International Survey Results on Current Adaptive Radiotherapy Implementation
Abstract
Purpose
While adaptive radiotherapy (ART) is increasingly being adopted into clinical practice, treatment planning, delivery, dose reporting, and clinical trial QA have not yet been standardized for national clinical trials, leaving a gap in ensuring consistent and precise implementation. To address this, a survey was conducted to assess current ART practices across clinics and inform ART credentialing program development.
Methods
A REDCap survey was distributed to primary physicists at approximately 1,900 clinics worldwide. The questionnaire explored ART implementation strategies (online and offline), modalities (photon and proton), anatomical sites, imaging techniques, adaptation drivers, staff training and roles, quality assurance tools, and barriers to adoption. Respondents were also asked about ART phantom availability and interest in an ART phantom credentialing program.
Results
A total of 365 responses were received (87% U.S., 6% Canada, 7% international). Overall, 55% of clinics reported performing some form of ART. Among these, 28% conducted online adaptation (all photon-based), while 88% conducted offline adaptation (91% photon, 11% proton). For photon ART, head and neck was the site most frequently adapted offline (96%), whereas online ART was most used for genitourinary treatments (75%). CT‑based workflows were reported more often for online adaptation (60%) compared to MR‑based workflows (35%). The most frequently cited barriers to ART implementation were resource limitations (76%) and time constraints (65%). Only 8% of clinics performing ART reported having a phantom dedicated to adaptive QA. In addition, 73% of respondents indicated that an adaptive end‑to‑end phantom would be beneficial, with dose accumulation and deformable image registration identified as the highest‑priority features.
Conclusion
These findings quantify ART availability, reveal variability in ART implementation, and highlight widespread interest in ART credentialing tools. These data will be use to develop standardized QA resources, including an adaptive phantom, to ensure accurate ART delivery and support clinical trial readiness.