Enabling gantry-less radiotherapy through upright patient positioning: Current consensus and future direction

Purpose: Gantry-less radiotherapy with a fixed treatment beam, in which an upright patient is slowly rotated,
promises reductions in treatment room costs and could offer anatomical / comfort benefits for certain patients.
Several radiotherapy centres worldwide have now designed or acquired upright patient immobilization systems;
however, many aspects of the upright treatment workflow are yet to be fully addressed.
Materials & Methods: During the 2024 ESTRO physics workshop on “Gantry-less Radiotherapy: Challenges and
Opportunities”, 22 participants, including medical physicists, a radiation oncologist, academics and represen-
tatives from industry, discussed in-depth the open questions and existing solutions for clinical implementation.
Clinical aspects, technical and implementation challenges, opportunities and a “wish-list for vendors” were
addressed