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Review
. 2023 Sep 2;18(1):144.
doi: 10.1186/s13014-023-02340-2.

Review of cone beam computed tomography based online adaptive radiotherapy: current trend and future direction

Hefei Liu  1   2 , David Schaal  2 , Heather Curry  2 , Ryan Clark  2 , Anthony Magliari  2 , Patrick Kupelian  2 , Deepak Khuntia  2 , Sushil Beriwal  3   4
Affiliations
Review

Review of cone beam computed tomography based online adaptive radiotherapy: current trend and future direction

Hefei Liu et al. Radiat Oncol. .

Abstract

Adaptive radiotherapy (ART) was introduced in the late 1990s to improve the accuracy and efficiency of therapy and minimize radiation-induced toxicities. ART combines multiple tools for imaging, assessing the need for adaptation, treatment planning, quality assurance, and has been utilized to monitor inter- or intra-fraction anatomical variations of the target and organs-at-risk (OARs). Ethos™ (Varian Medical Systems, Palo Alto, CA), a cone beam computed tomography (CBCT) based radiotherapy treatment system that uses artificial intelligence (AI) and machine learning to perform ART, was introduced in 2020. Since then, numerous studies have been done to examine the potential benefits of Ethos™ CBCT-guided ART compared to non-adaptive radiotherapy. This review will explore the current trends of Ethos™, including improved CBCT image quality, a feasible clinical workflow, daily automated contouring and treatment planning, and motion management. Nevertheless, evidence of clinical improvements with the use of Ethos™ are limited and is currently under investigation via clinical trials.

Keywords: Adaptive radiotherapy (ART); Cone-beam computed tomography (CBCT); Ethos™.

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Conflict of interest statement

Dr Hefei Liu reports temporary employment at Varian Medical Systems. Dr David Schaal employment at Varian Medical Systems. Dr Heather Curry reports employment at Varian Medical Systems. Mr Ryan Clark reports employment at Varian Medical Systems. Mr Anthony Magliari reports employment at Varian Medical Systems. Dr Patrick Kupelian reports employment at Varian Medical Systems. Dr Deepak Khuntia has a leadership role as the Senior Vice President and Chief Medical Officer at Varian Medical Systems. Dr Sushil Beriwal has a leadership role as the Vice President of Medical Affairs at Varian Medical Systems, reports grant as an Elsevier consultant, and reports participation in advisory board at Xoft DSMB.

Figures

Fig. 1
Fig. 1
HyperSight™ CBCT technology captures larger images with better contrast within only 6 s, which allows tumors that move with respiration to comfortably perform a single breath-hold for the machine to obtain high-quality images needed for daily treatment planning and delivery
Fig. 2
Fig. 2
Workflow comparison between IGRT and adaptive radiotherapy
See this image and copyright information in PMC

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