S2893
RTT - RTT education, training, and advanced practice
ESTRO 2026
Digital Poster Highlight 4849
Implementation of Two Softwares Tools to Optimize IGRT Dose Management in Pediatric Radiotherapy within the “Image Gently” Approach Lucrezia Bernabucci 1 , Gerardina Stimato 2 , Veronica Pollutri 1 , Cristiana Manta 3 , Elisa Meldolesi 1 , Amedeo Capotosti 2 , Chiara Elia 1 , Sara Iacovone 1 , Silvia Mariani 1 , Elisa Marconi 1 , Mariangela Massaccesi 1 , Antonio Ruggiero 4,5 , Angela Mastronuzzi 6 , Francesca Greco 2 , Maria Vaccaro 2 , Gabriele Turco 1 , Vincenzo Frascino 1 , Marco De Spirito 1,7 , Nicola Dinapoli 1 , Patrizia Cornacchione 1,3 , Luca Tagliaferri 1,3 , Maria Antonietta Gambacorta 1,3 , Silvai Chiesa 1 1 UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 2 .O.S.D. Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 3 Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy. 4 Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 5 Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy. 6 Department of Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. 7 Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Roma, Italy Purpose/Objective: In pediatric oncology, the improvement of survival rates requires increasing attention to long-term treatment-related effects, including those from cumulative radiation exposure. Although modern radiotherapy techniques ensure conformal dose delivery, Image-Guided Radiotherapy (IGRT) adds a non-negligible imaging dose, which is particularly relevant in pediatric patients due to their higher radiosensitivity. The Image Gently protocol by Varian© aims to balance target accuracy and imaging dose reduction. This study evaluated the feasibility and clinical benefits of implementing the Image Gently protocol in daily practice, supported by retrospective and prospective analyses using Python-based software tools. Material/Methods: The study included both retrospective and prospective phases starting in June 2024. The Image Gently CBCT protocol was applied using reduced parameters (80 kV, 20 mA; CTDIvol 0.94 mGy; DLP 20.2 mGy·cm). A first Python-based software was developed to automatically generate a cumulative dose report at the end of treatment, estimating the effective dose (ED) for each patient and for every imaging fraction. A
Conclusion: As expected, the oART workflow takes longer, as we are achieving a bespoke plan each day. No other timing data for post-operative endometrial cancer oART was found, making our data unique. Our workflow times are very similar to reported prostate cancer oART times of 34:11 minutes delivered using the Ethos platform (Varian, USA) (2). Contouring is clear area where we would like to reduce the time and AI auto contouring can help with this. Further work will examine the patient’s experience of this workflow. Keywords: oART workflow , Radixact , Raystation References: 1) Health Research Authority (HRA) (2018) Prospective Evaluation of Radiotherapy Using Magnetic Resonance Image Guided Treatment (PERMIT), IRAS ID 236188. Available at: https://www.hra.nhs.uk/planning-and- improving-research/application-summaries/research- summaries/permit/ (Accessed: 6 November 2025). 2) Byrne, M., Archibald - Heeren, B., Hu, Y., Teh, A., Beserminji, R., Cai, E., Liu, G., Yates, A., Rijken, J., Collett, N. and Aland, T. (2021). Varian ethos online adaptive radiotherapy for prostate cancer: Early results of contouring accuracy, treatment time. Journal
of Applied Clinical Medical Physics, 23(1). doi:https://doi.org/10.1002/acm2.13479.
Made with FlippingBook - Share PDF online