Speaker
Description
Barbara Knäusl is a senior post-doctoral research associate and clinical medical physicist at the Department of Radiation Oncology, Medical University of Vienna. She is PI of the interdisciplinary Christian Doppler Laboratory for image- and knowledge-driven precision radiation oncology, leading a group of four PhD students, one postdoc and two assistants.
Her research focuses on adaptive radiotherapy across photon and particle therapy with emphasis on image guidance, deformable image registration, breathing motion management, 4D treatments and outcome analysis. She has been involved for ten years in related research at the MedAustron Center for Ion Therapy and Research, most recently as PI and partner in the H2020 RAPTOR and RAPTOR+ consortium on real-time adaptive particle therapy, and as vice-coordinator of the FWF docFunds connect network on preclinical ion beam research.
She has long engaged with technology development now converging in AI-driven radiotherapy, including automated segmentation, synthetic image creation and workflow automation. As editor-in-chief of Physics and Imaging in Radiation Oncology, an active member of the ESTRO scientific council and physics committee, and supervisor of PhD and MSc students, she contributes to a broad spectrum of the medical physics developments in radiation oncology.
Summary
Adaptive radiotherapy (ART) aims to account for inter- and intra-fractional anatomical changes by adapting the initial treatment plan to the daily anatomy. While tumour shrinkage, organ motion, weight loss and filling variations are clear indicators for adaptive treatment concepts, translation into clinical practice remains challenging. This talk aims to give an overview of the current status of adaptive treatment strategies and the main challenges medical physicists and researchers face in bridging the gap between clinical need and practical implementation
The necessity for adaptation is not only driven by anatomical changes but also by the sensitivity and robustness of the radiation modality, the fractionation scheme, and the delivery technique and speed. While robust photon treatment techniques can reduce the need for adaptation, protons and carbon ions pose different challenges: the peaked depth-dose profile that enables their reduced integral dose and healthy-tissue sparing makes particle treatments highly sensitive to anatomical changes, positioning variations, and systematic uncertainties.
The rise of dedicated platforms for adaptive radiotherapy (e.g. MR-linac systems, CBCT-based treatment platforms) has brought online adaptive photon therapy into the clinic. Tools required for adaptive workflows, such as high-quality CBCT, AI-based auto-segmentation, synthetic CT generation or automated planning, are increasingly available also on standard C-arm linacs. However, for particle therapy, constraints on image quality and workflow robustness are even greater, while integrated platforms or dedicated in-room equipment remain scarce.
Once ART enters clinical routine, substantially increased quality assurance and automation demands must be addressed. Whether an offline, online or real-time adaptation schedule is desirable is mainly driven by the timescale of the underlying anatomical changes, with the choice ideally supported by real-time dose information. Clinical realisation in turn depends on the efficiency of the individual workflow steps, including plan generation, independent dose verification, image reconstruction, and deformable image registration.