S2886
RTT - RTT education, training, and advanced practice
ESTRO 2026
remaining 20 patients (Group 2) were treated using a Visual Coaching Device consisting of a wireless monitor displaying the respiratory waveform and gating window in real time. Treatments were delivered with volumetric-modulated arc therapy (VMAT) in 30 patients — 15 without and 15 with the optical viewer (3 arcs in 12 patients and 4 arcs in 3 patients in each group) — or with hybrid-VMAT (H-VMAT) in 10 patients (5 without and 5 with the optical viewer, using 2 tangential fields plus 2 arcs). For each patient, the mean setup time, mean treatment time, and mean total session time (including both setup and irradiation) were calculated across all 15 fractions. Comparative analyses were then performed between the two groups. Results: Patients treated with the optical viewer showed shorter treatment times compared to those treated without it. The mean setup time was 3:21 min vs 3:35 min, the mean beam-on time 2:37 min vs 3:10 min, and the mean total session duration 5:58 min vs 6:48 min, respectively. Overall, the introduction of the optical viewer led to an average reduction of 14 s in setup, 33 s in beam-on, and 50 s in total session time per fraction. The improvement was most evident in more complex treatment plans, with the greatest efficiency gain in multi-arc VMAT deliveries: H-VMAT: total time reduction 0:14 min, 3-arc VMAT: 0:53 min, and 4-arc VMAT: 1:24 min (Figure 1-2). The mean total treatment time decreased by approximately 50 seconds per session, corresponding to a cumulative saving of over 12 minutes per patient across the entire treatment course.
CHiPP bladder constraints; every patient required a PoD to ensure bladder constraints were achieved without replanning. RTT re - optimisation preserved PTV coverage in 9/10 patients; one case required reduced PTV coverage and would need full replanning to restore coverage. Sigmoid position was qualitatively checked but not dosimetrically quantified due to limited CBCT field of view. AI auto - contours required manual RTT edits in all cases. Plan complexity analysis indicated all sCT plans were deliverable without additional PSQA. Ninety - one CBCTs were analysed for potential PoD adoption. Retrospective application of the PoD workflow would have allowed PoD selection in 50/91 fractions (55%), reducing the need for replanning or additional imaging and shortening patient time in department. Conclusion: An RTT - led sCT and AI - supported PoD workflow on non - adaptive linacs is feasible, deliverable, and dosimetrically valuable. By leveraging existing equipment with modern AI tools and empowering RTTs to lead adaptive decision-making, this PoD approach delivers high-value care in resource-limited settings. Prospective validation and integration into
clinical pathways are warranted. Keywords: Lean, PoD, adaptive
Digital Poster 4259
Session time saving with optical viewer use in deep inspiration breath hold radiotherapy for left-sided breast cancer Francesca Cucciarelli 1 , Elena Galofaro 1 , Michela Medici 1 , Sara Zitti 1 , Vittoria Emanuela Morabito 2 , Marco Valenti 2 1 Department of Internal Medicine, Radiotherapy Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy. 2 Department of Radiological Sciences,
Medical Physics Unit, Azienda Ospedaliero- Universitaria delle Marche, Ancona, Italy
Purpose/Objective: The aim of this study was to evaluate the impact of an optical viewer system in patients undergoing Deep Inspiration Breath Hold (DIBH) radiotherapy for left-
sided breast cancer. Material/Methods:
Forty patients(pts) with left-sided breast cancer underwent whole-breast irradiation in DIBH using a Varian TrueBeam linear accelerator. Planning CT scans were acquired in DIBH, and respiratory motion was monitored in real time through the Real-Time Positioning Management (RPM) Gating System (Varian). Twenty patients (Group 1) were treated before the introduction of the optical viewer guided by the verbal instructions of the technologist. The
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