Immersive Radiotherapy Immobilisation System (IRIS): Development and evaluation

Research Question Can a virtual reality (VR) based immobilisation system reduce anxiety, and ensure accurate positioning for people using a radiotherapy treatment mask? Background Head and neck cancer (HNC) patients undergoing radiotherapy often experience significant anxiety, particularly due to the use of immobilisation masks, which can trigger claustrophobia and distress. Studies report that up to 40% of radiotherapy patients suffer from anxiety, with 20-50% experiencing heightened anxiety in the early stages of treatment. The mask, a rigid thermoplastic device designed to hold patients still during treatment, is a major source of discomfort, often worsening as therapy progresses. For some, the experience is so distressing that they require treatment breaks or anxiolytic medication. Anxiety during radiotherapy is exacerbated by the treatment environment, with patients frequently reporting feelings of isolation and heightened anxiety when left alone in the treatment room. This psychological distress not only impacts their mental health but can also affect their ability to tolerate treatment, leading to interruptions that may negatively influence the success of therapy, particularly for aggressive tumour types. Aims and Objectives The primary aim is to create and assess a novel "Immersive Radiotherapy Immobilisation System" (IRIS) that delivers a VR experience to reduce patient anxiety while enabling reproducibility of treatment. Specific objectives are: 1. To develop a prototype IRIS. 2. To test the functional capability and safety of IRIS in radiotherapy environments. 3. To evaluate the impact of IRIS on anxiety during radiotherapy. 4. To compare the immobilisation capability of IRIS to existing methods. Methods The study is divided into five work packages. WP1 involves developing a prototype IRIS comprising a radiation and magnetic-field-shielded projector, bone conduction audio delivery system, a mirror and eyepiece and rigid immobilisation arms. WP2 comprises the co-design of bespoke immersive VR visual and audio environments with service users and industry experts, followed by WP3 which tests the performance of the IRIS in a radiotherapy environment. WP4 assesses anxiety reduction and comfort in a diverse group of volunteers utilising IRIS using validated "State and Trait Anxiety" instruments and interviews with users. Finally, WP5 evaluates the system s ability to immobilise the head and neck region compared to standard practice using video capture technology. Timelines for Delivery The project progresses through distinct phases, beginning in month 3 with prototype IRIS development in WP1. By month 5, WP2 focuses on co-designing VR environments. From months 6 to 8, WP3 conducts safety and feasibility testing. The final phases, WP4 and WP5, take place from months 9 to 14, assessing the system s impact on anxiety and immobilisation. Anticipated Impact and Dissemination This feasibility project is expected to pave the way for future funded development and formal evaluation of a new medical device capable of reducing anxiety for HNC radiotherapy patients and improving their treatment experience and compliance with radiotherapy. Key outputs include copyrighted meditation and relaxation soundtracks, feasibility data for future clinical testing, conference presentations, workshops, and two open-access publications in "Practical Radiation Oncology" and "Radiography," sharing the system s impact on anxiety and user experience.