Accelerating Access, Managing Risk: Implementing Safe and Efficient Direct-to-Treatment Adaptive Workflows
Description
Direct-to-treatment (DTT) streamlines simulation, planning, QA and treatment into same-day, risk-managed pathways that start from diagnostic imaging or treatment-unit imaging. Clinical and physics evidence now supports multiple entry points: diagnostic-CT based SBRT, CBCT-based workflows with HU-accurate extended-field imaging, and MRI-first pathways where soft-tissue visualization is essential. Several trials have proven the feasibility and safety of DTT and its efficiency, showing that patient visits can be reduced to as few as one. Despite the gains in efficiency, DTT adaptive also introduces new layers of procedural and workflow complexity. This session emphasizes frameworks for governance, acceptance thresholds, secondary checks, documentation, and incident learning that enable safe, scalable adoption of DTT while measuring value across diverse practice environments. We will review planning approaches and key lessons from adaptive DTT trials, including urgent palliative cases, spine SBRT, abdominal treatments, and single-fraction adaptive lung SBRT.