2972 - Pediatric Upright Proton Therapy in a Tilting Chair: Anesthesia Integration, AV Immersion and Initial Clinical Experience
Presenter(s)
M. Clark1, L. E. K. Ghomsi2, S. Rodriquez3, C. T. Gibson4, S. Graham5, L. Xing6, Y. Yang6, B. W. Loo Jr7, S. M. Hiniker7, S. Charyyev7, and L. Skinner1; 1Stanford University, Stanford, CA, 2Department of Radiation Oncology, Stanford University, Palo Alto, CA, 3Department of Pediatric Anesthesia, Lucile Packard Children's Hospital, Stanford, CA, 4Stanford Health Care, Palo Alto, CA, 5Leo Cancer Care, Crawley, West Susse, United Kingdom, 6Department of Radiation Oncology, Stanford University, Stanford, CA, 7Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
Purpose/Objective(s): Upright proton therapy (UPT) is emerging for its ultra-compact footprint and proton arc capabilities, but upright anesthesia presents a new challenge. The lack of a safe, purpose-built solution for administering anesthesia to children in the upright position effectively excludes this important patient population from UPT. We developed a comprehensive, integrated approach combining a novel tilting chair for anesthesia-induction with patient distraction and engagement tools for cooperative patients. This integrated system is scheduled for first treatment in spring 2026, allowing presentation of the technical detail and initial clinical experience of this solution.
Materials/Methods: A three-component system has been developed and tested: (1) A tilting pediatric chair comprising of plastic and carbon fiber parts, enabling safe anesthesia induction, optimal positioning, and minimal water equivalent thickness. (2) An integrated audiovisual immersion system providing immersion and biofeedback for cooperative patients, and (3) pre-treatment educational tools including animated videos and engagement toys to reduce baseline anxiety. Validation included mechanical load testing, CT imaging compatibility assessment, and end-to-end clinical workflow simulation for both anesthetized and awake patient populations.
Results: The tilting chair prototype successfully transitions patients from supine anesthesia induction to upright treatment position while maintaining optimal beam access, ensuring patient safety and preserving compatibility with immobilization devices (vacuum bags, head cushions, and masks). CT imaging confirmed no artifacts were introduced when imaging and static load testing confirmed the chair’s structural integrity. Workflow simulations validated protocols for three potential patient categories: cooperative (without anesthesia), semi-cooperative (anesthesia administered in the vault in the modified chair), and nervous children (anesthesia administered with patient on gurney). The integrated system demonstrated feasibility for anesthesia-free treatments in appropriate candidates, while educational tools provided standardized pre-treatment preparation.
Conclusion: This comprehensive solution addresses critical barriers to pediatric UPT implementation by enabling safe anesthesia delivery while reducing anesthesia burden through patient engagement alternatives. The integrated system establishes a new standard for compassionate pediatric proton therapy, expanding access to advanced radiotherapy for vulnerable populations and improving both treatment outcomes and patient experience in pediatric radiation oncology practice.