Investigation of motion sickness and inertial stability on a moving couch for intra-fraction motion compensation

Background. Respiration-induced tumor motion compensation using a treatment couch requires moving the patient at non-trivial speeds. The purpose of this work was to investigate motion sickness and stability of the patient's external surface due to a moving couch with respiration-comparable velocities and accelerations. Material and methods. A couch was designed to move with a peak-peak displacement of 5 cm and 1 cm in the S-I and A-P directions, respectively, and a period of 3.6 s. Fifty patients completed a 16-question motion sickness assessment questionnaire (MSAQ) prior to, during, and after the study. Seven optical reflectors affixed to the abdomen of each patient were monitored by infrared cameras. The relationship between reflector positions under stationary and moving conditions was evaluated to assess the stability of the patient's external surface. Results and discussion. Among the 4800 responses, 95% were 1 (no discomfort) of 9, and there were no scores of 6 or higher. Mild discomfort (scores of 4-5) was similar during couch motion and before couch motion (p = 0.39). Mild discomfort was less common after couch motion (p = 0.039) than before or during couch movement. There was a near 1:1 correspondence between marker-pair regression coefficients and phase offset values during couch-stationary and couch-moving conditions. Our results show that patients do not suffer motion sickness or external surface instability on a moving couch.