Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit
Modern radiotherapy workflows depend heavily on software, yet proprietary solutions limit adaptability and transparency. Many institutions create in-house tools, resulting in duplicated efforts and sustainability challenges. Free and open-source software (FOSS) offers transparency, customization, and collaborative development opportunities, but faces barriers including fragmented efforts, regulatory complexity, and clinical adoption hurdles. This vision paper, inspired by the 2024 ESTRO Physics Workshop on "Resource sharing: open-source software & development in radiotherapy" explores these challenges and proposes strategies to promote sustainable and discoverable open-source ecosystems in radiation oncology. Key recommendations include improving interoperability, clear licensing, risk management, validation frameworks, and creating a centralised registry for resource visibility. Embracing open-source practices can accelerate innovation, reduce redundancy, and enhance patient care.
Authors
- L. Brualla (ORCID: https://orcid.org/0000-0003-3385-9623)
- Samuele Cavinato (ORCID: https://orcid.org/0000-0002-4706-1551)
- Alexia Delbaere (ORCID: https://orcid.org/0000-0002-2118-086X)
- K. Domański (ORCID: https://orcid.org/0000-0002-9741-0588)
- Marcel Nachbar (ORCID: https://orcid.org/0000-0001-8923-4740)
- Aditya Apte
- Josh Mason (ORCID: https://orcid.org/0000-0002-5066-2155)
- Giorgio Cartechini (ORCID: https://orcid.org/0000-0003-2092-7279)
- Masoud Zarepisheh (ORCID: https://orcid.org/0000-0001-6616-5949)
- Roman Ludwig (ORCID: https://orcid.org/0000-0001-9434-328X)
- Niklas Wahl (ORCID: https://orcid.org/0000-0002-1451-223X)
- Erik Roelofs (ORCID: https://orcid.org/0000-0003-2172-8669)
- Tobias Becher
- Ana M. Barragán-Montero
- Ali Zaila
- Hendrik Piersma (ORCID: https://orcid.org/0009-0007-1070-828X)
- Stine Korreman (ORCID: https://orcid.org/0000-0002-3523-382X)
- Samuel Ingram (ORCID: https://orcid.org/0000-0002-1786-349X)
- Goran Stanic
- Josh Kirby (ORCID: https://orcid.org/0009-0002-9371-2949)
Institutions
- Centre National de la Recherche Scientifique (FR)
- Memorial Sloan Kettering Cancer Center (US)
- Imperial College Healthcare NHS Trust (GB)
- Inserm (FR)
- German Cancer Research Center (DE)
- Aarhus University (DK)
- Heidelberg University (DE)
- Maastricht University Medical Centre (NL)
- King Faisal Specialist Hospital & Research Centre (SA)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Aarhus University Hospital (DK)
- Manchester University NHS Foundation Trust (GB)
- University Hospital of Zurich (CH)
- Heidelberger Institut für Radioonkologie (DE)
- Instituto de Física Corpuscular (ES)
- Istituto Oncologico Veneto (IT)
- National Center for Tumor Diseases (DE)
- European Society for Therapeutic Radiology and Oncology (BE)
- Institut Claudius Regaud (FR)
- The Maria Sklodowska-Curie National Research Institute of Oncology (PL)
- Radiotherapeutisch Instituut Friesland (NL)
- Maastro Clinic (NL)
- University of Tübingen (DE)
Publication Details
- Journal
- Radiotherapy and Oncology
- Published
- 2026-05-11
- DOI
- https://doi.org/10.1016/j.radonc.2026.111587
- Primary Topic
- Advanced Radiotherapy Techniques
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Memorial Sloan-Kettering Cancer Center
- University of Manchester
- H2020 Euratom