Patient-reported distress and anxiety during cone-beam CT imaging sessions with increased gantry rotation speeds

Introduction: We conducted a prospective imaging clinical trial to evaluate rapid cone-beam computed tomography (CBCT) imaging on a C-arm linear accelerator. As part of this trial, we evaluated patient-reported anxiety and distress before and after imaging sessions to evaluate the impact of increased gantry rotation speed on patient experience. Materials and methods: Forty patients undergoing radiotherapy (RT) as part of standard clinical care were separately imaged using CBCT imaging on a C-arm linear accelerator with faster gantry rotation (1.5 rpm versus standard 1.0 rpm speed used clinically) as part of an imaging clinical trial. Patient anxiety and distress were evaluated before and after multiple study imaging sessions for all patients, using the validated 6-item State- Anxiety Inventory (STAI-S-6) questionnaire. Changes in patient-reported anxiety responses throughout the patient experience on this linear accelerator with rapid on-board imaging were reported. Results: The median patient-reported STAI-S-6 anxiety level across all measurements was low at 20.0 [IQR: 20.0 - 30.0]. During the first image session, median state of anxiety scores were stable, with a median score change of 0.0 [IQR: -4.2 - 0.0] (p = 0.359). Median patient-reported state-based anxiety scores from before session 1 to after the last imaging session were significantly reduced, with median change of -3.3 [IQR: -10.0 - 0.0] (p = 0.001). For patients performing breath-hold during imaging, there was no observed association between breath-hold and state-based anxiety (p = 0.219). Conclusion: Exposure to rapid gantry rotation on a C-arm linear accelerator did not increase state-based patient-reported anxiety and distress during setup imaging for radiotherapy.