S2942
RTT- RTT operational practice and workflow innovations
ESTRO 2026
significant. Results:
Batista, V. (2020). Recent advances in surface guided radiation therapy. Radiation Oncology, 15, 187. Low- Dose radiation therapy for benign pathologies” (2020). Radiotherapy for benign pathologies – review article.Radiotherapy & Oncology, Leong, B., et al. (2019). Impact of use of optical surface imaging on initial patient setup and reduction of imaging dose. Practical Radiation Oncology (open access). Keywords: benign, treatment Digital Poster Highlight 4128 Impact of RTT empowerment on workflow efficiency in lung SBRT Audrey Jean Hendricks 1,2 , Robert Förster 1 , Daniel Rudolph Zwahlen 1,3 , Alessandro Clivio 2 , Joana Cristina de Azevedo Gomes 1,2 , Christoph Oehler 1,2 1 Radiation Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland. 2 Radiotherapy Center Rüti, Cantonal Hospital Winterthur, Rüti, Switzerland. 3 Radiotherapy Center Rüti, Cantonal Hospital Winterthur, Winterthur, Switzerland Purpose/Objective: Stereotactic body radiotherapy (SBRT) for lung tumors is a complex and time-intensive procedure. Despite advances such as flattening-filter-free (FFF) beams, volumetric modulated arc therapy (VMAT), and surface-guided radiotherapy (AlignRT®, VisionRT®), overall treatment duration remains considerable, and data on workflow components are limited. In 2021, Cantonal Hospital Winterthur (center A) and its 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
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 , 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.
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