Nano-X Image Guidance: CBCT With Gravity-induced Motion

NCT ID: NCT04488224

Last Updated: 2025-08-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

EARLY_PHASE1

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-01

Study Completion Date

2026-12-31

Brief Summary

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A pilot stage, device feasibility trial, to investigate the feasibility of acquiring cone beam computed tomography (CBCT) images for image guidance for radiation therapy by maintaining a fixed imaging system and rotating the participant about the horizontal axis using the Nano-X patient rotation system. It is a single-arm, controlled, single-blinded, non-treatment, non-invasive, single-institution trial.

Detailed Description

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Primary objective:

To investigate the feasibility of volumetric image guidance for the Nano-X patient rotation system (PRS).

Secondary objectives:

1. To develop image reconstruction methods that allow target and normal tissue visualisation at all treatment angles to a clinical cone beam computed tomography (CBCT) standard.
2. To determine the reproducibility and variability in Nano-X CBCT compared to clinical CBCT.
3. To measure the magnitude of gravity-induced anatomical deformation and translation.
4. To develop treatment plan adaptation methods to compensate for gravity-induced target motion based on Nano-X CBCT image reconstruction at varying treatment angles.
5. To quantify the participant experience of horizontal rotation using the Nano-X PRS for volumetric image guidance CBCT acquisition.

The investigators will perform a pilot stage, device feasibility trial, to investigate the feasibility of acquiring CBCT images for image guidance by maintaining a fixed imaging system and rotating the participant about the horizontal axis using the Nano-X PRS. It is a single-arm, controlled, single-blinded, non-treatment, non-invasive, single-institution trial.

Eligible participants will be asked to attend the Nelune Comprehensive Cancer Centre (NCCC) at the Prince of Wales Hospital on two separate occasions to obtain Nano-X CBCT scans. For each scan the participant will be rotated 360° about the horizontal axis which will take approximately 72 seconds to complete.

Participants will be asked to complete validated psychometric questionnaires before and after each Nano-X CBCT. The questionnaire responses will be used to quantify their experiences of anxiety and motion sickness, and report previous experiences of claustrophobia, in order to identify determinants of tolerance level.

The projection data sets from the Nano-X CBCT scans, along with conventional CBCTs obtained for the participants' standard radiotherapy treatment, will be used to investigate the image-related objectives. The two Nano-X CBCT data sets from each participant will be used to compare Nano-X CBCT variability and reproducibility to clinical CBCT acquisition.

Conditions

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Cancer

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

All participants will undergo CBCT imaging during rotation on the Nano-X patient rotation system. For each participant, quality of CBCT images acquired during the rotation session will be compared with quality of CBCT images collected during their standard radiation therapy treatment.
Primary Study Purpose

DEVICE_FEASIBILITY

Blinding Strategy

SINGLE

Outcome Assessors
The Postdoctoral Research Associate will collect and de-identify CBCT images acquired during Nano-X rotation session and during participants' routine treatment. The software used to display the scans will incorporate a random number generator to determine the labeling of images as 'A' or 'B'. Observers assessing image quality for study outcomes will be masked to the source of either image.

Study Groups

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Patients receiving CBCT Image Guidance during treatment

On two separate occasions, CBCT images will be acquired while participants are rotated 360° about the horizontal axis on the Nano-X Patient Rotation System. The rotation will take approximately 72 seconds to complete. Psychometrically validated questionnaires will be completed by the participant before and after each Nano-X CBCT session.

Participants in this arm undergo conventional CBCT for image guidance during standard of care (SOC) radiotherapy treatment. These participants do not require an additional conventional CBCT as the SOC conventional CBCT images are used to benchmark the experimental Nano-X CBCT scans for evaluation of the primary outcome measure.

Group Type EXPERIMENTAL

Nano-X Patient Rotation System

Intervention Type DEVICE

The Nano-X prototype is a horizontal patient rotation system that immobilises participants while being rotated on the horizontal axis.

This device will be used to rotate patients horizontally while cone-beam Computed Tomography (CBCT) projections are acquired.

Psychometrically validated questionnaires

Intervention Type OTHER

The Claustrophobia Questionnaire (CLQ), Short Form State/Trait Anxiety inventory (STAI) and Fast Motion Sickness (FMS) questionnaires administered. CLQ only once before the first session, STAI and FMS both before and after each Nano-X CBCT session.

