Nano-X Image Guidance: CBCT With Gravity-induced Motion

Study Overview
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Brief Summary
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A pilot stage, device feasibility trial, to investigate the feasibility of acquiring cone beam computed tomography (CBCT) images for image guidance for radiation therapy by maintaining a fixed imaging system and rotating the participant about the horizontal axis using the Nano-X patient rotation system. It is a single-arm, controlled, single-blinded, non-treatment, non-invasive, single-institution trial.

Detailed Description
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Primary objective: To investigate the feasibility of volumetric image guidance for the Nano-X patient rotation system (PRS). Secondary objectives: To develop image reconstruction methods that allow target and normal tissue visualisation at all treatment angles to a clinical cone beam computed tomography (CBCT) standard. To determine the reproducibility and variability in Nano-X CBCT compared to clinical CBCT. To measure the magnitude of gravity-induced anatomical deformation and translation. To develop treatment plan adaptation methods to compensate for gravity-induced target motion based on Nano-X CBCT image reconstruction at varying treatment angles. To quantify the participant experience of horizontal rotation using the Nano-X PRS for volumetric image guidance CBCT acquisition. The investigators will perform a pilot stage, device feasibility trial, to investigate the feasibility of acquiring CBCT images for image guidance by maintaining a fixed imaging system and rotating the participant about the horizontal axis using the Nano-X PRS. It is a single-arm, controlled, single-blinded, non-treatment, non-invasive, single-institution trial. Eligible participants will be asked to attend the Nelune Comprehensive Cancer Centre (NCCC) at the Prince of Wales Hospital on two separate occasions to obtain Nano-X CBCT scans. For each scan the participant will be rotated 360° about the horizontal axis which will take approximately 72 seconds to complete. Participants will be asked to complete validated psychometric questionnaires before and after each Nano-X CBCT. The questionnaire responses will be used to quantify their experiences of anxiety and motion sickness, and report previous experiences of claustrophobia, in order to identify determinants of tolerance level. The projection data sets from the Nano-X CBCT scans, along with conventional CBCTs obtained for the participants' standard radiotherapy treatment, will be used to investigate the image-related objectives. The two Nano-X CBCT data sets from each participant will be used to compare Nano-X CBCT variability and reproducibility to clinical CBCT acquisition.

Official Title
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Nano-X Image Guidance: CBCT With Gravity-induced Motion

Conditions
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Cancer

Intervention / Treatment
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* Device: Nano-X Patient Rotation System
* Radiation: Conventional CBCT scan
* Other: Psychometrically validated questionnaires


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cancer patients that are receiving radiation therapy that are able to be imaged with the Nano-X PRS with one of the following tumour sites: in the head/neck region in the chest/abdomen/pelvic region with fast CBCT used for standard of care image guidance and is aged 60 years or older in the chest/abdomen/pelvic region not receiving CBCT for standard of care image guidance and is aged 70 years or older diagnosis of lung cancer with stage II-IV ≥18 years of age ECOG Performance Status 0-2 Must be able to communicate fluently in English to: i. Receive instructions from operators of the PRS for safety entering and leaving the Patient Rotation System and required conduct during the during the rotation session, and ii. Communicate their level of comfort or distress to operators of the equipment. Signed, written informed consent or approved alternative, non-contact method for informed consent. Exclusion Criteria: Pregnant women Patients for whom attaining informed consent would not be possible, including mentally impairment Patients with severe vertigo or recent a diagnosis of Benign Paroxysmal Positioning Vertigo.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Device Feasibility
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: All participants will undergo CBCT imaging during rotation on the Nano-X patient rotation system. For each participant, quality of CBCT images acquired during the rotation session will be compared with quality of CBCT images collected during their standard radiation therapy treatment.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients receiving CBCT Image Guidance during treatment<br>On two separate occasions, CBCT images will be acquired while participants are rotated 360° about the horizontal axis on the Nano-X Patient Rotation System. The rotation will take approximately 72 seconds to complete. Psychometrically validated questionnaires will be completed by the participant before and after each Nano-X CBCT session. Participants in this arm undergo conventional CBCT for image guidance during standard of care (SOC) radiotherapy treatment. These participants do not require an additional conventional CBCT as the SOC conventional CBCT images are used to benchmark the experimental Nano-X CBCT scans for evaluation of the primary outcome measure. | Device: Nano-X Patient Rotation System<br>* The Nano-X prototype is a horizontal patient rotation system that immobilises participants while being rotated on the horizontal axis. This device will be used to rotate patients horizontally while cone-beam Computed Tomography (CBCT) projections are acquired.<br>Other: Psychometrically validated questionnaires<br>* The Claustrophobia Questionnaire (CLQ), Short Form State/Trait Anxiety inventory (STAI) and Fast Motion Sickness (FMS) questionnaires administered. CLQ only once before the first session, STAI and FMS both before and after each Nano-X CBCT session.<br>|
| Experimental: Patients not receiving CBCT Image Guidance during treatment<br>On two separate occasions, CBCT images will be acquired while participants are rotated 360° about the horizontal axis on the Nano-X Patient Rotation System. The rotation will take approximately 72 seconds to complete. Psychometrically validated questionnaires will be completed by the participant before and after each Nano-X CBCT session. Participants in this arm do not undergo conventional CBCT for image guidance during standard of care (SOC) radiotherapy treatment. As such these participants will receive an additional conventional CBCT scan on standard equipment which used to benchmark the experimental NAno-X CBCT scans for evaluation of the primary outcome measure. | Device: Nano-X Patient Rotation System<br>* The Nano-X prototype is a horizontal patient rotation system that immobilises participants while being rotated on the horizontal axis. This device will be used to rotate patients horizontally while cone-beam Computed Tomography (CBCT) projections are acquired.<br>Radiation: Conventional CBCT scan<br>* A conventional cone-beam Computed Tomography (CBCT) scan is acquired on standard radiotherapy machinery.<br>Other: Psychometrically validated questionnaires<br>* The Claustrophobia Questionnaire (CLQ), Short Form State/Trait Anxiety inventory (STAI) and Fast Motion Sickness (FMS) questionnaires administered. CLQ only once before the first session, STAI and FMS both before and after each Nano-X CBCT session.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Cone Beam Computed Tomography (CBCT) images acquired with horizontal patient rotation that are deemed to be of comparable image quality to clinical CBCT or deemed acceptable for radiotherapy image guidance as scored by a panel of experts. | Observers will view the image sets in 3 orthogonal views and grade the image quality considering geometrical accuracy, anatomical visualisation, sharpness of the image, soft tissue contrast, image noise and uniformity and overall clinical usability. The imaging method will be deemed technically feasible if >70% of CBCT images acquired with horizontal patient rotation are deemed of clinical quality. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Short Form State/Trait Anxiety inventory (STAI) and Fast Motion Sickness (FMS) questionnaire scores before and after rotation as assessed by the Wilcoxon signed rank test. | Wilcoxon signed rank test used to determine statistically significant differences in anxiety and motion sickness assessed using psychometrically validated surveys completed prior to and post horizontal rotation CBCT scan. The STAI questionnaire is used to assess anxiety and is comprised of 6 questions scored 1-4. These are combined for a final score between 6 and 24, where a higher number indicates a greater level of anxiety. The FMS questionnaire is used to assess motion sickness. Participants rate their levels of motion sickness on a scale of 0-20 where 0 is no feeling of nausea and 20 is feeling terrible and very sick. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Radiation Therapy, Image Guidance