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Related Experiment Video

Updated: Jul 16, 2026

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System
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Patient setup variation on Elekta Unity and its impact on adaptive planning.

Maggie Yan1, Erika Kollitz2, Sheng-Hsuan Sun2

  • 1Department of Computer Information and Science Engineering, University of Florida, Gainesville, Florida, USA.

Journal of Applied Clinical Medical Physics
|February 13, 2025
PubMed
Summary

Significant patient setup variations (PSVs) occur with MR-linac treatments due to immobilization challenges. Adaptive planning effectively manages these PSVs, but minimizing them, especially rotations, is crucial for reducing intra-fraction motion and treatment time.

Keywords:
Elekta UnityMR‐linacadaptive planningpatient setup variation

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Technology

Background:

  • The unique design of Magnetic Resonance Linear Accelerators (MR-linacs) can limit the use of immobilization devices.
  • This limitation may lead to significant patient setup variations (PSVs), impacting treatment accuracy.
  • Understanding and managing PSVs is critical for optimizing MR-linac treatments.

Purpose of the Study:

  • To analyze patient setup variations (PSVs) on the Elekta Unity MR-linac system.
  • To investigate the impact of these PSVs on adaptive radiotherapy planning workflows.
  • To evaluate the effectiveness of adaptive planning in accommodating PSVs.

Main Methods:

  • Patient setup variations (PSVs) were analyzed for brain, pancreas, prostate, and rectum treatments on the Elekta Unity.
  • Prostate and pancreas treatment plans were used to simulate PSVs by shifting reference scans (1-3 cm LR, SI).
  • Adaptive-to-position (ATP) and adaptive-to-shape (ATS) workflows were compared for planning time, monitor units (MUs), and dosimetric outcomes.

Main Results:

  • Significant PSVs were observed across treatment sites, particularly in the superior-inferior and left-right directions for brain and pancreas/pelvis treatments.
  • The adaptive-to-shape (ATS) workflow required two to three times longer than the adaptive-to-position (ATP) workflow.
  • Both adaptive planning workflows successfully maintained target coverage and organ-at-risk sparing, irrespective of PSV magnitude, with only minor increases in MUs for ATP in prostate cases.

Conclusions:

  • Suboptimal immobilization on the Elekta Unity MR-linac results in considerable patient setup variations (PSVs).
  • Adaptive radiotherapy planning demonstrates efficacy in compensating for these PSVs in treatments like prostate and pancreas.
  • Reducing PSVs, especially rotational errors, is recommended to mitigate intra-fraction motion and shorten overall treatment duration.