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Updated: Jan 18, 2026
Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System
Published on: April 11, 2018
Optimizing Workflow for Cone Beam Computed Tomography-Based Online Adaptive Radiation Therapy Toward Reduced
Goda Kalinauskaite1,2,3,4,5, Luise A Künzel1,3,4,5, Anne Kluge1
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology and Radiotherapy, Augustenburger Platz 1, 13353 Berlin, Germany.
An optimized online adaptive radiation therapy workflow significantly reduced physician involvement in prostate cancer treatment. This streamlined process, using more automated segmentation, improved efficiency and was well-tolerated by patients.
Area of Science:
- Radiation Oncology
- Medical Physics
- Oncology
Background:
- Online adaptive radiation therapy (ART) utilizes daily imaging for treatment adjustments.
- Physician involvement in ART workflows can be time-consuming and impact efficiency.
- Optimizing workflow steps is crucial for integrating advanced techniques like cone beam computed tomography (CBCT)-based ART.
Purpose of the Study:
- To evaluate the impact of an optimized online adaptive radiation therapy workflow on physician involvement.
- To compare the efficiency of different adaptive workflow configurations in prostate cancer treatment.
Main Methods:
- A prospective phase 2 trial analyzed data from 34 prostate cancer patients undergoing CBCT-based online ART.
- Three workflows were compared: 2-influencer (rectum, bladder), 3-influencer (+prostate), and 5-influencer (+seminal vesicles, bowel).
- Manual interventions, time for workflow steps, and target volume changes were assessed across workflows.
Main Results:
- The 5-influencer workflow reduced manual target corrections to 11% compared to 51% (3-influencer) and 61% (2-influencer) (P < .001).
- Median target review times were shortest with the 5-influencer workflow (2.5 minutes) versus 3-influencer (5.0 minutes) and 2-influencer (5.6 minutes).
- Median overall session duration was 24.0 minutes, with 84% of patients finding treatment time tolerable.
Conclusions:
- Optimized workflows decrease physician involvement in online CBCT-guided adaptive radiation therapy for prostate cancer.
- These workflows may enable a more radiation therapist-driven approach, similar to image-guided radiation therapy.
- Further research in other cancers, focusing on clinical outcomes, is needed to enhance CBCT-guided online ART.
