ESTRO 2025 Congress Report I Mini-Oral Session Highlights I RTT Track
Report by the ESTRO positioning & immobilisation focus group
This session on next-generation radiotherapy spotlighted breakthroughs in immobilisation, imaging, adaptive radiotherapy, and artificial intelligence. It underscored how emerging technologies and collaborative clinical workflows are driving significant improvements in treatment precision, patient safety, and efficiency. The following report presents each session’s contributions and their implications for the evolving role of radiation therapists (RTTs) and multidisciplinary oncology teams.
Simone Leopoldo Antonetti (Italy)
Role of RTTs in Optimising Patient Positioning with a New Immobilisation System for Total Marrow Irradiation
Simone Antonetti introduced an in-house-developed immobilisation system that had been customised for total marrow irradiation (TMI), which requires stable immobilisation of extensive anatomical regions over prolonged sessions. The design prioritises patient comfort to reduce motion and facilitates tolerability during lengthy treatments, which is critical for effective dose delivery. RTTs were deeply involved in implementing the device; they performed daily patient setups and conducted verification scans via cone beam CT (CBCT). It seemed that the system significantly reduced patient positioning errors. Furthermore, the session highlighted how RTTs’ adherence to rigorous protocols is fundamental to the assurance of patient comfort, reproducibility and safe delivery. This presentation underscored the essential interplay between technology design and skilled RTT operation in delivering complex, high-precision therapies such as TMI.
Enkelejda Lamaj (Switzerland)
Photon-counting CT for Treatment Planning of Head-and-Neck Cancer
Enkelejda Lamaj presented photon-counting detector CT (PCD-CT) as a transformative imaging technology that overcomes limitations of conventional CT, particularly in reducing metal-induced artefacts that are common in head-and-neck cancer patients with dental restorations. The electron density maps were directly converted into mass densities, and a calibration was done for virtual-monoenergetic-image (VMI) 70keV. No clinically significant differences were observed in the doses to the planning target volumes (PTVs) and organs at risk (OARs) when treatment plans that had been made on electron density and the recalculated 70 VMI keV were compared. Lamaj emphasised that PCD-CT images could be utilised in the radiotherapy workflow, as they provided high-quality images but reduced the radiation exposure to the patient.
Eline de Groot-van Breugel (The Netherlands)
Impact of Margin Reduction on Acute GU Toxicity in Prostate SBRT on a 1.5T MR-linac
Eline De Groot-van Breugel shared compelling evidence that supported the integration of 1.5T MRI guidance in prostate stereotactic body radiotherapy (SBRT). Daily MRI scans provide exquisite soft tissue contrast, enabling precise visualisation of the prostate and surrounding OARs. This imaging facilitates substantial reductions of PTV margins (tight margins 2mm (left-right, cranio-caudal) and 3mm (anterior-posterior)) from conventional standards (isotropic 5mm)), thereby limiting radiation dose to the bladder and urethra. No significant difference in genitourinary (GU) toxicity between the tight and safe margin groups was found. However, the researchers found a significantly higher dose to the bladder of the patients who experienced GU toxicity. They started with comprehensive motion management to correct for movements of the target volume during the treatment, and with this, reduced the anterior-posterior margin to 2mm. The researchers have to wait to find out whether this will result in less GU toxicity. This research emphasises the need for constant evaluation of the outcome of radiation treatment to be able to optimise it.
Vale Chin (Singapore)
Streamlining Palliative Radiotherapy: Establishing a Dedicated Planning and Treatment Unit
Vale Chin’s presentation detailed an innovative organisational model that was designed to enhance palliative radiotherapy delivery, critical for rapid symptom relief in advanced cancer patients. The dedicated palliative radiotherapy planning and treatment unit streamlines workflows by minimising bottlenecks from simulation through to treatment initiation. A key highlight was the empowerment of RTTs to participate actively in treatment planning and dosimetry discussions, breaking down traditional role boundaries and fostering a multidisciplinary approach. This enhanced collaboration led to markedly reduced wait times and optimised resource allocation. Chin’s model serves as an exemplar for radiotherapy departments that aim to meet growing palliative care demands efficiently without compromising quality.
