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Session: Therapy General ePoster Viewing [Return to Session]

A Critical Analysis of Adaptive Therapy Guidelines for Patient Safety, Treatment Quality and System Safety Tests

J Hindmarsh1*, S Dieterich2, J Booth3, P Keall1, (1) ACRF Image X Institute, Faculty of Medicine and Health, University of Sydney, Eveleigh, NSW, AU, (2) Department of Radiation Oncology, UC Davis Medical Center, Sacramento, CA, (3) Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, AU


PO-GePV-T-329 (Sunday, 7/10/2022)   [Eastern Time (GMT-4)]

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Purpose: To perform a systematic review of the adaptive radiotherapy safety literature and evaluate the scope of practice and where further development is needed to assure safety of such systems.

Methods: A systematic search of the literature was conducted using Web of Science. Nine adaptive techniques or capable technologies were used as the initial search term, for example ‘Radixact’ and ‘intrafraction monitoring’. These search results were refined using terms such as ‘commissioning’ or ‘real-time’. The titles and abstracts of the resulting papers were assessed, and those that covered whole systems, used hazard analysis, or included specific system tests were selected for closer review. This review involved assessing the tests in each paper and categorizing them according to whether they tested patient safety, system safety or treatment quality. Patient safety tests check the systems that keep the patient safe during treatment (e.g., interlocks), treatment quality tests are those that ensure a minimum level of treatment quality, and system safety tests are those that check the safe operation of the system.

Results: The systematic search of the literature identified ten papers of which six included specific tests to be performed for commissioning and/or quality assurance. These six papers covered MLC tracking, localization and positioning, robotic radiosurgery, MRI-linacs, and kilovoltage intrafraction monitoring. All six papers included treatment quality tests and, where appropriate, patient safety tests. However, system safety tests were overlooked or poorly covered in three of the six papers.

Conclusion: There are areas of adaptive treatment that do not have commissioning or quality assurance papers published. To help in the safe and effective implementation of these techniques, further development of appropriate guidelines is required. These guidelines should be careful to consider system safety and not only treatment quality and patient safety.

Funding Support, Disclosures, and Conflict of Interest: This research was supported by a Cancer Institute NSW Translational Program Grant


Commissioning, Quality Assurance, Radiation Therapy


TH- External Beam- Photons: adaptive therapy

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