SGRT at Oslo University Hospital: Transforming Patient Setups and Workflows

Oslo University Hospital, home to one of Europe’s largest cancer centers, has integrated Surface Guided Radiation Therapy (SGRT) into daily clinical practice, enhancing precision, workflow, and patient care. Fredrik Nordby, Radiation Therapist, Mojgan Heydari, Medical Physicists and Stine Gyland Mikalsen, Medical Physicist, have been involved since the beginning and recall how SGRT has become an integral part of breast cancer treatment — enhancing accuracy, workflow, and patient experience while reducing the need for traditional tattoos.

How Did Oslo University Hospital Introduce SGRT?

The initial adoption of AlignRT began in 2017on two linacs, primarily to support deep inspiration breath hold (DIBH) for left-sided breast cancer treatments:

“We first started looking into the system because we needed a new solution for DIBH,” says Mojgan.

Expansion was gradual but rapid. Today, SGRT is used across 10 linacs at Oslo, with the second hospital in the network adopting it a couple of years later. Today, there is a total of at Oslo: 10 at the Radium Hospital, 6 at Ullevål, and 2 systems at the Proton site. In addition, the team also has SimRT and MapRT.

“At the start, people were rolling their eyes, why do we need a new system? Everything seemed to be working fine. But if I ask staff today, no one wants to go back,” Frederick recalls. “When I started using the system, I was blown away, especially for breast treatments, where contours make positioning tricky. The setup matched the planning CT much better, and we didn’t need to move the patient around as much.”

To ensure all staff stay confident and consistent in using SGRT across a large, rotating team, Oslo has developed a network of “super users” — advanced therapists who serve as front-line resources for troubleshooting and standardization. Regular workshops led by Vision RT clinical application specialists further support skill development:

“Thanks to the clinical application specialists, live workshops are run to ensure everyone on the team maintains the same level of SGRT knowledge,” says Mojgan.

Why Did Oslo Move to Tattoo-Free Breast Cancer Treatments?

SGRT has also allowed Oslo to implement tattoo-free workflows for almost all breast cancer patients, a change that has been in place for approximately four years. Tattoos, once standard for positioning, often caused patient distress:

“Some breast cancer patients worry a lot about the thought of having a tattoo. Not just the mark itself, but because it’s a reminder of going through cancer treatment — it’s not something anyone wants to carry around. When we started using SGRT, we realized tattoos weren’t necessary. They didn’t add anything, so it was an easy decision to stop using them,” says Frederick.

Patient compliance has improved alongside accuracy. Therapists can monitor positioning in real-time and provide confidence to patients:

“Sometimes nervous patients ask, ‘What if I cough or move my head?’ We tell them not to worry, if anything happens, the automatic beam-hold ensures they won’t be treated while moving. It really gives patients a sense of safety,” says Mojgan.

How Has SGRT Improved Workflow and Efficiency?

SGRT has significantly enhanced efficiency, precision, and workflow at Oslo. “AlignRT is being used on close to all our patients across all types of diagnoses,” says Mojgan.

Postural Video, introduced three years ago, has further streamlined setup:

“Since we started using Postural Video, life has been easier for the staff treating patients. Therapists who are familiar with the system can quickly decide how to adjust the patient to align the surface with the reference CT,” says Frederick.

The Postural Video module gives therapists a multi-angle, real-time view of the patient’s overall alignment relative to their reference position during setup and monitoring by using an outline of the reference surface and a live video stream of the patient.

Internal studies show measurable improvements:

“We tested the setup accuracy and efficiency of Postural Video for surface-guided positioning and found the system provided clear, real-time guidance, reducing setup time by an average of 40 seconds per fraction compared to standard SGRT,” says Mojgan.

Frederick emphasizes the benefit of seeing the whole patient at once:

“With Postural Video, you can see the whole patient and know immediately if positioning is right. It’s faster, and the results are better. When you’re used to that level of precision, you don’t want to go back.”

SGRT has become a game-changer for radiation therapy at Oslo University Hospital. Now fully integrated across multiple linacs, it enables tattoo-free breast treatments, boosts patient confidence, and enhances both setup accuracy and workflow efficiency — establishing itself as an indispensable tool for radiation therapists at one of Europe’s leading therapy centers.