Maria Giulia Vincini (Italy)
Impact of Anatomical Inter-fraction Variations on Dose Distribution in Robustly Optimised Proton Therapy Plans for Head-and-Neck Patients
Maria Vincini addressed the dynamic challenges that clinicians face during proton therapy for head-and-neck cancers, in which anatomical changes such as tumour shrinkage, weight loss, and oedema occur throughout the treatment course. Despite the use of robust optimisation in treatment planning to account for uncertainties, these inter-fraction anatomical variations can lead to unintended dose deviations in both target volumes and OARs. Frequent re-evaluation CTs revealed increased doses in some critical structures despite robust plans, highlighting the limitations of static planning approaches. The robustness parameters seemed adequate in avoiding unexpected violations in patients who did not undergo re-planning during the course of treatment.
Thijs Ackermans (The Netherlands)
Technological Advancements in Radiotherapy: The Perspective of Dutch Radiotherapy Technologists
Thijs Ackermans explored the impact of rapid technological evolution on the radiation therapy workforce. The integration of automation, contouring assisted by artificial intelligence (AI), and advanced imaging modalities is transforming daily RTT workflows. While most RTTs embrace these advancements that improve precision and efficiency, challenges such as technostress, cognitive overload, and the need for ongoing education were identified. Survey data indicated that institutional support through management engagement and robust training programmes was essential to ease transitions. Job autonomy is important to maintain job satisfaction. Ackermans stressed that RTTs must be confident that they have the appropriate training and skills to perform the tasks assigned to them.
Roel Bouwmans (The Netherlands)
A Fast, RTT-led Workflow for Long-scheme Treatments on the MR-Linac: Adapt-to-Shape Lite
Roel Bouwmans introduced adapt-to-shape (ATS)-Lite, which is an efficient online adaptive radiotherapy workflow tailored for long-course treatments (>15 fractions) on MR-linac systems, particularly for rectal and oesophageal cancers. ATS-Lite streamlines adaptive planning by employing deformable contour propagation and limiting manual contour adjustments to cases in which this is clinically necessary. This approach reduces treatment duration to a median of 21-23 minutes, which facilitates scheduling within standard treatment slots and makes MR-guided adaptive therapy more feasible in clinical practice. This workflow empowers RTTs to lead the adaptation process, enhancing their clinical role and contributing to real-time precision radiotherapy without compromising quality or patient safety.
Kirsten Offereins (The Netherlands)
Feasibility and Accuracy of Patient Setup in Gynaecological Cancer Treatments Using Surface-Guided Radiotherapy
Kirsten Offereins evaluated the clinical application of surface-guided radiotherapy (SGRT) for patient setup in gynaecological cancers, comparing it with traditional tattoo-based alignment methods. The analysis of over 1000 CBCT-based setup verifications (500 CBCTs per group) showed that the use of SGRT did not decrease the treatment accuracy and did not increase the number of fractions in which patients needed to be repositioned. The use of SGRT eliminates the need for permanent skin tattoos. This technique aligns with modern patient-centred care goals and shows that SGRT can become a standard for tattoo-free radiotherapy setup in gynaecological cancer.
Conclusion
The ESTRO 2025 mini-oral session showed us that radiotherapy is entering an exciting new era in which technology, teamwork, and smarter workflows are coming together to make cancer treatment better than ever. The presentations highlighted how advances in patient immobilisation, imaging, adaptive radiotherapy, and AI are changing the way treatments are planned and delivered, making them more precise, personalised, and focused on the patient’s well-being.
One important take-home message was how the role of RTTs is evolving. RTTs are no longer just carrying out treatment but are becoming key players in planning, decision-making, and quality control. By giving RTTs more training and responsibility, clinics can use advanced technologies such as MR-guided radiotherapy, proton therapy, and AI tools more effectively, leading to better outcomes for patients.
AI holds great promise to automate complex tasks and support clinicians, but it must be introduced thoughtfully with proper training and support so that it benefits both patients and healthcare teams without causing extra stress.
There are still challenges ahead, especially around funding, infrastructure, and making adaptive radiotherapy a routine part of care. To overcome these, institutions must invest in resources, foster teamwork, and prioritise ongoing education.
In short, ESTRO 2025 made it clear that the future of radiotherapy depends on combining advanced technology with skilled, empowered professionals—especially RTTs. By embracing these innovations and working together, the radiation oncology community is ready to deliver cancer treatments that are safer, more effective, and tailored to each patient’s needs, ultimately improving their quality of life.
Mirjam Mast PhD
Executive senior radiation therapist
Staff member R&D
The Hague, The Netherlands
Chair, ESTRO positioning & immobilisation focus group
ESTRO- Positioning and immobilisation
Prakash Umbarkar, M.Sc. Physics (PGDRTT)
P.D. Hinduja Hospital, Mumbai, India
Member of ESTRO positioning & immobilisation focus group