Online adaptive radiotherapy

Adaptive radiotherapyis ready. Is your service?

Six domains, three minutes, an honest picture of where the gaps are.

Why it matters

The challenge

Most clinical risk is preventable, and rarely technical.

The technology is the easy part. What stalls programmes is the human system around it, and that is what we build: align, implement, sustain.

Align

Agree who decides

Adaptive workflows blur professional boundaries. Delegation without an agreed directive is unsafe.

Anchored by Compass

Implement

Credential the task, not the title

Credential each workflow step against a gold standard, rather than sign off a profession.

Anchored by Catalyst

Sustain

Build a service, not a pilot

Competency is perishable. Maintaining it is what keeps a demonstration from slipping back.

Anchored by Connect

Grounded in current consensus

Not our opinion, the field's.

The readiness check reflects the frameworks radiotherapy services are already being measured against.

Safety and governance

ASTRO adaptive and image-guided safety white papers2,3,4

The consensus on quality and safety for adaptive RT, including the daily adaptive directive, alongside AAPM TG 100 on prospective risk analysis.

Physics and commissioning

ESTRO-ACROP recommendations and QA guideline5,6

Consensus on clinical implementation, QA and medical-physics commissioning for online image-guided adaptive systems.

Workforce and credentialling

ACPSEM position paper and the RTT credentialling literature1,7,8,9,10

Scope of practice and staffing levels, the published advanced-adapter credentialling pathway, and the case that certification is not competency.

Want the background first?

Talk it through with us, or read the protocol the check is built on.

Get in touchSee the Adaptive Credentialling Protocol

References

The eighteen statements are drawn from these sources. Numbering is shared with the rest of the site, so a reference keeps its number wherever it is cited.

  1. 1.Pavord L, Bellezza S, Christodouleas JP, et al. A report from the AAPM Subcommittee on Guidelines for Competency Evaluation for Clinical Medical Physicists in Radiation Oncology. Journal of Applied Clinical Medical Physics. 2016;17(4):5804. doi:10.1120/jacmp.v17i4.5804
  2. 2.Huq MS, Fraass BA, Dunscombe PB, et al. The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management. Medical Physics. 2016;43(7):4209. doi:10.1118/1.4947547
  3. 3.Quality and Safety Considerations for Adaptive Radiation Therapy: An ASTRO White Paper. International Journal of Radiation Oncology, Biology, Physics. 2024. doi:10.1016/j.ijrobp.2024.03474
  4. 4.Qi XS, Albuquerque K, Bailey S, et al. Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update. Practical Radiation Oncology. 2023;13(2):97-111. doi:10.1016/j.prro.2022.09.004
  5. 5.Corradini S, Alongi F, Andratschke N, et al. ESTRO-ACROP recommendations on the clinical implementation of hybrid MR-linac systems in radiation oncology. Radiotherapy and Oncology. 2021;159:146-154. doi:10.1016/j.radonc.2021.03.025
  6. 6.An ESTRO-ACROP guideline on quality assurance and medical physics commissioning of online MRI guided radiotherapy systems based on a consensus expert opinion. Radiotherapy and Oncology. 2023;181:109504. doi:10.1016/j.radonc.2023.109504
  7. 7.Shepherd M, Graham S, Ward A, et al. Pathway for radiation therapists online advanced adapter training and credentialing. Technical Innovations and Patient Support in Radiation Oncology. 2021;20:54-60. doi:10.1016/j.tipsro.2021.11.001
  8. 8.Shepherd M, Joyce E, Williams B, et al. Training for tomorrow: Establishing a worldwide curriculum in online adaptive radiation therapy. Technical Innovations and Patient Support in Radiation Oncology. 2025;33:100304. doi:10.1016/j.tipsro.2025.100304
  9. 9.Hogan L, Jameson M, Crawford D, et al. Old dogs, new tricks: MR-Linac training and credentialing of radiation oncologists, radiation therapists and medical physicists. Journal of Medical Radiation Sciences. 2023;70:99-106.
  10. 10.ACPSEM Magnetic Resonance Imaging Linac Working Group. ACPSEM position paper on ROMP scope of practice and staffing levels for magnetic resonance linear accelerators. Physics and Engineering Sciences in Medicine. 2023;46:521-527.

This readiness check is an educational self-assessment, not a clinical, safety or regulatory audit, and does not constitute regulatory advice. Delegation of adaptive tasks, particularly target editing and treatment authorisation, must be confirmed against your regulator, professional-body scope-of-practice rules and institutional medico-legal governance. Frameworks referenced are the property of their respective organisations.