Impact of Radiotherapy Machine Downtime on PatientOutcomes and Workflow Efficiency
Abstract Background Radiotherapy remains one of the most critical components of modern cancer management,relying on accurate and continuous dose delivery over a planned course of treatment.However, in many hospitals—particularly in resource-limited environments—unplannedinterruptions often occur due to equipment malfunction, maintenance delays, or electricityissues. These disruptions not only compromise treatment quality but also contribute toemotional distress among patients and additional workload for healthcare professionals. Objective The purpose of this study was to examine how radiotherapy machine downtime affectspatient treatment schedules, tumor control outcomes, and psychological well-being. Thestudy also aimed to assess the impact on technologists’ workflow, stress levels, and overallservice delivery. Methods Data were collected from patients who experienced delays caused by machine breakdowns,along with responses from radiotherapy technologists working in a public-sector hospital.Key parameters included duration of treatment interruption, tumor location, prescribedradiation dose, and patient-reported anxiety levels. A cross-sectional survey amongtechnologists evaluated machine failure frequency, backlog management, andcommunication challenges. Literature findings were reviewed to compare the local impactwith broader evidence. Results Frequent downtime resulted in treatment delays ranging from 1 to 10 days. Interruptions hada noticeable negative effect on treatment outcomes, particularly in cancers of the head andneck, cervix, and breast, where continuous fractionation is crucial. Extended gaps werelinked to reduced tumor control probability and higher risk of tumor regrowth. Patientsfrequently reported anxiety and fear of disease progression during delays.From the technologists’ viewpoint, machine downtime led to heavy workloads oncetreatments resumed, difficulties in rescheduling patients, and increased emotional stress.Communication gaps and patient dissatisfaction were also observed. Conclusion Radiotherapy machine downtime has significant implications for both clinical outcomes andworkflow efficiency. Consistent preventive maintenance, reliable technical support, andeffective communication between staff and patients are essential to reduce treatment gaps.Establishing backup systems and clear contingency plans can improve operational stabilityand support better patient care in low-resource radiotherapy centers.
Emerging Advances Shaping the Future of Radiotherapy: AI Integration, AdaptiveImaging, and Particle-Based Precision
Mr. Asif Rauf1, Dr Khalid Iqbal2, Mr. Khurram Khan3. Shaukat Khanum Memorial Cancer Hospital and Research Centre Introduction Radiotherapy is entering a new era shaped by the integration of artificial intelligence (AI), adaptiveimaging, and precision particle delivery, fundamentally advancing its role in personalizedoncology. These innovations aim to overcome limitations of conventional static planning byenhancing accuracy, biological relevance, and real-time adaptability. Methods This review synthesizes emerging technological developments in adaptive radiotherapy (ART),image-guided systems, and proton/heavy-ion therapy through critical evaluation of recentliterature. Key focus areas include AI-enabled segmentation, dose prediction and online planadaptation; MR-LINAC and PET-LINAC–based functional imaging for biologically guided dosemodulation; and particle therapy innovations such as AI-assisted range prediction, Monte Carlodose computation, and LET-optimized planning. Additional modalities such as FLASHradiotherapy, spatially fractionated techniques, theranostics, and radioimmunotherapy are alsoexamined. The review consolidates these developments to provide a comprehensive reference forclinicians, trainees, and researchers. Results AI-driven ART demonstrated improved target conformity, reduced margins, and decreased normaltissue toxicity across multiple clinical applications. Advanced IGRT platforms enhanced real-timetumor visualization and supported biologically adaptive dose delivery. Proton and heavy-iontherapies demonstrated substantial gains in dose localization and treatment robustness throughintegration of AI-assisted optimization techniques. Emerging modalities showed strong potentialto further enhance therapeutic precision by combining imaging, radiobiology, and machinelearning innovations. Conclusion Collectively, these developments highlight a major paradigm shift toward intelligent, adaptive, anddata-centric radiotherapy. The convergence of physics, engineering, biology, and informatics isaccelerating the transition to highly personalized cancer treatment. Although these technologiesremain at varying stages of clinical adoption and validation, their combined progress is poised toredefine the therapeutic boundaries and clinical capabilities of radiation oncology in the comingdecade.
Assessing Congruence of Planned and Delivered Doses in Prostate VMAT Using Dolphin®-Compass System
Arisha Iqbal, Dr. Kareem Bhutto Bukhsh, Hamid Jameel, Sindh Institute of Urology and Transplantation INTRODUCTION The evolution of radiation therapy, marked by the advent of highly conformal delivery systems, necessitates a paradigm shift in patient-specific quality assurance (PSQA). The technological strides in PSQA devices, exemplified by the Dolphin Phantom employed in this study, enable prospective evaluation of radiation safety prior to treatment delivery, thereby directly influencing patient outcomes and survival rates. The Dolphin® Compass system, a dosimetry solution, manifests versatility in executing diverse radiation treatment quality assurance protocols. METHOD & MATERIAL A retrospective analysis of 10 prostate cancer cases was conducted to assess treatment delivery accuracy. Offline treatment monitoring employed the Dolphins Phantom affixed to the Versa-HD Linear Accelerator head. Volumetric Modulated Radiation Treatment (VMAT) plans, utilizing 6 MV photon beams, were orchestrated using the Monaco® Treatment Planning System (version 5.11). The Compass, 3D volumetric gamma analysis software, facilitated the comparison of planned and measured doses. RESULT Analysis of 3D volumetric gamma pass rates, in contrast to 3D planner pass rates, demonstrated commendable concordance with corresponding Treatment Planning System (TPS) calculated values across all prostate VMAT plans delivered. CONCLUSION A careful examination of 10 VMAT cases was conducted to assess the Dolphin-Compass dosimetry’s capacity to replicate 3D dosage on patient CT scans. Leveraging Versa HD LINAC- modeled beam data, the dosimetry system was deployed. The findings accentuate the reliability and precision of the Dolphin® Phantom in elevating quality assurance for prostate VMAT treatments. Implementation of the Dolphin® -Compass system ensures congruence between delivered and planned doses, solidifying its pivotal role as an invaluable tool in advancing patient-specific quality assurance within the realm of radiation therapy.
