Surface Guided Radiation Therapy Enhances Precision and Safety for Patients at UPMC Hillman Cancer Center in Central Pennsylvania

UPMC Hillman Cancer Center in central Pennsylvania now offers Surface Guided Radiation Therapy (SGRT), an advanced form of optical tracking of patient movements that provides more precision, reproducibility, and safety of external beam radiation therapy.

SGRT uses a three-dimensional stereo camera to generate a real-time map of the patient’s body during each treatment session. SGRT monitors the patient for movement continuously without using additional imaging radiation. The system helps ensure that the therapeutic dose is delivered exactly as planned and remains confined to the targeted tissues and anatomy over multiple sessions.

At UPMC Hillman in central Pennsylvania, SGRT is now fully integrated into the daily radiation therapy workflow. The SGRT system captures the patient’s surface contour in real time and transmits positional data directly to the treatment console. This allows clinical staff to verify patient alignment before treatment begins and maintain that alignment during the entire treatment session. UPMC Hillman Cancer Center in Mechanicsburg now uses SGRT in approximately 90% of patient cases, with plans to extend access to all the regional radiation oncology sites as equipment upgrades occur.

“This technology allows us to treat patients with greater precision and safety, while also improving comfort,” says Alexandra Chahwala, MHA, R.T.(R)(T), regional operations manager for radiation oncology.

A New Layer of Precision in Daily Treatment

The SGRT system creates a continuous comparison between the patient’s current surface position and the reference surface created during simulation. If the system detects any patient motions or movement outside the tolerance range predefined by the clinical teams, the linear accelerator automatically pauses radiation delivery until the patient returns to the correct position.

“When I tell patients the system shuts off automatically if they move, you can see the weight lift off their shoulders,” says Joella Wilson, MD, regional vice chair of radiation oncology at UPMC Hillman. “It helps them relax and trust that their treatment is safe and precise.”

The continuous monitoring capabilities of SGRT provides an enhanced level of patient positional awareness during treatment that is especially important when the treatment margins are narrow or and when movement can influence therapeutic accuracy.

“The system never stops tracking the patient while the beam is on, which gives us a level of positional awareness that intermittent X-ray imaging cannot provide,” Dr. Wilson says. “The precision of SGRT supports the use of tighter margins and helps reduce exposure to surrounding tissue. It is capable of submillimeter accuracy, which allows us to refine our fields and limit dose to nearby organs.”

Clinical Integration Across Cancer Types

SGRT currently is being used in the treatment of all cancer types, except for cancers of the head and neck because the rigid immobilization devices used in these cases are not compatible with the SGRT camera system.

For left-sided breast cancer, SGRT strengthens deep inspiration breath-hold protocols by verifying that each breath hold is accurately reproduced.

“We can ensure patients reproduce the same breath hold during every treatment session, which is essential for minimizing radiation exposure to the heart in these cases,” Dr. Wilson says.

In cases when stereotactic body radiation therapy (SBRT) is used, for example in liver and pancreas cancer treatment, the high doses are delivered over a small number of fractions and proximity to sensitive organs requires precise targeting.

“It gives us confidence to use tighter margins and still deliver high therapeutic doses to complex abdominal targets,” Dr. Wilson says.

SGRT also contributes to improved reproducibility in postlumpectomy partial breast radiation where target volumes are smaller and depend on very accurate localization of the lumpectomy cavity. SGRT alignment helps ensure consistent patient positioning over time. In cases requiring cranial radiation (i.e., brain tumors), the SGRT system supports the use of open-face immobilization masks without compromising precision.

“Patients appreciate being able to see and breathe more comfortably during treatment, and SGRT lets us maintain accuracy without relying on more restrictive approaches,” Chahwala says.

Target Reproducibility and Margin Reduction

One of SGRT’s most meaningful contributions is its ability to support tighter planning target volumes by providing continuous feedback on patient position. This feedback allows the radiation therapists and oncologists to refine margins and improve the therapeutic ratio by limiting the dose to healthy tissue.

Dr. Wilson has applied SGRT to support dose escalation in select abdominal and thoracic sites where even small positional uncertainties can affect safety and efficacy.

“Tighter margins are achievable because we have uninterrupted positional feedback,” Dr. Wilson says. “This is especially meaningful for pancreatic and liver cases, where normal tissue tolerance is a major concern.”

Improving the Treatment Experience

SGRT is completely noninvasive and functions without any physical contact with the patient. Many patients are unaware of the system while it operates, but it plays a central role in maintaining safety throughout treatment. The visibility of the camera system also supports clearer communication between therapists and patients during daily setups for treatment. This helps patients understand the mechanics of their treatment and the safeguards in place.

SGRT also creates a pathway to tattoo-free workflows. UPMC Hillman in central Pennsylvania has introduced tattoo-free setup for patients with right-sided breast cancer and is exploring expanding this option for other disease sites.

“Many patients prefer not to have permanent tattoos, and SGRT gives us the accuracy we need to support that,” Chahwala says.

Workflow Efficiency and Program Development

Incorporating SGRT in the radiation oncology practice at UPMC Hillman in central Pennsylvania has provided a number of efficiency benefits for patients and providers. Pre-imaging alignment is more precise and reduces the need for repeated adjustments. This shortens room turnover between patients and supports a more consistent setup across the radiation therapy provider teams. SGRT also reduces the need for some immobilization devices, particularly in breast and thoracic treatments, which leads to increased efficient patient preparation.

“Continuous surface guidance supports more efficient throughput without compromising precision and patient safety,” Dr. Wilson says. “Once we set up the targeting parameters as the outset of a patient’s treatment, we can repeat those session-to-session with a high degree of accuracy and do it rapidly.”

Expanding Access to Advanced Cancer Care

Currently, UPMC Hillman in central Pennsylvania is the only region within the UPMC network with SGRT in routine clinical use.

“We’re one of the few centers in the state offering this level of technology locally,” Dr. Wilson says. “It ensures that patients can receive advanced, high-quality care without having to travel.”

Referring Physicians and Patient Referrals

For more information about any of the services available at UPMC Hillman Cancer Center, or to refer a patient, please call the general Information and Referral Service line at 412-282-3111. To contact the UPMC

Hillman Cancer Center in Mechanicsburg, please call 717-988-1400.