AlignRT for intracranial stereotactic radiosurgery

The technology and indication described in this briefing is the AlignRT patient position monitoring system, for guiding intracranial stereotactic radiosurgery (SRS). This may avoid incomplete or inaccurate treatment that can be caused by patient movement.

The innovative aspects are that it does not use potentially uncomfortable patient frames or bite plates, additional ionising radiation, or separate radiation sources or tracking systems.

The intended place in therapy would be in a standard radiation treatment suite with a linear accelerator (LINAC). It would be used in people with secondary brain tumours as an adjunct to existing position monitoring systems. These existing systems use X‑rays or CT scanning and radiologist/radiographer visual monitoring.

The main points from the evidence summarised in this briefing are from 5 observational and retrospective studies including a total of 244 adult patients in a tertiary care setting in the US. They suggest that AlignRT is as effective as existing position monitoring systems for people having SRS to treat brain tumours.

Key uncertainties are that the evidence is limited in quality and quantity. There are no direct comparisons of AlignRT with current NHS comparators for position monitoring, although such trials are unusual in this clinical area.

The cost of AlignRT is £250,000 per unit (excluding VAT) plus an annual service charge of £25,000 or an additional estimated cost per procedure of £1,000 per patient treatment. Savings that could be offset against this include more accurate initial treatment and a reduced need for repeat treatments, or management of the adverse effects of increased radiation exposure.