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Session: Adaptive and Biology-guided Radiation Therapy [Return to Session]

A Single Institution Comprehensive Time Analysis of KV-CBCT Based Online Daily Adaptive Radiotherapy Treatment Deliveries

CE Cardenas, J Belliveau, RA Popple, DN Stanley*, The University of Alabama at Birmingham, Birmingham, AL


TU-D1000-IePD-F7-4 (Tuesday, 7/12/2022) 10:00 AM - 10:30 AM [Eastern Time (GMT-4)]

Exhibit Hall | Forum 7

Purpose: Daily online adaptive radiotherapy (OART) programs are being widely adopted in clinics around the world. To date, there is little published data on how much time is needed for treatment delivery of online-adaptive treatments. The need for efficient and streamlined workflow is imperative because increased treatment times can result in changes to internal anatomy that can, in severe cases, require restarting of the OART session. To further understand each aspect of the OART process this study includes a comprehensive time analysis of the Ethos OART treatment delivery workflow.

Methods: Ethos daily machine logs were used to extract information for all individual patient’s treatment sessions including time-stamps for each step in the OART treatment delivery workflow. For this study, we identified timepoints for the following steps in the Ethos adaptive workflow: 1) patient set up, 2) start of auto-contouring review, 3) completion of contour review/editing (i.e. start of dose optimization/calculation), 4) start of treatment delivery, and 5) session completion.

Results: Logs from August 2021 to February 2022 were analyzed for this study. During this time, our clinic delivered over 450 online daily-adaptive treatments for 26 unique patients from 11 radiation oncologists with 4 physicists. Treatment sites included prostate, GYN, lungs, breast, H&N, and abdomen. On average(±std), adaptive sessions took 37±16mins from start to end. Average contour review/edit time was 7.8±5.5mins. After contour approval, it took an average of 10.1±3.4mins for plan generation, evaluation, and selection to start of treatment delivery. Daily adaptive plans were selected for 96% of treatments. No time difference was noticed between standard-fractionated and SBRT adapted treatments (p=0.6).

Conclusion: OART treatments require significant clinical time and resources. Algorithm and workflow improvements are needed to increase treatment delivery efficiency and reduce clinical treatment time, which can lead to a potential decrease in anatomical changes during OART sessions.


Not Applicable / None Entered.


TH- External Beam- Photons: adaptive therapy

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