Session

Overview: This joint ESTRO-AAPM session will highlight emerging strategies for real-time intra-fraction adaptation and their potential to improve precision in radiation therapy delivery. Drawing on lessons from tracking-enabled platforms such as Vero, the session will explore how motion management has evolved from marker-based to marker-free approaches across moving targets including lung, liver, and pancreas. It will then address key enabling technologies, including real-time segmentation and quality assurance of auto-generated structures, as well as clinically available and emerging real-time tracking solutions, spanning geometry-guided and dose-guided approaches, advanced techniques to account for deformation, AI-based methods and quality assurance consideration. Finally, the session will discuss real-time dose reconstruction, covering adaptive dose calculation, dose accumulation across fractions, and the QA and validation challenges that must be addressed for safe clinical implementation.