S2884
RTT - RTT education, training, and advanced practice
ESTRO 2026
Raffaella L Barzaghi 4 , Antonella del Vecchio 3 , Nadia Di Muzio 1 , Diego Catania 2 1 Radiotherapy, IRCCS Ospedale San Raffaele, Milano, Italy. 2 Radiology, IRCCS Ospedale San Raffaele, Milano, Italy. 3 Medical Physics, IRCCS Ospedale San Raffaele, Milano, Italy. 4 Neurosurgery, IRCCS Ospedale San Raffaele, Milano, Italy Purpose/Objective: Verifying the patient's set-up is an essential step in radiosurgical treatments. In treatments performed with Gamma Knife (GK), the use of the Leksell stereotactic helmet guarantees submillimetre precision, minimising positioning errors. However, modern GKs are also equipped with pre-treatment imaging systems (CBCT). The aim of this study is to validate the IGRT system integrated into the GK equipment installed at our hospital. Material/Methods: Between May and October 2024, pre-treatment CBCT images were acquired at the Gamma Knife Unit of the IRCCS San Raffaele Hospital for 350 patients treated with GK ICON for intracranial lesions. Of these, 310 in a single session and 40 with fractionated schedules (up to 5 sessions), maintaining the stereotactic helmet for the entire duration of the treatment. Pre-treatment CBCTs were co-registered with reference images, MRI planning for single-fraction treatments and CBCTs from the first session for fractionated treatments, to assess translational and rotational shifts. The number of dose recalculations by the clinician was also noted.
affiliated Center for Radiotherapy Rüti (center B) implemented a structured Radiation Therapist (RTT) empowerment program, enabling RTTs to perform workflow steps traditionally supervised by physicians. This study aimed to quantify the impact of RTT empowerment on lung SBRT session duration and to identify factors influencing workflow efficiency. Material/Methods: A retrospective analysis included 1,239 SBRT sessions delivered to 162 patients with primary lung cancer or pulmonary metastases treated between January 2022 and October 2025 at centers A (112 patients) and B (50 patients). Detailed AlignRT® data were available for 52 patients. Session data from ARIA and AlignRT® were segmented into setup, imaging, matching, beam-on, and other components. Session duration was compared between physician-supervised and RTT-led (non-supervised) treatments and analyzed by year, location, patient age, and RTT education and experience. Statistical comparisons were performed using unpaired t-tests, with p ≤ 0.05 considered significant. Results: The proportion of RTT-led sessions increased from 43% in 2022 to approximately 70% in 2025. Mean session duration was 14.5 ± 4.8 min, with RTT-led sessions significantly shorter than physician- supervised sessions (12.8 ± 2.9 vs. 16.8 ± 5.6 min, p < 0.01). At center B, mean RTT-led session duration decreased from 13.3 min (2022) to 11.5 min (2024). Treatment duration was primarily influenced by physician attendance (up to 5-min difference), RTT education level until 2023 (up to 3.5 min), and treatment site (up to 2 min). Session components comprised setup (6%), imaging (17%), matching (25%), beam-on (25%), and other (27%) times. Imaging and beam-on times were influenced by cone-beam CT (CBCT) type, treatment technique, and monitor units. Conclusion: RTT empowerment significantly improved workflow efficiency in lung SBRT, primarily through shorter image-matching times and greater RTT autonomy, without compromising safety or treatment accuracy. Continued professional training, process standardization, and reduction of non-technical components (“other” time) offer further potential to enhance radiotherapy efficiency and patient throughput. Keywords: treatment duration, workflow optimization Digital Poster 4129 Verification of patient set-up using pre-treatment CBCT in radiosurgery with Gamma Knife Antonio V Merola 1 , Vincenzo Sacco 1 , Giuseppe R Bonfitto 2 , Giovannella Salvadori 1 , Lucia Perna 3 ,
Results: In single-session treatments, the average translational and rotational shifts resulted in a maximum average shot deviation of 0.96 mm, mainly along the longitudinal axis. For this type of treatment, the analysis of target volume coverage (V100%) showed an
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