S2932
RTT- RTT operational practice and workflow innovations
ESTRO 2026
processes, and multidisciplinary coordination underpinning implementation. Material/Methods:
>2 weeks between simulation and first treatment, and 26% traveled > 90 minutes to the hospital. Almost all patients (95%) preferred same-day planning and treatment.Since February 2025, ten patients (six renal, four pancreatic) underwent the OSS workflow (1x26 Gy kidney, first fraction of 5x8 Gy pancreas). Nine patients filled out the satisfaction survey. The average total duration was 4h29 minutes. Total time improved from 5h5 minutes for the first five patients to 3h58 minutes for the last five patients. All patients reported a positive experience and appreciated the reduced waiting time and travel burden. One patient indicated that the time between simulation and treatment was too long. Conclusion: A patient-centered OSS workflow on the MR-Linac is feasible and efficient. This workflow shows that, despite high complexity and high fraction dose, treatment can be safely delivered within hours after simulation. Workflow optimization enabled treatment within five hours which was highly appreciated by patients, highlighting the value of integrating patient feedback in MRIgSABR workflow design. References: 1: Palacios, M.A. Verheijen, S. Schneiders, F.L. Bohoudi, O. Slotman, B.J. Lagerwaard, F.J. Senan, S. Same-day Consultation, Simulation and Lung Stereotactic Ablative Radiotherapy Delivery on a Magnetic Resonance-linac. Physics and Imaging in Radiation Oncology. 2022. 76-81 Keywords: MRIgRT, Patient experience, One-Stop- Shop Digital Poster 3144 Establishing MRI in the treatment position for patients with hepatobiliary malignancies Anna Crawley 1 , Laura Allington 1 , Emma Dwyer 1 , Caroline Thould 1 , Turmi Patel 1 , Amanda Webster 1,2 1 Radiotherapy and Proton Beam Therapy, UCLH, London, United Kingdom. 2 Medical Physics and Biomedical Engineering, UCL, London, United Kingdom Purpose/Objective: Optimising MRI for hepatobiliary (HPB) radiotherapy planning requires adapting sequences to capture motion and soft-tissue contrast in the treatment position. Despite MRI’s recognised advantages, there is limited literature describing the optimal workflow for acquiring and integrating MRI into radiotherapy pathways. This work assesses the development of an MRI-in-treatment-position workflow for HPB cancers, detailing the iterative optimisation of sequences,
Development began with a literature review, inter- centre collaboration, MDT consultation, and vendor engagement to identify suitable sequences. Diagnostic protocols from two NHS sites and ten retrospective hepatobiliary cases informed initial selection. Institutional approval was obtained for a staged pathway comprising development, phantom, healthy volunteer, and patient imaging phases under the existing MRI consenting framework. A ten-patient feasibility study was authorised.Sequences were iteratively tested in phantoms and refined in eight healthy volunteers. Subsequently, patient imaging was performed in treatment position using MR-compatible immobilisation, breath hold (BH), and abdominal compression (AC), jointly conducted by a diagnostic radiographer and RTT. Cine MRI was adapted to assess liver motion, with all datasets exported to the radiotherapy planning system, except cine sequences, which were exported to PACS. For each phase, data were collected on sequence type, imaging parameters and staff present. Results: The programme spanned July 2022–February 2025 (31 months), progressing from phantom testing to completion of the ten-patient feasibility phase. Eight volunteers and ten patients were scanned successfully without adverse events. Sequence evaluation guided protocol optimisation. Iterative testing of T1-, T2-, diffusion-, and balanced FFE cine acquisitions established optimal combinations for image quality, motion control, and export compatibility. The iterative process and finalised MRI sequences are shown in Table 1.Initial sessions required a diagnostic radiographer, RTT, radiologist, and physicist. As parameters and documentation stabilised, scanning was streamlined to a two-person (radiographer and RTT) operation with remote MDT input, where required. Efficiency improved through structured MDT planning, protected scanner time, and progressive workflow standardisation.
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