Real-Time MRI-Guided Tumor Tracking in Radiotherapy: Early Clinical Experience with MR-Linac in DUHS.
Author: Muhammad Uzair Memon, Syed Ashar Amjad, Syeda Aisha Arooj, Hafsa Zameer Affiliation: Dow University of Health Sciences Background:Tumor motion during radiotherapy compromises precision and normal tissue sparing. Magnetic Resonance Linear Accelerator (MR-Linac) systems combine MRI with radiation delivery, enabling real-time visualization and adaptive planning. Objective:To evaluate the feasibility and clinical benefits of real-time MRI-guided tumor tracking using MR-Linac in Pakistan. Methods:From October 2024 to May 2025, 40 patientswith lung, prostate, breast, and pelvic tumors were treated using MR-Linac at Dow University of Health Sciences Karachi. Continuous MRI monitored target motion during beam delivery. Online plan adaptation was performed when displacement exceeded defined thresholds. Setup time, motion magnitude, adaptation frequency, and acute toxicity were analyzed. Results:Real-time MRI provided continuous visualization in all patients. Mean intrafraction displacement was 3.2 mm, allowing accurate gating and reduced margins. Adaptive planning was applied in 35% of fractions, reducing dose to nearby organs. All treatments were completed without major interruptions, and no ≥Grade 2 acute toxicities were observed. Conclusion:MR-Linac enabled precise real-time tumor tracking and adaptive planning, improving treatment accuracy and safety. This represents one of the first clinical experiences of MRI-guided radiotherapy in Pakistan, demonstrating its feasibility and clinical value.
Paediatric Radiotherapy solutions in low resource settings: A case study in Zimbabwe’s context
CLINICAL DATA A four-year-old female patient presented with a posterior fossa tumour with a year history of postprandial vomiting, headaches, partial vision loss and inability to walk. A biopsy revealed it to be classic medulloblastoma. A VP shunt was inserted and mass excision was performed to debulk the tumour. IMAGING AND PATHOLOGY Post craniotomy, an MRI and CT scan revealed a residual tumour measuring (1.6x 3.2 x 2.0) cm with no leptomeningeal or spinal drop lesions. The patient was then referred for chemo-radiotherapy. A CT scan was done for treatment planning. The patient was positioned supine using a vacuum bag, headrest, and beam-directional shell for immobilization, ensuring precision during treatment. Whole-body images were obtained with 5mm slices from vault of the skull to the bottom of the sacrum, with 3mm slices throughout the primary tumour. CLINICAL COURSE 3D-Conformal radiotherapy commenced one month post-surgery and included craniospinal irradiation using 2 parallel opposed cranial fields and one direct posterior field to the spine (23.4 Gy in 13 fractions) followed by a posterior fossa boost (30.6 Gy in 17 fractions), totalling 54 Gy. Treatment employed multi-leaf collimators and weekly field feathering to optimize dose distribution and minimize toxicity. Dexamethasone was used to cater for vasogenic oedema. The patient was able to complete treatment without severe late effects and with a single interruption. Reactions noted were erythema, vasogenic oedema and fatigue, these resolved post treatment and the patient since regained the ability to walk DISCUSSION The patient showed significant clinical improvement, including regaining ability to walk, indicating effective tumour control, neurological recovery and reduced treatment-toxicity. This case shows the importance of timely, precise radiotherapy and supportive care in achieving favourable outcomes in low-resource countries when treating paediatric brain tumours AUTHOR: LAVERNE HAMADZIRIPI-SOBER rufarosober@gmail.com
Conventional vs MR-Linac Workflow: A Radiation Therapist’s Perspective
Author: Hafsa Zameer, Ashar Amjad, Aisha Urooj Affiliation: Dow University of Health Science Background: The integration of magnetic resonance imaging with linear accelerator technology (MR-Linac) has transformed radiotherapy practice by enabling superior soft-tissue visualization and online adaptive planning. Compared with conventional Linac systems, which rely on CT-based simulation and cone-beam CT (CBCT) for setup verification, the MR-Linac allows real-time imaging and plan modification based on daily anatomical changes. This evolution has significantly influenced the workflow and clinical responsibilities of radiation therapists. Objective: To compare the conventional Linac and MR-Linac workflows from a radiation therapist’s perspective, highlighting differences in imaging, treatment adaptation, and professional responsibilities. Method: A descriptive workflow comparison was conducted, outlining each treatment phase—from simulation to treatment delivery. Key differences were analyzed regarding image acquisition, patient positioning, plan verification, adaptation, and quality assurance. Results: Conventional Linac workflows follow an offline planning process with fixed treatment plans and limited daily variation. MR-Linac workflows incorporate daily MR imaging, online contour review, adaptive plan optimization, and real-time motion monitoring. These steps increase treatment time but enhance target precision and organ-at-risk sparing. Radiation therapists have expanded roles in MR image assessment, adaptive decision support, MR safety, and patient communication. Conclusions: The MR-Linac introduces a dynamic, adaptive workflow that elevates treatment precision and expands the radiation therapist’s role. As frontline professionals, therapists are integral to the success of MR-guided adaptive radiotherapy, requiring ongoing training, multidisciplinary collaboration, and workflow refinement to ensure safe and efficient clinical implementation.