S2881
RTT - RTT education, training, and advanced practice
ESTRO 2026
radiotherapy to the stellate ganglion, may be a non- invasive alternative (1). Treating patients with ICDs, on MR Linac (MRL) systems poses significant safety concerns, as individuals’ devices must be programmed to MR safe mode, thereby avoiding the risk of an inadvertent therapy whilst on treatment. Careful patient monitoring is therefore required during this period with a readiness for resuscitation should the patient develop an abnormal heart rhythm while on treatment. A standard resuscitation cannot occur within the MRL bunker (2). This study evaluated the effectiveness of a radiographer-led safety framework and emergency preparedness process for MRL treatment of VA patients with ICDs, focusing on planning, preparedness, and structured safety implementation. Material/Methods: Prior to the first MRL simulation, radiographers conducted timed mock resuscitation drills to ensure confidence and readiness in managing a potential emergency, in line with evidence that simulation- based training improves team performance (3). A centre-wide drill confirmed all members of the Resuscitation team (Basic and Advanced Life Support) were prepared. Two days before treatment, radiographers notified the resuscitation team of the appointment time. On treatment days, a designated radiographer verified that all resuscitation team members were onsite before any device management, reprogramming to MR- safe mode was undertaken. Pulse and electrocardiogram monitoring were performed during treatment. Pacemaker assessment forms were uploaded to the Oncology Management System, and the resuscitation team was notified upon session completion. Results: All five patients completed hypofractionated radiotherapy to the stellate ganglia on the MRL without adverse events. Although no standard evacuation time exists, guidance recommends immediate transfer (2), and simulations showed two radiographers could move a patient to a safe resuscitation area in under two minutes. All resuscitation team members were onsite, pacemaker assessments were uploaded successfully, and the radiographer-led safety framework ensured efficient workflow. Conclusion: Radiographer-led planning and safety protocols enabled the safe delivery of hypofractionated MRL radiotherapy for VA patients with ICDs. Multidisciplinary coordination and resuscitation drills enhanced efficiency and response times. This radiographer-led framework shows that complex cardiac cases can be safely managed on MRL systems through simulation training and coordinated emergency planning.
Conclusion: DIBH, EBH, and FBG all achieved substantial respiratory motion reduction in lung SABR. DIBH and EBH provided superior motion control but were associated with longer treatment times, particularly for EBH. FBG offered effective motion reduction with improved efficiency compared to EBH and DIBH. These results highlight the importance of tailored MM, balancing motion reduction, patient suitability and workflow efficiency to optimise treatment delivery. Keywords: Lung, SABR, Gating References: 1. Remmerts de Vries IF, Dahele M, Rosario TS, Slotman BJ, Verbakel W. Clinical experience with free- breathing expiration-gated 10MV FFF VMAT stereotactic lung radiotherapy. Radiother Oncol. 2025;205:110783. Radiographer-led safety and resuscitation framework for MR linac radiotherapy in ventricular arrhythmia patients with ICDs within the RadioStar Trial Emildah Rukoni 1 , Roxanne Clelland 1 , Nash Mahleki 1 , Alexander Goodman 1 , Ben George 2 , Ami Sabharwal 3 1 Radiotherapy, GenesisCare UK, Oxford, United Kingdom. 2 Service Delivery, GenesisCare UK, Oxford, United Kingdom. 3 Consultant Oncologist, GenesisCare UK, Oxford, United Kingdom Digital Poster 3512 Purpose/Objective: Surgical resection of the stellate ganglion has emerged as a therapeutic option for ventricular arrhythmias (VAs), providing an alternative for patients unresponsive to pharmacological therapy and catheter ablation and avoiding the need for recurrent implanted cardiac defibrillator (ICD) therapies which have a detrimental effect on quality of life. Surgical resection is a complex undertaking with significant associated side effects. Ultrahypofractionated
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