S2952
RTT- RTT operational practice and workflow innovations
ESTRO 2026
kV, 20 mA; CTDIvol 0.94 mGy; DLP 20.2 mGy·cm). A first Python-based software was developed to automatically generate a cumulative dose report at the end of treatment, estimating the effective dose (ED) for each patient and for every imaging fraction. A second, prospective software was then implemented, integrating patient- and treatment-specific data (age, anatomical site, number of fractions, CBCT mode). This tool provides recommendations on CBCT frequency, allowing adjustment of the imaging schedule to maintain dose optimization while ensuring image quality and set-up accuracy. Results: A total of 41 pediatric patients were enrolled: 23 retrospectively and 18 prospectively. The retrospective analysis revealed a high degree of variability in CBCT acquisition parameters, mainly related to operator- dependent choices, resulting in a non-homogeneous IGRT workflow (Figure 1). The implementation of the Image Gently low-dose protocol was therefore adopted as a shared standard, enabling uniform and standardized imaging practice among radiation therapists (Figure 2). The prospective use of the predictive software further optimized CBCT scheduling, maintaining the cumulative imaging dose below the predefined threshold without compromising image quality or set-up accuracy. In some cases, the number of CBCTs was intentionally reduced compared with the total number of treatment sessions (Figure 3), while remaining fully compliant with international reference protocols.Overall, the Image Gently protocol reduced the mean effective dose by 92.5% compared with standard protocols, with an additional 1.1% reduction achieved through predictive planning. Conclusion: The integration of these software tools has become an essential part of the daily workflow for radiation therapists, ensuring operator-independent, standardized, and optimized IGRT management. This approach allows for personalized yet homogeneous radiotherapy delivery, significantly reducing the additional dose contribution from IGRT and enhancing safety, quality, and sustainability in pediatric treatments. Keywords: Pediatric Radiotherapy, CBCT, Gentle IGRT Digital Poster 4863 Phantom-Based Evaluation of Topographic Metrics for SGRT ROI Optimisation Paul O Connor 1 , Serena O'Keeffe 1 , Ciaran Malone 1,2
Digital Poster Highlight 4849
Implementation of Two Softwares Tools to Optimize IGRT Dose Management in Pediatric Radiotherapy within the “Image Gently” Approach Lucrezia Bernabucci 1 , Gerardina Stimato 2 , Veronica Pollutri 1 , Cristiana Manta 3 , Elisa Meldolesi 1 , Amedeo Capotosti 2 , Chiara Elia 1 , Sara Iacovone 1 , Silvia Mariani 1 , Elisa Marconi 1 , Mariangela Massaccesi 1 , Antonio Ruggiero 4,5 , Angela Mastronuzzi 6 , Francesca Greco 2 , Maria Vaccaro 2 , Gabriele Turco 1 , Vincenzo Frascino 1 , Marco De Spirito 1,7 , Nicola Dinapoli 1 , Patrizia Cornacchione 1,3 , Luca Tagliaferri 1,3 , Maria Antonietta Gambacorta 1,3 , Silvai Chiesa 1 1 UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 2 .O.S.D. Fisica Medica e Radioprotezione, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 3 Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy. 4 Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 5 Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Roma, Italy. 6 Department of Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. 7 Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Roma, Italy Purpose/Objective: In pediatric oncology, the improvement of survival rates requires increasing attention to long-term treatment-related effects, including those from cumulative radiation exposure. Although modern radiotherapy techniques ensure conformal dose delivery, Image-Guided Radiotherapy (IGRT) adds a non-negligible imaging dose, which is particularly relevant in pediatric patients due to their higher radiosensitivity. The Image Gently protocol by Varian© aims to balance target accuracy and imaging dose reduction. This study evaluated the feasibility and clinical benefits of implementing the Image Gently protocol in daily practice, supported by retrospective and prospective analyses using Python-based software tools. Material/Methods: The study included both retrospective and prospective phases starting in June 2024. The Image Gently CBCT protocol was applied using reduced parameters (80
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