Patients not receiving CBCT Image Guidance during treatment

On two separate occasions, CBCT images will be acquired while participants are rotated 360° about the horizontal axis on the Nano-X Patient Rotation System. The rotation will take approximately 72 seconds to complete. Psychometrically validated questionnaires will be completed by the participant before and after each Nano-X CBCT session.

Participants in this arm do not undergo conventional CBCT for image guidance during standard of care (SOC) radiotherapy treatment. As such these participants will receive an additional conventional CBCT scan on standard equipment which used to benchmark the experimental NAno-X CBCT scans for evaluation of the primary outcome measure.

Group Type EXPERIMENTAL

Nano-X Patient Rotation System

Intervention Type DEVICE

The Nano-X prototype is a horizontal patient rotation system that immobilises participants while being rotated on the horizontal axis.

This device will be used to rotate patients horizontally while cone-beam Computed Tomography (CBCT) projections are acquired.

Conventional CBCT scan

Intervention Type RADIATION

A conventional cone-beam Computed Tomography (CBCT) scan is acquired on standard radiotherapy machinery.

Psychometrically validated questionnaires

Intervention Type OTHER

The Claustrophobia Questionnaire (CLQ), Short Form State/Trait Anxiety inventory (STAI) and Fast Motion Sickness (FMS) questionnaires administered. CLQ only once before the first session, STAI and FMS both before and after each Nano-X CBCT session.

Interventions

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Nano-X Patient Rotation System

The Nano-X prototype is a horizontal patient rotation system that immobilises participants while being rotated on the horizontal axis.

This device will be used to rotate patients horizontally while cone-beam Computed Tomography (CBCT) projections are acquired.

Intervention Type DEVICE

Conventional CBCT scan

A conventional cone-beam Computed Tomography (CBCT) scan is acquired on standard radiotherapy machinery.

Intervention Type RADIATION

Psychometrically validated questionnaires

The Claustrophobia Questionnaire (CLQ), Short Form State/Trait Anxiety inventory (STAI) and Fast Motion Sickness (FMS) questionnaires administered. CLQ only once before the first session, STAI and FMS both before and after each Nano-X CBCT session.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Cancer patients that are receiving radiation therapy that are able to be imaged with the Nano-X PRS with one of the following tumour sites:

1. in the head/neck region
2. in the chest/abdomen/pelvic region with fast CBCT used for standard of care image guidance and is aged 60 years or older
3. in the chest/abdomen/pelvic region not receiving CBCT for standard of care image guidance and is aged 70 years or older
4. diagnosis of lung cancer with stage II-IV
2. ≥18 years of age
3. ECOG Performance Status 0-2
4. Must be able to communicate fluently in English to:

i. Receive instructions from operators of the PRS for safety entering and leaving the Patient Rotation System and required conduct during the during the rotation session, and ii. Communicate their level of comfort or distress to operators of the equipment.
5. Signed, written informed consent or approved alternative, non-contact method for informed consent.

Exclusion Criteria

1. Pregnant women
2. Patients for whom attaining informed consent would not be possible, including mentally impairment
3. Patients with severe vertigo or recent a diagnosis of Benign Paroxysmal Positioning Vertigo.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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South Eastern Sydney Local Health District

OTHER_GOV

Sponsor Role collaborator

University of Sydney

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Paul J Keall, PhD

Role: PRINCIPAL_INVESTIGATOR

ACRF Image X Institute, University of Sydney

Michael Jackson, MD

Role: PRINCIPAL_INVESTIGATOR

Prince of Wales Hospital

Simon Downes, MASc

Role: STUDY_CHAIR

Prince of Wales Hospital

Mark Gardner, PhD

Role: STUDY_CHAIR

ACRF Image X Institute, University of Sydney

Central Contacts

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Trial Coordinator

Role: CONTACT

+61 2 8627 1185

Program Manager

Role: CONTACT

+61 2 9114 0998

References

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Debrot E, Liu P, Gardner M, Heng SM, Chan CH, Corde S, Downes S, Jackson M, Keall P. Nano X Image Guidance in radiation therapy: feasibility study protocol for cone beam computed tomography imaging with gravity-induced motion. Pilot Feasibility Stud. 2023 Jun 13;9(1):95. doi: 10.1186/s40814-023-01340-z.

Reference Type DERIVED
PMID: 37312127 (View on PubMed)

Other Identifiers

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Nano-X IG

Identifier Type: -

Identifier Source: org_study_id

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