Imaging Across the SRS Workflow: From Planning Precision to Treatment Guidance and Response Assessment
Description
Imaging lies at the core of stereotactic radiosurgery (SRS), defining the geometric and biological precision required to safely deliver ablative doses to intracranial targets. Rapid advances in image acquisition, integration, and analysis are transforming every stage of the radiosurgical workflow – from simulation and planning to real-time treatment guidance and post-therapy assessment. This educational symposium will provide a comprehensive overview of imaging across the full SRS continuum, focusing on three key domains: 1) planning, 2) treatment, and 3) response evaluation. The session will review state-of-the-art imaging strategies for SRS planning, including CT, MRI, PET, and angiography, emphasizing sequence optimization, image fusion accuracy, and geometric quality assurance to ensure submillimeter targeting. It will then explore emerging on-board imaging technologies, such as Varian HyperSight, which enhance localization, motion monitoring, and adaptive dose verification. The role of MR-Linac systems will be highlighted, demonstrating how real-time MR guidance achieves stereotactic precision while enabling visualization of intracranial anatomy throughout beam delivery. Finally, the symposium will address post-treatment imaging techniques, such as advanced MRI (perfusion, diffusion, spectroscopy), PET tracers, and radiomic biomarkers, that help distinguish true progression from treatment effect and guide personalized follow-up. By bridging physics, radiology, and clinical implementation, this session will provide attendees with a unified perspective on how imaging innovations are redefining SRS precision – from accurate planning and real-time guidance to personalized response assessment. Participants will gain practical strategies to optimize image acquisition, quality assurance, and integration throughout the radiosurgical workflow.