S2945
RTT- RTT operational practice and workflow innovations
ESTRO 2026
the verbal instructions of the technologist. The 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.
Conclusion: The use of the optical viewer during DIBH radiotherapy promotes active and more effective patient participation, improves breath-hold reproducibility, and reduces overall treatment time. These findings support its routine implementation as a practical visual feedback tool to enhance workflow efficiency and patient experience in left-sided breast radiotherapy. Keywords: optical viewer, breath hold, breast cancer RTT led quality improvement project establishing a pathway for automated hippocampal contouring for hippocampal sparing radiotherapy Linda Walshe 1 , David Fitzpatrick 1 , Nazmy ElBeltagi 1 , Oleksandr Boychak 1 , Palak Sharma 1 , Christina Skourou 1 , Claire Fitzpatrick 1 , Sarah McDermott 1 , Gerry Hanna 2 , Ruth Woods 1 , Ciaran Malone 1 1 Radiation Oncology, St Luke's Radiation Oncology Network, Dublin, Ireland. 2 St James's Cancer Institute, Trinity College Dublin, Dublin, Ireland Proffered Paper 4261 Purpose/Objective: The RTOG0933 study showed a reduction in impaired memory and verbal learning demonstrating that hippocampus avoidance whole brain radiotherapy (HA-WBRT) is an alternative option for patients with good performance status (1). However, manual hippocampal contouring can be time consuming and complex, requiring significantly more resources than
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