Upright benefits
Psychological
Radiographer
Clinical
We spend most of our lives standing or sitting, our most natural positions. Some studies suggest that, when upright, our internal organs move less than when lying down, potentially leading to greater radiation beam accuracy during treatment while sparing surrounding healthy tissue.
Psychological Benefits
Comfort
To remain completely still for the 20-60 minutes that treatment can take a patient must be comfortable enough to do this. Early research involving patients who have previously experienced radiotherapy in a supine position has all shown a preference for the upright position in terms of comfort.
Communication
55% of communication is non-verbal therefore over half of our communication as healthcare professionals and over half of our patient’s communication to us is lost because a patient’s field of view during treatment setup is purely the ceiling tiles above their head when lying down to receive treatment.
Control
Research has taught us time and time again how important patient-centered healthcare is. Patients want and need to be part of their treatment decision-making. Where they lack autonomy we often see low mood, feelings of helplessness and non-compliance.
Radiographer Benefits
Musculoskeletal disorders are the second most common workplace-related illness.
These affect muscles, tendons, ligaments, joints, nerves, and spinal discs. Symptoms include localized or widespread pain, worsened by movement, stiffness, fatigue, sleep disturbances, muscle twitching, and a burning sensation. These injuries reduce quality of life, impacting both mental and physical health. They result from fixed body positions, repetitive movements, force on small body parts like hands or wrists, and a fast-paced work environment with limited recovery time. Radiographers treat 40-50 patients per shift on the Linear Accelerator (LINAC), often maneuvering patient immobilization devices and assisting patients onto and off treatment couches, which can strain their bodies.
In 2012 The Society of Radiographers published the results of a survey they conducted on musculoskeletal disorders in Therapeutic Radiographers, which had 352 respondents.
The advantage of treatment in an upright position is that patients themselves find it easier to get in and out of the position compared to supine treatments as confirmed in a study by Boisbouvier (2023) where 94% of patients said that they could get in and out of an upright patient positioning system easily whereas 60% said the same about the supine treatment position. With this easy maneuvering in and out of upright treatment radiographers have less need to physically assist their patients therefore there is less repetitive strain on their bodies.
Clinical Benefits
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Head and Neck
Perceived difficulty swallowing is 6 times greater when in a supine position compared to upright making the management of radiation-induced salivary changes much harder to manage lying down.
Liver
Imaging has shown that the liver drifts for up to 35 minutes moving in some cases up to 20 millimetres. In terms of targeting, this is a considerable shift and means that without careful monitoring, a tumor could move out of the treatment field.
Prostate
A recent study explored the male pelvic anatomy in the upright position and found that gravity works in our favor by pushing the organs above down on the prostate and seminal vesicles holding them in a more fixed position.
LUNG
Supine radiotherapy for the treatment of lung cancer can be a real challenge for this patient group as it can make their breathing even more laborious. A study suggested that upright, lung volume was on average 25% larger but in some cases up to 50% larger.
Breast
Treating breast cancer in an upright position poses a challenge due to gravity's effect on breast tissue which tends to flatten against the chest wall and abdomen, increasing the infra-mammary fold and maintaining proximity to the chest wall. A recent study including radiotherapy bras may have solved this issue.