IOMP Webinar: Upright Radiotherapy: Challenges and Opportunities

Friday, 28th April 2023 at 12 pm GMT; Duration 1 hour

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NEW: CME/CPD credit point shall be awarded for participation in the webinar in full.

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Organizer: Eva Bezak, IOMP 
Moderator: M Mahesh, IOMP

Speaker: Tracy Underwood, PhD

Dr Tracy Underwood is a Senior Physicist at Leo Cancer Care, an innovative young company who are developing medical devices for upright radiotherapy. She is also a UKRI Future Leaders Fellow and an Honorary Senior Research Fellow at University College London.

As a radiotherapy researcher she has worked at some of the most innovative clinics and academic departments worldwide, including Massachusetts General Hospital / Harvard Medical School in Boston, IUCT Oncopole in Toulouse, the Christie NHS Foundation Trust, the University of Manchester, and the University of Oxford. She is passionate about medical physics education and is part of the editorial board of “The Encyclopaedia of Medical Physics”, which is published as an open resource at, as well as in hardcopy by CRC Press.

Tracy was awarded the 2015 IMechE JRI: Best Medical Engineering PhD Prize and the 2017 Early Career Academic Prize from the UK Institute of Physics and Engineering in Medicine.

She likes to spend her free time on the beach or in the forest with her husband and two young kids.


Treatments which combine fixed radiation beams with upright, rotating patient positioning systems have been investigated since the advent of radiotherapy. However, recently there has been an upsurge of interest in this topic, as evidenced by new academic publications and commercial systems.

In Heidelberg, one of the only carbon ion gantries in the world weighs ~600 tonnes. For proton therapy, gantries typically weigh ~100-200 tonnes. Even conventional photon gantries weigh ~5 tonnes: around the weight of an adult elephant.

Eliminating the gantry could vastly reduce the radiation shielding required and the 3D footprint of treatment bunkers. It could also reduce the complexity of beam delivery equipment, leading to reduced maintenance, easier upgrades, and lower expertise barriers. These factors can bring down treatment room costs, not just for heavy ion / proton radiotherapy, but also for conventional photon radiotherapy where global access is unacceptably low. There may be tumour sites where upright radiotherapy is better medicine (e.g., lung, liver). For certain patients (e.g., those with head and neck cancers), upright positioning is also likely to prove more comfortable.

Against the advantages of upright radiotherapy, we need to weigh the practical challenges of re-implementing the clinical workflow. Questions also remain over immobilisation and how treatment plan quality and radiotherapy effectiveness will vary with body position.

Given the decades of enhancements across supine radiotherapy, how committed are we to the traditional paradigm? Here we will explore the published evidence, challenges and opportunities associated with upright radiotherapy.