Workflow Considerations for Implementing a Cone-Beam CT-Guided Adaptive Radiation Therapy Program

Abstract Cone-beam CT-guided adaptive radiation therapy (CTgART) is an emerging treatment paradigm that enables the delivery of online adaptive radiation therapy (ART) using CT-based onboard imaging. Our department installed and implemented a CTgART system in 2019 and has since developed workflows for the delivery of CTgART to a wide variety of disease sites. Herein we describe workflow considerations for implementing a CTgART program with a specific focus on the template-based treatment planning methodology that drives online adaptive plan creation on our department’s CTgART platform (Ethos; Varian Medical Systems, Palo Alto, CA). We describe disease-site-specific information for the delivery of CTgART to the thorax, abdomen, prostate, and bladder, and discuss future directions for this technology, which is becoming increasingly accessible and utilized in radiation oncology.