S1457
Interdisciplinary - Other
ESTRO 2026
Klaassen 6,2 , Lisanne G.M. Zwart 7 , Koen M. Kuijer 8 , Mischa S Hoogeman 1,2 , Judith H. Sluijter 1 1 Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands. 2 Radiotherapy, HollandPTC, Delft, Netherlands. 3 Department of Radiation Oncology (Maastro Clinic), Maastricht University Medical Center+, Maastricht, Netherlands. 4 Department of Radiotherapy, Amsterdam UMC, Amsterdam, Netherlands. 5 Radiotherapy, Cancer Center Amsterdam, Amsterdam, Netherlands. 6 Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands. 7 Department of Radiotherapy, Medisch Spectrum Twente, Enschede, Netherlands. 8 Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands Purpose/Objective: Radiotherapy is rapidly evolving toward personalized treatments, driven by innovations such as online adaptive treatments and AI-driven workflows. As these technological advancements become more complex, new competencies that extend beyond the traditional domains of radiation oncologists, medical physics experts, and radiation therapists are required. Additionally, relying solely on the traditional professionals is neither economically viable nor feasible given current staffing constraints. Therefore, there is a growing need for healthcare professionals with both technical and clinical expertise. In the Netherlands, a new type of healthcare professional is being trained to meet this need: the technical physician [1]. Here, their current role within radiotherapy is described. Material/Methods: The Technical Medicine program, launched in 2003, is a six-year integrated bachelor’s and master’s curriculum, that combines medical, scientific, engineering, and informatics expertise and insight. The final two years consist of clinical internships, where students apply both technical and clinical expertise to improve patient care [2]. Graduates can register in the Dutch register for Professions in Individual Health Care, granting them a protected title and the authority to perform specific clinical procedures independently. Results: By June 2025, over 1,000 technical physicians have graduated and are working across various medical fields [3, 4]. In radiotherapy, thirty technical physicians currently work in ten Dutch institutes (Figure 1). Of these, twenty mainly focus on research (including three assistant professors), while others work as technical physicians or in other roles. Thirteen are directly involved in patient care, with specializations in online adaptive radiotherapy, treatment planning, proton therapy, hyperthermia, and brachytherapy (Figure 2). Technical physicians enable safe and
demographic data (DICOM RTPLAN, RTDOSE, RTSTRUCT, CT, etc.) are automatically exported nightly to MIMCloud (MIM Software Inc.), a GDPR-validated, encrypted cloud service. Non-DICOM files (e.g., plan reports, triage lists) are encoded to DICOM format via a custom MIMCloudTool, with security validations (DICOM syntax checks, malware scans using DCMTK, etc.).Scenario 1: An isolated emergency Aria OIS (Varian) is activated, with network rerouting to connect treatment machines (e.g., TrueBeam). Patient data is batch-imported via HL7 interfaces.Scenario 2: For total infrastructure failure, patients are triaged (Table 1) and referred to collaborating hospitals. Data is shared securely via MIMCloudOrganizer (MFA-enabled). Fallback planning uses dose mimicking in RayStation (RaySearch) to adapt plans for different machines (e.g., Varian to Elekta). Proof-of-concept testing involved phantom simulations (STEEV head phantom, 30x2Gy prescription) with QA via SunCHECK ArcCHECK (3%/3mm gamma criteria). Service Level Agreements (SLAs) outline collaboration details (Table 3). An action chart guides decision-making (Figure 2). Results: Data upload to MIMCloud is automated and integrated into clinical workflows. Retrieval and conversion for ~70GB (full patient load) takes ~4 hours. Bidirectional testing between institutions succeeded: fallback plans showed <1% average dose difference for targets (e.g., prostate cases) with similar OAR sparing. QA gamma passing rates were 100% (Varian) and 99.1% (Elekta) at 2%/2mm. End-to-end validation confirmed safe delivery on TrueBeam and Versa HD machines. Conclusion: This cloud-based fallback strategy, with emergency OIS and inter-hospital dose mimicking, ensures radiotherapy continuity within clinically acceptable timeframes (~4 hours). SLAs and regular testing are essential. Future expansions include more vendors and a national network. This approach also supports downtime events beyond cyberattacks and enables DICOM data archiving for research. References: Flavin A, et al. A National Cyberattack Affecting Radiation Therapy: The Irish Experience. Adv Radiat Oncol. 2022;7(3):100921. Zhang B, et al. A practical cyberattack contingency plan for radiation oncology. J
Appl Clin Med Phys. 2020;21(7):181-186. Keywords: cyberattack,dose mimicking
Digital Poster 3969 Ready for a new colleague? Meet the technical physician Eva M Negenman 1,2 , Anouk Corbeau 1 , Iris E.W.G. Laven 3 , Daphne M.V. de Vries-Huizing 4,5 , Lisa
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