S2880
RTT - RTT education, training, and advanced practice
ESTRO 2026
plan comparison was identified as a major bottleneck. Although it could not be eliminated due to Dutch insurance requirements, several streamlined workflows were introduced, reducing processing time and increasing treatment planning capacity. Additional measures increased both planning capacity and gantry availability: automation of treatment planning, deep learning-based auto-segmentation, and replacement of most measurement-based dosimetry with independent dose calculation.Interview analysis identified further possible improvements in communication, quality checks, and automation (Figure 1). Communication issues were addressed by refining the external referral form and implementing early data completeness checks. Redundant quality checks were removed, and initiation of independent dose calculation was shifted to radiation therapists, reducing physicist workload. Integration of software systems remained unresolved, and a communication guideline was recommended as an interim measure. Parts of the workflow and quality checks were automated, with further developments ongoing. Conclusion: Lean-based workflow evaluation and insights from semi-structured interviews, identified improvements across the proton therapy workflow. Reduction in fraction time increased annual treatment capacity by 100 patients without extending opening hours or altering the case mix. These findings demonstrate that systematic workflow optimization can significantly improve access to proton therapy. Keywords: Proton therapy, capacity, workflow
Purpose/Objective: Respiratory motion introduces geometric uncertainty in lung stereotactic ablative body radiotherapy (SABR), necessitating advanced motion management (MM) strategies such as deep inspiration breath hold (DIBH), exhale breath hold (EBH), and free-breathing gating (FBG) (1). This facilitates increased sparing of healthy tissue and dose escalation. However, the clinical benefit of these techniques must be balanced against workflow efficiency and patient compliance. This study aimed to evaluate institutional practice patterns for MM and quantify respiratory motion reduction and treatment time across different gating techniques. Material/Methods: A retrospective review was performed for all patients receiving lung SABR with advanced MM between May- 2023 and March-2025. Data was extracted from MOSAIQ (Elekta, Stockholm, SE) and Eclipse (Varian Medical Systems, Palo Alto, CA), including gating type (DIBH, EBH, FBG), respiratory motion magnitude (superior–inferior, tumour motion or surrogate), duty cycle, whether a pre-simulation assessment was completed and treatment duration (from first verification image to end of last treatment field). Differences in respiratory motion pre-/post-gating were assessed using the Wilcoxon signed-rank test (p < 0.05). Results: Table 1 summarises the number of patients, gating techniques and respiratory motion during the study period. Of the 104 evaluable patients (out of total 510 20%), 44 (42%) underwent a pre-simulation assessment for suitability for DIBH, EBH or FBG. Fractionation schedules ranged from 1-5, 57% ,54% and 100% of DIBH, FBG and EBH cohorts were a single fraction respectively (DIBH 2%, 5% 11% 25% were 2, 3, 4 and 5 fractions respectively and FBG 7%, 23 and 16% were 3, 4 and 5 fractions respectively).81 patients had paired pre-/post-gating respiratory motion measurements. Median (IQR) respiratory motion in the superior–inferior direction was reduced with gating 15.2mm (11.0–20.0) vs 3mm (2.2 – 4.5), with significant motion reduction for FBG and DIBH p < 0.001. The median duty cycle for FBG at the time of CT was 48% (IQR 41.0–56.2). Figure 1 demonstrates treatment times the median (IQR) treatment times were 26.1 mins (20.1– 37.1), 28.3 mins (22.3– 40.5) and 44.4 mins (37.7– 54.8) for FBG, DIBH and EBH.
optimization References:
[1] Womack, J. and D. Jones, Lean Thinking : Banish Waste and Create Wealth in Your Corporation. Vol. 48. 1996.[2] Creswell, J.W., Qualitative inquiry and research design: Choosing among five approaches, 2nd ed. 2007, Thousand Oaks, CA, US: Sage Publications, Inc. xvii, 395-xvii, 395.
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Selection of motion management strategies in lung stereotactic body radiotherapy (SABR) and their impact on motion reduction and workflow Thomas Devereux 1,2 , Rohan Jackson 3 , Grace Morgan 1 , Mark Burns 1 , Adam Yeo 3,2 , Vanessa Panettieri 3,2 , Nikki Plummridge 4,2 , Shankar Siva 4,2 , Katrina Woodford 1,2 , Nicholas Hardcastle 3,2 1 RTS, Peter MacCallum Cancer Centre, Melbourne, Australia. 2 Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia. 3 Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia. 4 Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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