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Software, not hardware, limits real-time adaptive radiotherapy. Challenges in reliability, integration, and calculation time for deformable image registration, adaptive replanning, and dose accumulation are being addressed for precise cancer treatment.

Area of Science:

Medical Physics
Radiation Oncology
Radiotherapy Software Development

Background:

High-end linear accelerators possess the necessary hardware for real-time adaptive image-guided radiotherapy.
Software limitations, specifically in reliability, integration, and calculation time, hinder the achievement of highly accurate and precise radiotherapy for dynamic patient anatomy.
Existing algorithms are available, but their practical implementation faces significant hurdles.

Purpose of the Study:

To review the software solutions crucial for real-time adaptive image-guided radiotherapy.
To identify and discuss the challenges associated with integrating these software components.
To provide an outlook on the future implementation of these technologies in clinical practice.

Main Methods:

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Discussion of software solutions across four key areas: deformable image registration, adaptive replanning, real-time image guidance, and dose calculation and accumulation.
Analysis of current research and development efforts in both academic and commercial sectors.
Focus on overcoming limitations related to software reliability, integration, and computational efficiency.

Main Results:

Software components for real-time adaptive radiotherapy are under active development.
Key areas of focus include deformable image registration, adaptive replanning, real-time guidance, and dose calculation.
Reliability, integration, and calculation speed are critical factors for clinical adoption.

Conclusions:

Software development is the primary bottleneck for implementing real-time adaptive image-guided radiotherapy.
Ongoing research and development are actively addressing these software challenges.
Integration of these advanced software solutions is expected across major manufacturers in the coming years.