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Adaptive Radiotherapy

UC San Diego has a long history developing and testing adaptive radiotherapy (RT) approaches in multiple tumor sites. We were among the first to explore the use of different treatment plans based on the “anatomy of the day” in cervical cancer patients undergoing chemoradiotherapy. Our team also pioneered the use of high-speed computer techniques to allow the real-time generation of new treatment plans for patients, helping open the door to on-line adaptive RT approaches.

Image-Guided Adaptive RT Techniques

An important area of active adaptive RT research at our Center is on the development of tools and approaches to detect changes that can be adapted to; these changes may be patient-related (weight loss, edema), normal tissue-related or tumor-related. Such changes can impact on the quality and delivery of treatment.

One approach we are exploring is to use the widely available electronic portal imaging device (EPID) (right). We are evaluating anatomy and positional changes detected by EPID pixel intensity as a function of time. We are also exploring radiomics approaches to quantify anatomic changes based on feature changes on daily cone-beam CT (CBCT) images. These changes will be used to trigger automated re-planning.

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To learn more about our image-guided adaptive RT research, check out the following faculty labs:

Bojechko Lab

Bojechko Lab


Moore Lab

Moore Lab


Ray Lab

Ray Lab


Sim-less Planning and Delivery

A mainstay of conventional radiotherapy treatment planning is the “simulation” whereby a CT scan of the patient is taken in the planned treatment position and its images are used to identify the tumor (target) as well as surrounding normal tissues. These images are then used to generate a treatment plan which is designed to deliver the prescription radiation dose to the tumor while optimally sparing surrounding normal tissues. Each day in the treatment room, considerable effort is performed to re-position the patient and the internal anatomy to match the day of simulation.

Our researchers are exploring a novel adaptive approach whereby the simulation is replaced with imaging of the tumor and normal tissues on the treatment couch and an automated planning process is used to generate a treatment plan. In short, the treatment plan is adapted to the patient’s anatomy on the treatment table. We are focused on using this novel adaptive approach in multiple tumor sites, with an initial focus on patients undergoing palliative RT on a clinical trial.

To learn more about our sim-less adaptive RT research, check out the following faculty lab:



Moore Lab

Moore Lab