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Related Concept Videos

Computed Tomography01:10

Computed Tomography

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Tomography refers to imaging by sections. Computed tomography (CT) is a non-invasive imaging technique that uses computers to analyze several cross-sectional X-rays to reveal minute details about structures in the body.
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
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Related Experiment Video

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Implementing a fully computed tomography-free online adaptive palliative radiotherapy: a one-visit workflow.

Ashaya T Jaglal1,2, Koen J Nelissen1,2, Angelique R W van Vlaenderen1,2

  • 1Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, the Netherlands.

Physics and Imaging in Radiation Oncology
|January 16, 2026
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Summary

A new computed tomography (CT)-free workflow using cone-beam CT (CBCT) enables same-day palliative radiotherapy. This efficient approach significantly reduces treatment times and departmental workload, making it ideal for urgent cases.

Keywords:
Cone beam computed tomographyOnline adaptive radiotherapyPalliative care

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Radiotherapy Workflow Optimization

Background:

  • Conventional CT-based radiotherapy workflows cause significant delays and resource strain.
  • Advances in cone-beam CT (CBCT) offer potential for accurate dose calculation without planning CT.
  • High-quality CBCT enables development of CT-free radiotherapy workflows.

Purpose of the Study:

  • To evaluate the feasibility and efficiency of a fully CT-free online adaptive workflow for same-day palliative radiotherapy.
  • To assess the use of high-quality CBCT in a CT-free planning and delivery process.
  • To compare workflow times and plan quality against conventional CT-based methods.

Main Methods:

  • Prospective study of 15 patients undergoing single-fraction palliative radiotherapy.
  • Utilized a reference plan on a phantom; no planning CT was acquired.
  • Employed Varian Ethos 2.0 with HyperSight CBCT for online plan adaptation and delivery on the treatment day.

Main Results:

  • All 15 treatments were successfully delivered, meeting clinical objectives.
  • The CT-free workflow reduced median departmental time to 73 minutes (vs. 335 minutes for CT-based).
  • Urgent cases demonstrated rapid referral-to-treatment times (2.5 hours in one instance).

Conclusions:

  • A fully CT-free workflow is feasible and efficient for same-day palliative radiotherapy.
  • This approach significantly reduces departmental workload and is suitable for urgent treatments.
  • High-quality CBCT facilitates accurate planning and delivery, enabling rapid patient throughput.