CBCT adaptive RT is increasingly automated, but clinical decision-making still needs human oversight
AI can automate major components of CBCT-guided adaptation, but validated triggers, end-to-end QA and patient-outcome evidence remain limited.
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Adaptive RT
CBCT dose changes predicted adaptive radiotherapy benefit better than volume changes
Week-three CBCT dose changes predicted head and neck adaptive radiotherapy benefit with AUC 0.78 versus 0.54 using volume changes.
HyperSight CBCT approached simulation-CT dosimetry for offline adaptive breast radiotherapy
HyperSight reduced PTV dose-recalculation deviations versus Halcyon 3.1 while using a lower imaging dose in 12 breast radiotherapy patients.
Complex deformable dose accumulation rarely changed adaptive SBRT decisions
More accurate deformable registration lowered estimated bowel dose, but produced nearly identical in-treatment adaptation decisions to simple DVH summation.
Anatomy-based traffic lights missed important dose changes during lung radiotherapy
In 604 fractions, traffic-light alerts partially identified target undercoverage but were unreliable proxies for organ-at-risk dose changes.
CBCT-derived synthetic CT predicted head and neck replanning with 92% sensitivity and specificity
DART predicted clinically triggered head and neck adaptation with 92% sensitivity and specificity using a unified 2-Gy dosimetric threshold.
Heart dose rises during esophageal IMPT but adaptive replanning limits the increase
Mean heart dose increased during esophageal IMPT, while heart-dose–triggered replanning reduced the excess dose in patients requiring adaptation.
BARitOne will escalate oropharyngeal dose only for MRI-defined non-responders
BARitOne uses on-treatment diffusion MRI to increase gross tumour dose from 65 to 73 Gy only in predicted non-responders.
Exit-dose gamma alerts identified head-and-neck replanning needs on Halcyon-E
Strict exit-dose gamma thresholds correlated with anatomical change and identified all clinically replanned patients in a retrospective validation cohort.
Early CBCT shifts failed to predict dosimetric compromise in head and neck VMAT
Early three-dimensional CBCT shifts performed no better than chance for identifying patients with at least 3% PTV coverage loss.
HyperSight protocol selection substantially changed CBCT organ dose
Low Dose HyperSight protocols reduced exposure by 55%, while Slow and Large protocols increased imaging dose and accentuated secondary-risk estimates.
In-beam PET enabled real-time radioactive ion beam range adaptation in mice
Radioactive carbon-11 beams enabled PET-guided range adjustment during irradiation, with biological outcomes matching insufficient, optimal and excessive beam penetration.
Head and neck positioning management should extend beyond couch correction
Rigid couch correction cannot fully resolve regional posture mismatch, immobilization failure or progressive anatomical change during head and neck radiotherapy.
Fraction 15 was optimal for one-time offline replanning in head and neck proton therapy
A single offline replan at fraction 15 captured most achievable dosimetric benefit in simulated head and neck proton therapy.
Deep learning synthetic computed tomography supported head-and-neck adaptive radiotherapy dose recalculation
Synthetic computed tomography from cone-beam computed tomography achieved a 98.7% gamma pass rate for head-and-neck dose recalculation.