S2892
RTT - RTT education, training, and advanced practice
ESTRO 2026
Marsden NHS Foundation Trust, London, United Kingdom
Purpose/Objective: In March 2025, we introduced online adaptive radiotherapy (oART) on our Radixact (Accuray, USA) treatment platform utilising Raystation’s (Raysearch, Sweden) adaptive planning solution. Our first oART treatment indication was post-operative endometrial cancer, which has pelvic targets with large interfraction motion during radiotherapy, warranting online adjustment of a patient’s treatment plan. However, oART has longer treatment time for patients compared to IGRT treatment on Radixact®. An in- house timing sheet was created with the purpose to measure the length of time it takes to successfully treat a patient adaptively. We set out to quantify our oART treatment times and compare these to our standard IGRT workflow. Material/Methods: Timing data was collected using a timing sheet modified from the PERMIT Trial (1) for all patients receiving post-operative endometrial cancer oART from March to October 2025.Actions captured on the timing sheet included: patient set-up time, planning scan started/finished, image registration started/finished, contouring started/finished, plan optimisation started/finished, plan export, checking time, verification image started/finished, image verification review, beam- on and beam off time and time the patient leaves the room. RTT’S were given a stopwatch and appropriate training to record the data.Only oART fractions were included. Machine services and breakdown meant on occasion, patients were treated with their non-adaptive IGRT plan, these fractions were excluded from analysis.Mean workflow time from patient set up confirmed until beam off was calculated and compared against previous timing data for 8 post-operative endometrial cancer IGRT treatment times on Radixact®. Detailed oART times were presented, to enable comparison with published oART timing data. Results: Eleven eligible patients had 201 oART fractions out of the total fractions. The mean oART workflow time on Radixact® was 32:14 minutes, compared to the IGRT workflow which was 13:12 minutes (Figure 1). Additional oART workflow steps increased the average treatment time by 19:02 minutes, stepwise oART timing data is presented in Table 1.
Keywords: DIR, breathing model, DIBH References: [1] Weistrand, O. and Svensson, S. (2015), The ANACONDA algorithm for deformable image registration in radiotherapy. Med. Phys., 42: 40-53.[2] Dose constraints in breast cancer radiotherapy. A critical review De Rose, Fiorenza et al. Radiotherapy and Oncology, Volume 202, 110591[3] Li, Z., Jian, et al. Clinical benefits of deep inspiration breath-hold in postoperative radiotherapy for right-sided breast cancer: a meta-analysis. BMC Cancer 24, 1238 (2024).[4] Mayr, et al. Reducing Cardiac Radiation Dose From Breast Cancer Radiation Therapy With Breath Hold Training and Cognitive Behavioral Therapy. Topics in Magnetic Resonance Imaging 29(3):p 135- 148, June 2020. Digital Poster 4597 Online adaptive radiotherapy using integrated vendor platforms: workflow timings using Radixact® and Raystation. Samira Shire 1 , Sophie Alexander 1 , Aswathi Alexander 1 , Irena Blasiak-Wal 2 , Alex Dunlop 2 , Adriana Guerra 1 , Simrah Jaweria 1 , Susan Lalondrelle 1 , Katy Lonsdale 1 , Chandni Patel 1 , Benjamin Thomas 1 , Shabanaz Boodhoo 1 1 Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom. 2 Physics, The Royal
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