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Radiation Pressure: Problem Solving

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The radiation pressure applied by an electromagnetic wave on a perfectly absorbing surface equals the energy density of the wave. The wave's momentum also gets transferred to the surface when an electromagnetic wave is entirely absorbed by it. The rate at which momentum is transmitted to an absorbing surface perpendicular to the propagation direction equals the force on the surface.
The average value of the rate of momentum transfer divided by the absorbing area represents the average force per...

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Clinical Implementation of Simulation-Free Palliative Radiation Therapy: Consensus Recommendations From a Modified

Melissa O'Neil¹, Vivian S Tan^2,3, Thilo Schuler^4,5

¹Department of Radiation Therapy, London Health Sciences Centre, London, Ontario, Canada.

Advances in Radiation Oncology

|February 18, 2026

Summary

This summary is machine-generated.

Simulation-free radiation therapy (sim-free RT) expedites palliative care by using diagnostic scans for treatment planning. Expert consensus provides guidance for its safe implementation in palliative radiation therapy (PRT) practice.

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Area of Science:

Medical Physics
Radiation Oncology
Radiotherapy Technology

Background:

Simulation-free radiation therapy (sim-free RT) leverages diagnostic CT scans, bypassing traditional simulation CTs for treatment planning.
This approach aims to streamline palliative radiation therapy (PRT) and improve resource allocation.
Standardized guidelines are lacking, hindering widespread adoption of sim-free RT.

Purpose of the Study:

To establish expert consensus on clinical, technical, and educational aspects of sim-free RT implementation in PRT.
To develop evidence-based recommendations for integrating sim-free RT into palliative care settings.

Main Methods:

A modified Delphi process involving international experts in sim-free RT (radiation oncologists, medical physicists, radiation therapists).
Multiple survey rounds assessing agreement on 12 domains related to sim-free RT.
Consensus defined as ≥75% agreement, with strong support at ≥90%.

Main Results:

Consensus reached on 95% of statements, with strong support for sim-free RT in low-risk palliative sites using conventional fractionation.
Key prerequisites include high-quality recent diagnostic scans, rigorous quality assurance, and multidisciplinary oversight.
Limited agreement exists regarding the use of older scans, cervical spine targets, and advanced planning techniques (IMRT/VMAT).

Conclusions:

Expert consensus provides recommendations for the safe implementation of sim-free RT in palliative radiation therapy.
Identified suitable indications, workflow safeguards, and training requirements for sim-free RT.
Further dosimetric validation and evaluation in diverse settings are necessary to support broader adoption.