{"entity":{"id":"idea-mach-upright-versus-supine-registry","kind":"idea","name":"A shared registry comparing upright and lying-down radiotherapy","aka":[],"tldr":"Upright proton machines are being installed, cleared mainly for the head, neck and upper chest, without any head-to-head comparison with lying down. A proposal: every centre records set-up accuracy, comfort and side effects the same way so the comparison exists.","summary":"Upright positioning removes the proton gantry and is now cleared in the United States and Europe (P-Cure 2023, Leo Cancer Care Marie 2025, Mevion S250-FIT 2025), with the S250-FIT limited to sites above the mid-chest when fully seated. OnCo found no randomised or matched comparison of upright and supine treatment. This proposal, which no source makes in these words, is a common registry across upright sites recording daily set-up error, replanning rate, patient-reported comfort and acute toxicity, matched to supine patients at the same centres.","asOf":"2026-11-04","links":[{"label":"FDA 510(k) K250986: Mevion S250-FIT, seated indication limits","url":"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K250986"},{"label":"FDA 510(k) K250970: Leo Cancer Care Marie","url":"https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K250970"}],"tags":["machines-wave3","proposal"],"related":[],"cancers":[],"sections":["radiation"],"technologies":["upright-radiotherapy-positioning","proton-therapy-systems"],"targets":[],"drugs":[],"companies":["leo-cancer-care","mevion","p-cure"],"institutions":["stanford"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-surgery-radiation-innovation","b-trial-design"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"provenance":{"editedBy":"OnCo machines inventory (openFDA, accessdata.fda.gov, ClinicalTrials.gov v2, Europe PMC, maker pages)","editedOn":"2026-11-04"},"hypothesis":"For head, neck and upper thoracic targets, upright treatment gives set-up reproducibility within the margins used for supine treatment and better patient-reported comfort in people who find lying flat difficult.","rationale":"The clearances define where upright treatment may be used but not how it compares; the number of installations is small enough that a shared registry from the start is feasible.","test":"Pool set-up, imaging and patient-reported data from the first upright centres for two years and compare with matched supine patients; publish the protocol before the data.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":3},"route":"/ideas/idea-mach-upright-versus-supine-registry/","neighbours":{"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"proton-therapy-systems","kind":"technology","name":"Proton therapy machines: cyclotrons, synchrotrons and single-room systems","route":"/technologies/proton-therapy-systems/"},{"id":"upright-radiotherapy-positioning","kind":"technology","name":"Upright radiotherapy positioning (Leo Cancer Care Marie, P-Cure, Mevion S250-FIT)","route":"/technologies/upright-radiotherapy-positioning/"}],"company":[{"id":"leo-cancer-care","kind":"company","name":"Leo Cancer Care","route":"/companies/leo-cancer-care/"},{"id":"mevion","kind":"company","name":"Mevion Medical Systems","route":"/companies/mevion/"},{"id":"p-cure","kind":"company","name":"P-Cure","route":"/companies/p-cure/"}],"institution":[{"id":"stanford","kind":"institution","name":"Stanford Health Care / Stanford Cancer Institute","route":"/institutions/stanford/"}],"bottleneck":[{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"}],"roadmap":[{"id":"particle-therapy-machines-roadmap","kind":"roadmap","name":"Particle therapy machines: from Loma Linda to proton rooms in a linac vault, carbon gantries and FLASH","route":"/roadmaps/particle-therapy-machines-roadmap/"}]}}