S2951
RTT- RTT operational practice and workflow innovations
ESTRO 2026
1 Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom. 2 Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom Purpose/Objective: In March 2025, we introduced online adaptive radiotherapy (oART) on our Radixact (Accuray, USA) treatment platform utilising Raystation’s (Raysearch, Sweden) adaptive planning solution. Our first oART treatment indication was post-operative endometrial cancer, which has pelvic targets with large interfraction motion during radiotherapy, warranting online adjustment of a patient’s treatment plan. However, oART has longer treatment time for patients compared to IGRT treatment on Radixact®. An in- house timing sheet was created with the purpose to measure the length of time it takes to successfully treat a patient adaptively. We set out to quantify our oART treatment times and compare these to our standard IGRT workflow. Material/Methods: Timing data was collected using a timing sheet modified from the PERMIT Trial (1) for all patients receiving post-operative endometrial cancer oART from March to October 2025.Actions captured on the timing sheet included: patient set-up time, planning scan started/finished, image registration started/finished, contouring started/finished, plan optimisation started/finished, plan export, checking time, verification image started/finished, image verification review, beam- on and beam off time and time the patient leaves the room. RTT’S were given a stopwatch and appropriate training to record the data.Only oART fractions were included. Machine services and breakdown meant on occasion, patients were treated with their non-adaptive IGRT plan, these fractions were excluded from analysis.Mean workflow time from patient set up confirmed until beam off was calculated and compared against previous timing data for 8 post-operative endometrial cancer IGRT treatment times on Radixact®. Detailed oART times were presented, to enable comparison with published oART timing data. Results: Eleven eligible patients had 201 oART fractions out of the total fractions. The mean oART workflow time on Radixact® was 32:14 minutes, compared to the IGRT workflow which was 13:12 minutes (Figure 1). Additional oART workflow steps increased the average treatment time by 19:02 minutes, stepwise oART timing data is presented in Table 1.
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. 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. Keywords: oART workflow , Radixact , Raystation
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