Work Packages

WP2 will conduct a systematic literature review (SLR) to answer: “What are the procedures used for the optimization of linac-mounted CBCT imaging for positioning verification in RT?” The review will identify procedures based on general imaging dose metrics (e.g., CTDIvol and DLP) and organ-specific metrics (e.g., spinal cord absorbed dose). Reported according to PRISMA guidelines, its findings will underpin a European survey of how these procedures are implemented in practice.

The survey will map current practices, variations, and challenges, helping tailor WP3’s training programme to its audience. By combining evidence with real-world practice, WP2 supports OPTIMIZE-RT’s objectives and grounds the training in robust procedures, enabling healthcare professionals to reduce radiation doses without compromising image quality, patient safety, or treatment efficacy. WP2 will also identify best practices and knowledge gaps to refine training and guide ongoing research and improvement.

The primary objective of WP3 will be to develop a comprehensive, evidence-based training programme that empowers RT professionals to competently implement CBCT dose optimization protocols. This directly supports the overall project goal of increasing the number of RT departments that adopt optimized imaging practices, thereby reducing unnecessary radiation exposure to patients.

Specific objectives of WP3 include:

1. Design a Fully Online Training Curriculum:

2. Pilot the Training Programme:

3. Integrate Continuous Feedback and Quality Improvement:

4. Develop Open-Access Training Materials:

4. Accreditation and Dissemination:

WP4 aims to:

- Implement protocols: Enable RT departments to apply WP3’s CBCT optimization protocols, reducing unnecessary radiation exposure while maintaining or improving image quality for treatment verification.

- Refine training: Collect implementation outcomes and challenges systematically, using real-world feedback to update WP3 materials for diverse clinical settings.

- Validate protocols: Test protocols across departments with varied equipment and patient populations. Assess dose and image quality metrics used in dose reduction CTDI, DAP, SNR, CNR, VGA, and clinical staff feedback to confirm effectiveness and wider applicability.

- Share results: Disseminate validated protocols and outcomes through WP5’s website, social media, conferences, webinars, and events, making best practices accessible and supporting standardization across Europe.

This WP includes the following activities:

5.1 International conference presentations

5.2 Webinars

5.3 National multiplier events

5.4 Final international dissemination conference

5.5 Online dissemination (website and social media)

Presentations at international conferences (e.g., ESTRO, EFOMP) will reach RT professionals, researchers, and policymakers, raising awareness of CBCT optimization and its clinical benefits.

Webinars will raise awareness of radiation doses in radiotherapy patients and present research findings (WP2) and optimization results (WP4).

National multiplier events in Malta and Italy will share knowledge with local RT communities and promote optimized CBCT protocols in clinical practice at low cost.

The final international conference in Portugal will bring together clinicians, physicists, radiographers, researchers, and professional organizations to present project results and discuss their application in routine RT.

A project website will offer open-access training materials, findings, and implementation guidelines. Social media and press releases will boost visibility and participation. Engagement with ESTRO, ICRP, EFOMP, and EFRS will support continued sharing of results and keep CBCT optimization a priority in RT.

These efforts will extend OPTIMIZE-RT’s reach and translate its findings into better cancer treatment by reducing unnecessary radiation exposure and improving imaging quality in RT departments.