ArticleJournal of applied clinical medical physics2025
Adaptive-driven CT simulation-free multi-fraction SBRT radiotherapy: Initial clinical experience.
Article in Journal of applied clinical medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Workflow and dosimetric results for direct-to-unit single-fraction adaptive lung SBRT delivered on the ONE-STOP prospective pilot clinical trial.Clinical and translational radiation oncology · 2026Article
- Prospective feasibility study of diagnostic CT-based simulation-free palliative radiotherapy.Journal of radiation research · 2026Article
- Initial experience of clinical implementation of an Online Simulation-free CBCT-based Adaptive Radiotherapy (OSCAR) workflow for palliative and urgent treatment indications.Journal of applied clinical medical physics · 2026Article
- Impact of CT calibration curves on radiotherapy planning using diagnostic CT scans and a planning CT supporting DirectDensity reconstruction.Journal of applied clinical medical physics · 2026Article
- Adaptive-driven CT simulation-free multi-fraction SBRT radiotherapy: Initial clinical experience.Journal of applied clinical medical physics · 2025Article
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Authors and funding
6 authors.
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Abstract
introductionUsing diagnostic CT for radiotherapy (RT) planning can bypass traditional CT simulation but introduces challenges in patient positioning and Hounsfield unit (HU) fidelity, affecting dose accuracy. Here a Varian Ethos adaptive-driven CT direct-to-treatment (DtT) multi-fraction stereotactic body radiation therapy (SBRT) workflow is presented.
methodsThis study employed institutional diagnostic PET-CT images to generate an initial reference Ethos treatment plan. HU and dosimetric accuracy were validated for PET-CT, Ethos CBCT images (with and without Hypersight (HS), and the gold-standard helical CT simulators). Following the SBRT reference plan creation on the low dose diagnostic PET-CT, the first fraction was delivered with a newly generated adaptive plan calculated on the HS CBCT (Ethos) images. For multi-fraction treatments, the first day CBCT images and adaptive plan become the reference for subsequent IGRT treatments. This study includes workflow validation and initial three patient experience.
resultsThe DtT adaptive SBRT workflow was successfully implemented, with initial end-to-end testing demonstrating feasibility. In-house solutions were introduced to facilitate the adaptive to IGRT plan conversion. The Ethos system, especially with HS, maintained HU fidelity and dose calculation accuracy comparable to helical CTs. On-table adaptive sessions were within 37-51 min, aligning with single-fraction palliative studies. Subsequent non-adaptive IGRT fractions were efficiently completed within 7-27 min.
conclusionsThis study demonstrates the feasibility of DtT adaptive-driven multifraction SBRT using diagnostic PET-CT. This approach reduces the need for on-site patient presence prior to treatment, expands planning lead times, and improves overall efficiency in radiotherapy for well selected patients.
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