ESTRO Course Report

14-17 September 2025
Online course
 

Course directors: Andrew Hope (Toronto, Canada), Jan-Jakob Sonke (Amsterdam, The Netherlands)
Faculty: Sophie Alexander (London, United Kingdom), Uwe Oelfke (London, United Kingdom), Gitte Persson (Copenhagen, Denmark), Parag Parikh (Detroit, USA), Marcel van Herk (Manchester, United Kingdom) , Karin Goudschaal (Amsterdam, The Netherlands)

Course Overview

The ESTRO Image-Guided and Adaptive Radiotherapy (IGRT) 2025 course provided a comprehensive, multidisciplinary update on the topic. Conducted as an interactive online programme, it brought together physicists, clinicians and radiation therapists (RTTs) from across the world to explore how imaging and adaptation continue to redefine precision radiotherapy.

The course combined pre-course recorded lectures with four days of live sessions, and this structure struck an excellent balance between theory and practical application, all underpinned by strong evidence and open discussion. The pre-recorded content covered both fundamentals and advanced topics. I found Andrew Hope’s session on radiotherapy for stereotactic cardiac fibrillation particularly fascinating.

Highlights and Learning

The opening day established the foundations of IGRT. Gitte Persson outlined the clinical rationale for adaptation in lung and prostate cancer. Marcel van Herk explored key concepts of margin management, while Jan-Jakob Sonke concluded with correction strategies and adaptive workflows, bridging theory and clinical practice.

On day two, Uwe Oelfke introduced 4D-IGRT and motion management. After this, Professor Persson, Parag Parikh, and Karin Goudschaal presented clinical insights into breast and lung treatments. Prof Hope then discussed the evolution of frameless stereotactic radiotherapy and demonstrated how precision and patient comfort can coexist.

RTT-focused sessions played a central role. Ms Goudschaal presented practical case studies on registration of cone beam computer tomography (CBCT) for breast and lung, covering various examples of “traffic light” action levels for adaptation. Sophie Alexander contributed insights into prostate registration and the growing autonomy of RTTs in adaptive workflows; she emphasised their vital role in image assessment and plan selection. These sessions provided highly practical guidance for RTT participants.

In later sessions, adaptive radiotherapy concepts and practice were explored. Prof Oelfke described improvements in CBCT image quality that enabled online adaptation, while Ms Goudschaal shared examples of RTT-led adaptive workflows that showed measurable clinical benefits. Dr Parikh presented data from recent trials in MR-guided adaptation. On the final day, speakers addressed artificial intelligence (AI), with Profs Sonke and Hope discussing AI-driven segmentation and planning. Prof Persson and Dr Parikh closed by comparing MR- and CT-guided adaptive systems, highlighting their complementary strengths.

Participant Experience

Participants were given the opportunity to choose among discipline-specific breakout sessions. Joining the RTT sessions proved particularly valuable, as they were highly practical; they showcased real-world adaptive workflows and encouraged open discussion.

Despite being online, the course was remarkably interactive. The faculty promoted lively Q&A sessions, and the dynamic debates among speakers added an enjoyable, thought-provoking dimension as they challenged each other on differing clinical and technical perspectives.

Key Takeaways

• Education and training are essential to support the new ways of working that are required for adaptive radiotherapy.
• RTT roles are evolving; RTTs have increasing autonomy and make more decisions on adaptation, while leading workflows and taking charge of quality assurance..
• AI and automation will enhance, not replace, clinical expertise.
• MR- and CT-guided systems both play valuable, complementary roles.

Conclusion

The ESTRO IGRT 2025 course was a highly engaging, evidence-based exploration of the state-of-the-art in this field. It successfully combined physics, clinical, and RTT perspectives into a cohesive, practical learning experience.

Even in its virtual format, the course delivered exceptional interactivity and collegial exchange. I would highly recommend this course to all those professionals, whether clinicians, physicists, or RTTs, who seek to update or deepen their understanding of adaptive and image-guided treatment approaches.

Dr Anita O’Donovan
Assistant professor
Discipline of Radiation Therapy
Trinity College Dublin, Ireland
Email: anita.odonovan@tcd.ie