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Related Experiment Video

Updated: May 16, 2026

Radiation Planning Assistant - A Web-based Tool to Support High-quality Radiotherapy in Clinics with Limited Resources
05:18

Radiation Planning Assistant - A Web-based Tool to Support High-quality Radiotherapy in Clinics with Limited Resources

Published on: October 6, 2023

Best Practice: CT-guided Adaptive Radiotherapy Reference Planning on the Ethos Platform.

Xenia Ray1, Joseph Harms2, Alex Price3

  • 1Department of Radiation Medicine and Applied Sciences, Moores Cancer Center, University of California San Diego, San Diego, California, USA.

Journal of Applied Clinical Medical Physics
|May 14, 2026
PubMed
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This summary is machine-generated.

Online adaptive radiotherapy (ART) improves cancer treatment by adapting plans daily. This new "Thinking in 4D" framework enhances ART plan robustness and efficiency for better patient outcomes.

Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Conventional radiotherapy uses static plans, limiting adaptation to anatomical changes.
  • Online adaptive radiotherapy (ART) allows real-time treatment plan adjustments.
  • CT-guided ART (CTgART) on the Varian Ethos platform is increasingly adopted but relies heavily on initial reference plan quality.

Purpose of the Study:

  • To present a practical framework, termed "Thinking in 4D," for designing robust online adaptive radiotherapy reference plans.
  • To provide strategies for integrating standard planning with temporal workflow considerations in ART.
  • To improve the quality, efficiency, and safety of adaptive radiotherapy planning and delivery.

Main Methods:

  • Development of a planning framework integrating standard planning with temporal workflow considerations.
Keywords:
CT‐guided ARTonline adaptive radiotherapytreatment planning

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  • Leveraging high-volume clinical experience with hundreds of adaptive cases across multiple institutions.
  • Formulating practical recommendations and strategies for robust Varian Ethos reference plan template design.

    • Main Results:

    • The "Thinking in 4D" framework emphasizes understanding upstream planning impacts on downstream adaptation.
    • Practical strategies are provided to enhance optimization robustness and on-treatment efficiency.
    • Recommendations are based on accumulated clinical experience to guide template design.

    Conclusions:

    • The "Thinking in 4D" approach offers practical guidance for clinicians designing ART reference plans.
    • This paradigm aims to improve adaptive plan quality, efficiency, and safety.
    • The framework supports the implementation, training, and routine checks for teams adopting advanced ART.