New Research Published: Evaluating Upright Breast Radiotherapy, Arm Positioning and Beam Access

Recent research published by Sands et al. (2025) explored the feasibility of delivering upright breast radiotherapy for both photon and proton treatments, with particular focus on how arm positioning and the use of a dedicated radiotherapy bra influence beam access, treatment field size, patient comfort, and setup reproducibility. The pre-clinical study involved 21 healthy female volunteers aged 24 to 83, with recruitment weighted toward larger breast sizes (median bra size 36DD, ranging from B to H cup) to reflect more challenging treatment anatomies.

Three upright arm positions were evaluated: arms raised above the head using dedicated arm supports, arms resting by the sides, and arms positioned behind the body with a modified backrest. Each setup was assessed both with and without a specialized immobilization device, the Chabner XRT radiotherapy bra. Optical surface scans were used to generate pseudo-CT models for treatment planning analysis, allowing researchers to assess beam access across upper, mid, and lower regions of the breast, alongside measurement of superior–inferior field length and inframammary skin fold (ISF) size. Participants also completed comfort questionnaires and underwent repeated “hands-off” repositioning trials to evaluate unaided setup reproducibility.

The use of the radiotherapy bra produced a marked reduction in inframammary skin folds across all arm positions, with complete elimination of the fold in approximately 60% of measured cases. This is clinically relevant, as larger ISFs have been associated with increased skin toxicity during breast radiotherapy. In addition, wearing the bra consistently shortened the required treatment field length by an average of 2.5 cm, a reduction that may translate into lower irradiation of the ipsilateral lung for photon treatments.

However, while the bra improved breast positioning and anatomical separation from the chest wall, it also brought the breasts closer together medially. This increased the risk of contralateral breast clipping for photon beam arrangements, adding complexity to treatment planning. The authors proposed a novel strategy that successfully overcame this.

Arm positioning had a significant impact on beam access. The arms-by-side position proved unsuitable for conventional photon treatments due to obstruction of lateral beam entry, although it remained compatible with en-face proton fields. The arms-up position provided the greatest flexibility in photon beam angles and achieved the highest rate of successful treatment plans, particularly when combined with the radiotherapy bra. In contrast, the arms-back position resulted in beam obstruction in approximately 16% of photon planning scenarios, most commonly due to the ipsilateral arm blocking access to the upper breast region.

From a patient experience perspective, feedback was largely positive. Most participants reported feeling well supported and comfortable in both the upright treatment chair and the radiotherapy bra, with over 60% indicating a preference for treatment with the bra rather than without it. Importantly, participants were able to reposition themselves with sub-centimetre accuracy in repeated unaided setups, demonstrating strong natural reproducibility. This “hands-off” approach could reduce the need for extensive manual adjustment by radiotherapy staff and may enhance patient dignity, confidence, and overall treatment experience.

Overall, the study demonstrates that upright breast radiotherapy is technically feasible for both photon and proton modalities, with the arms-up position emerging as the most versatile and robust option. The use of a dedicated radiotherapy bra offers clear anatomical and dosimetric advantages, particularly in reducing skin folds and treatment field length, though it requires thoughtful planning strategies to manage contralateral breast proximity. Together, these findings support upright positioning as a promising approach that could improve patient comfort while potentially reducing treatment costs and expanding global access to radiotherapy.

Lead author Dr Gordon Sands talks us through this research in his own words:

Read the full article here.