S2948
RTT- RTT operational practice and workflow innovations
ESTRO 2026
centres where there were dedicated late effect services these were usually run by RTTs (48.4 %). Most of these did not have a dedicated Multidisciplinary Team to discuss complex cases. Knowledge of validated assessment tools for pelvic radiotherapy side effects in patients treated for gynaecological cancer was poor (figure 1)
and review and recording of late effects using a recognised toxicity score was also lacking, with only 20 % of respondents using validated questionnaires. Conclusion: There is wide variation in RTT assessment, management and referral pathways for patients with pelvic radiotherapy late effects across radiotherapy departments in the UK. There is a significant gap in support, investigation and management of late effects after pelvic radiotherapy in gynaecological cancer. The majority of established clinics rely on charitable funding, while others operate without dedicated funding. Substantial infrastructure investment and institutional commitment are essential to remedy the current deficiencies. References: 1. Best practice pathway for pelvic radiotherapy disease. https://www.prda.org.uk2. Clinical Oncology Gynaecological cancer: RCR consensus statements, April 2024. https://www.rcr.ac.uk/our-services/all-our- publications/clinical-oncology- publications/gynaecological-cancer-rcr-consensus- statements/ Keywords: Guidelines, Equity, Late-effects Lean Six Sigma and Automatic Couch Correction to Improve Daily Patient Repositioning in Vertebral Metastases Leonardo Nicotera 1,2 , Andrea Bresolin 2 , Carmela Galdieri 1,2 , Aurora Zucca 2 , Simone Antonetti 2 , Ciro Franzese 1,2 , Marta Scorsetti 1,2 , Pietro Mancosu 1,2 1 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy. 2 Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy Digital Poster 4444
Digital Poster Highlight 4445 Implementation of TBI-VMAT with SGRT: Workflow Optimization and Imaging Reduction Sonia Bermejo Martínez 1 , Cristina Ansón Marcos 2 , Jéssica Jiménez Sánchez 1 , Míriam Mancera Soto 2 , Ainoa Vizuete Pérez 2 , Guillermo Gómez de Segura Melcón 2 , Noé Ventosa Lli 1 , Albert Clols Fuentes 1 , Helena Vivancos Bargalló 2 , Ana María Soto Cambres 1 , Eugènia Otero Pla 1 , Núria Farré Bernadó 1 , Gemma Sancho- Pardo 1 1 Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 2 Radiation Physics and Radiation Protection, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain Purpose/Objective: To evaluate setup accuracy and workflow optimization in total body irradiation (TBI) delivered with volumetric modulated arc therapy (VMAT) using a surface-guided radiotherapy (SGRT) system, aiming to reduce imaging procedures while maintaining treatment precision. Material/Methods: We report the evolution of the workflow for the first seven patients (five pediatric and two adult) treated with myeloablative TBI-VMAT on a TrueBeam linear accelerator (Varian). Patients were treated with either a standard regimen of 12 Gy in six fractions of 2 Gy, administered twice daily, or within a reduced-intensity platform delivering 8 Gy in four fractions over two days. Treatment planning in Eclipse v15.6 (Varian) included 7–8 isocenters per plan and a 1.5 cm skin flash.Patients were positioned supine on a rotational board and immobilized with a vacuum cushion and thermoplastic mask. Initial setup was performed with the AlignRT (VisionRT) SGRT system, using a 3 mm / 2° tolerance. The Postural Video module was employed
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