Clinical Review: Improved Respiratory Motion Management in SBRT with The AIO Solution 3.0

Respiratory motion remains a persistent challenge in stereotactic body radiation therapy (SBRT), especially when targeting tumors near the diaphragm. Traditional abdominal compression methods often introduce variability, discomfort, or inefficiencies in treatment workflows. In response, AdventHealth Colorado has developed a novel abdominal compression masking technique using Orfit's AIO solution 3.0, offering a reproducible, patient-friendly, and clinically effective approach for motion management. 

AdventHealth Rocky Mountain Region operates with a standardized ecosystem featuring SGRT (Surface Guided Radiation Therapy) and Orfit’s AIO immobilization system across all sites. This environment supports high-conformity treatments without reliance on tattoos or external compression paddles, streamlining workflows and improving the patient experience.

Conventional abdominal compression approaches—ranging from belts to bridge-and-paddle systems—often result in setup inconsistencies, limited reproducibility, and increased collision risks. Patients may also experience discomfort, especially with central or rigid compression, leading to potential motion during treatment. Furthermore, many of these systems are incompatible with non-coplanar treatment arcs due to added bulk around the patient. 

• Treatment Planning Considerations:
  • SGRT is used for both setup and motion tracking, eliminating the need for tattoos or RPM markers.
  • The compression mask significantly reduces artifacts in 4DCT, improving tumor visibility and reducing uncertainty in target volume.
  • By conforming tightly to patient anatomy, the system minimizes collision risks and allows broader use of non-coplanar beams.

Case studies demonstrate the clinical value:

• In one patient who failed DIBH setup, the compression mask enabled high-quality 4DCT acquisition at 10 BPM (vs. 6.5 BPM prior), eliminating artifacts and reducing planning volume.
• Treatment time was significantly reduced, with total beam-on times of just 2-3 minutes and full treatment completed in  about 8 minutes per session.

• Efficiency: 20-30 minute simulation process with minimal need for rework or reimaging.
• Reproducibility: Consistent application technique leads to tight internal anatomy alignment.
• Flexibility: Suitable for various tumor sites (lung, liver, pancreas) and body types.
• Improved Patient Comfort: Avoids painful localized pressure; setup remains tolerable even for frail or elderly patients.
• Compatibility with SGRT and Non-Coplanar Arcs: Enables high-quality treatment delivery without compromising planning geometry.

• Training: Proper technique is essential. Mask stretch should be uniform, and therapist coordination is key.
• Patient Education: Clear communication improves compliance and setup accuracy.
• Body Habitus Limitations: Larger patients may present challenges; adaptation or alternative approaches may be needed.
• Mask Cooling: Fully curing and cooling the mask prior to simulation is critical to ensure reproducibility.

The compression masking technique represents a practical, scalable, and highly effective solution to respiratory motion management in SBRT. By integrating compression into the immobilization process, clinics can reduce complexity, enhance treatment precision, and improve patient experience – all without sacrificing clinical outcomes.