Adaptive radiotherapy from past to future frontiers

increased. For the first day of the treatment, an imaging and plan related algorithm leads to construct the patient’s non-treatment geometric model. Thus, one can adaptively modify not only the PTV margin, but also the spatial dose distribution to best accommodate any change in patient’s anatomy as well as the dosimetric deviation from the prescription incurred in previous fractions. A cumulative treatment plan provides an overall estimation of the treatment. In the last few years, much of the research has been dedicated to this ART and also notably, various vendors are making significant efforts. With technical advancements, particularly in computer, networking technology and optimization algorithms, online practices are becoming increasingly feasible and may likely become a ‘‘standard practice’’ in the near future. In this approach, the role of simulation geometry and the treatment plan is different from whatever is in current practice. In conclusion, the workflow and technology features are essential factors for introducing and providing robust adaptation of the treatment plan throughout the course of treatment. Indeed, the useful measure to identify patients’ need for an adaptive treatment is the goal of strategy.