Emerging Role of CT and MR-Guided Online Adaptive Radiotherapy for Upper GI Malignancies
Online adaptive radiotherapy (ART) is a current and emerging technology and approach that leverages CT and MR images obtained on the treatment delivery platform to personalized daily RT fractions to account for organ and tumor motion, deformation, and positioning with the potential of improving outcomes such as survival and toxicity. Upper abdominal gastrointestinal GI sites have been identified as ideal clinical scenarios for online ART for several reasons. CT and MR based online ART each have unique advantages and disadvantages that might make one approach better than the other one in unique situations. In addition, both online ART platforms require more intensive engagement of the radiation oncologist, physicist, dosimetrist, and therapist on the treatment console, analogous to performing a surgical procedure. Due to time and resource intensive nature of this process, the existing RT workflow often does not allow the treating physician and team to be the same team that performs these important tasks before treatment delivery. Therefore, a well-conceived and standardized sign-out process with essential transfer of critical information is necessary to ensure that the online ART team achieve the treatment intent and intended prioritization of tumor or organs at risk objectives daily. Both CT and MR based online ART have unique physics and quality assurance requirements necessary to ensure safe and optimal treatment for each fraction delivered. Finally, both CT and MR based online ART can leverage AI to expedite the online ART process and expand its role to more complex treatments.
- CT-Based Online Adaptive Radiotherapy for Upper GI Cancers
Lauren Henke, MD, MSCI
- MR-based Online Adaptive Radiotherapy for Upper GI Cancers
Jessica Frakes, MD
- Artificial Intelligence and Online ART: What are its Capabilities and Role of Human Expertise in AI-Enabled ART?
Borna Maraghechi, PhD
- Q and A
This activity is available from February 6, 2024, through 11:59 p.m. Eastern time on February 5, 2026.
This activity was originally recorded at the 2023 ASTRO Annual Meeting.
The activity is designed to meet the interests of radiation oncologists, physicists, radiation dosimetrists, radiation therapists, and residents.
Upon completion of this activity, participants should be able to:
- Explain the current state of online ART including both CT and MR based approaches, their trade-offs, as well as existing evidence for their added value in GI and non-GI disease sites.
- Discuss the radiation oncologist's role in signing out to the online ART team and identify what critical information needs to be transferred to accomplish the stated goals of the treatment.
- Explain how AI can expedite the online ART process in the future, possibly reducing the need for a dedicated online ART team, and the role of the human interaction in optimizing the AI-enabled online ART treatment.
- Percy Lee, MD, FASTRO, is employed by City of Hope National Medical Center and Orange County Lennar Foundation Cancer Center. Dr. Lee receives consulting fees/honoraria from AstraZeneca, RTOG Foundation, Varian, Inc., and Viewray. Dr. Lee serves on the Independent Data Monitoring Committee for Roche and Genentech.
- Lauren E. Henke, MD, MS, is employed by University Hospitals Seidman Cancer Center, Case Western Reserve University. Dr. Henke receives research funding from Varian. She receives honoraria from ViewRay and LusoPalex.
- Jessica M. Frakes, MD, is employed by H. Lee Moffitt Cancer Center and Research Institute. Dr. Frakes receives honoraria/consulting fees from Boston Scientific and ViewRay.
- Borna Maraghechi, PhD, is employed by Washington University School of Medicine in St. Louis.
The person(s) above served as the developer(s) of this activity. Additionally, the Education Committee had control over the content of this activity. All relevant relationships have been mitigated.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing education to physicians.
ASTRO is awarded Deemed Status by the American Board of Radiology to provide SA-CME as part of Part II Maintenance of Certification.
- 1.00 AMA PRA Category 1 Credit™The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.00 Certificate of AttendanceThis activity was designated for 1.00 AMA PRA Category 1 Credit™.
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