & Patient Support in Radiation Oncology, 3-4, pp.7–12.
- Olausson et al., (2017). Development and psychometric testing of an instrument to measure the patient’s experience of external radiotherapy: The Radiotherapy Experience Questionnaire (RTEQ). Technical Innovations & Patient Support in Radiation Oncology, 3-4, pp.7–12.
- Wei et al., (2020). Quantifying the impact of optical surface guidance in the treatment of cancers of the head and neck. Journal of Applied Clinical Medical Physics, 21(6), pp.73–82.
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