Adaptive Treatment Planning

Although not a routine, it is not uncommon during the course of a radiation therapy treatment to make changes in the patient's treatment plan. Historically, such plan modifications are necessitated by changes in the patient's anatomy that were not captured during the initial simulation. Multimodality imaging-aided radiotherapy, together with four-dimensional simulation and delivery, gated treatments, beam tracking, advanced treatment planning including radiobiological imaging and fast hardware platforms enable us to consider replanning options during the course of treatment for several patients who could potentially benefit from such intervention. Adaptive radiotherapy (ART) is the implementation of such a workflow that interrogates the significance of anatomical changes during the treatment, to trigger the generation of a new treatment planning while tracking the total dose given to the patient. We will present the challenges and possible solutions for the implementation of an ART program.