For Head & Neck radiation therapies, a patient’s position needs to be reproduced accurately, in order to ensure effective treatments and minimize side effects. Historically, full-face masks were used to accomplish this. 

But the sub-millimetric accuracy offered by SGRT with AlignRT has enabled clinics to implement open-face masks – or even to move towards completely maskless treatments. 

AlignRT can reduce the complexity of treatment setups and can track motion with better than 1mm accuracy, with reduced need for immobilization. AlignRT is fully integrated into the treatment workflow, allowing for automatic beam pause if the patient moves during treatment delivery.  

The benefits of AlignRT for H&N

43% of patients reporting “significant anxiety” before mask-making sessions²

Studies have shown that patients have reported mask immobilizations, using closed-face masks, to be among the “worst” parts of their Radiation Therapy experiences¹. Nearly half (43%) of patients reported clinically significant anxiety before their mask-making session².  24% of patients were also reported to have some level of session disruption during their first treatment³.  Improving patient comfort while minimizing session disruption are key elements in improving treatment outcomes. 

AlignRT provides patient-centered care for Head and Neck treatments. 

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 setups⁴.  AlignRT, combined with 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 reduce time per fraction by 90 seconds

AlignRT also has the potential to better evaluate changes in skin contour due to weight loss earlier than other methods.

Find a list of compatible open-face masks here. 

The benefits of MapRT for H&N


Non-coplanar treatment planning using clearance mapping has shown the potential to enhance outcomes, as shown in this planning study of head and neck retreatments: MapRT has been shown to facilitate noncoplanar planning by showing which couch/gantry angles are safe for delivery.

“4Pi plans may allow dose escalation with significant and consistent improvements in critical organ sparing, tumor control, and coverage.” ²

Calculated Outcome Probabilities

Voice of Experience

Head & neck presentations from the SGRT Community

Selected evidence:


Has been shown to detect rigid setup errors with good accuracy.²
– Olga Gopan and Qiuwen Wu, “Evaluation of the accuracy of a 3D surface imaging system for patient setup in head and neck cancer radiotherapy”

Open-face mask improves comfort and tolerability for patients³

Comparable immobilization and posture preservation to closed masks⁴
– David Wiant, Sarah Squire, Han Liu, Jacqueline Maurer, T Lane Hayes, Benjamin Sintay, “A prospective evaluation of open face masks for head and neck radiation therapy”

Patients reported greater neck and shoulder comfort and overall satisfaction during CT simulation…Open masks with CHR provide comparable yet comfortable immobilization to closed masks with SHR, for HN radiotherapy.⁵
– Zaheeda Mulla, “A comparative study between open-face and closed-face masks for head and neck cancer (HNC) in radiation therapy”

In head and neck cancer cases, postural reproducibility deteriorates due to the non-rigidity of H&N…image-guided corrections cannot completely compensate for this.⁶
– “In head and neck cancer cases, postural reproducibility deteriorates due to the non-rigidity of H&N…image-guided corrections cannot completely compensate for this.”

  1. Olausson, K., Holst Hansson, A., Zackrisson, B., Edvardsson, D., Östlund, U. and Nyholm, T. (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. doi:
  2. 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. doi:
  3. Clover, K., Oultram, S., Adams, C., Cross, L., Findlay, N. and Ponman, L. (2010). Disruption to radiation therapy sessions due to anxiety among patients receiving radiation therapy to the head and neck area can be predicted using patient self-report measures. Psycho-Oncology, 20(12), pp.1334–1341. doi:
  4. Wei, W., Ioannides, P.J., Sehgal, V. and Daroui, P. (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. doi:
  5. “Large Network Approach: Streamlining Workflows & Increasing Efficiency” Kira-Lee Oliver, Director – Service of the Future GenesisCare, 2022 SGRT USA Meeting

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