Clinical decision-making, tumour and organ segmentation as well as treatment planning in radiation oncology are based on quantitative anatomical information derived from computed tomography (CT). Since CT imaging is mostly advanced to meet the requirements in radiology, the needs in radiation oncology are often not addressed optimally. Common CT innovations, which have clearly improved the overall image quality, have not been translated into a widespread clinical routine in radiation oncology yet. Guidelines and recommendations on commissioning, calibration and quality assurance for radiotherapeutic CT applications are often insufficient or even missing, which further hamper the time-consuming clinical implementation of CT innovations.

With the introduction of dual-energy CT (DECT) scanners, numerous tailored applications based on the huge variety of DECT-derived datasets have been developed. Recent research studies have identified multiple promising benefits of DECT for treatment planning as well as tumour and organ delineation, for instance. However, the clinical transition from conventional CT to DECT impacts the entire radiotherapy chain from delineation to treatment planning and finally dose application. Hence, this requires even more efforts than the implementation of common CT innovations.

To ensure a proper, fast and widespread clinical integration of CT innovations and improve current practice in radiation oncology, a close collaboration between experienced clinical research institutes and industry partners is worth aspiring to define technical requirements dedicated to radiotherapy, provide guidelines and recommendations on calibration, quality assurance and clinical acceptance levels as well as encourage standardisation.

This workshop will focus on the standardisation of CT commissioning and calibration as well as the clinical implementation of CT and DECT innovations for treatment planning and tumour delineation.



We aim at exchanging clinical experiences, challenges and desires in CT commissioning, calibration, routine clinical application, and quality assurance within an interdisciplinary group of medical physicists, radiation oncologists and industry partners to

  • specify technical requirements and standardisation guidelines in radiation oncology,
  • provide recommendations on CT commissioning, calibration, quality assurance as well as implementation of CT innovations,
  • assemble an international expert group to facilitate the widespread clinical implementation of CT innovations and regularly update CT requirements in radiation oncology,
  • write a joint white paper and establish future research collaborations.


Online Pre-Meeting on 10-11 June 2021
Day I – General Gathering (14:00-14:15)
 • Welcome & housekeeping rules
Day I – Introduction Workshop (14:15-14:30)
 • Outline topical workshop (main topics, respective goals for online  and in-person meeting)
 • Overview of online pre-meeting
Day I – Get to Know (14:30-15:00)
 • Brief introduction of participants
Day I – Panel Discussion (15:00-16:00): CT in Radiotherapy – Commissioning, Quality Assurance &

 • Kick-off presentations from invited panel participants covering two main topics:
  1) CT calibration and standardisation for treatment planning (challenges in calibration,
parameters, requirements)
  2) CT commissioning and quality assurance (current features & obstacles, phantoms,
check-up frequency)
 • Panel discussion with Q&A
Day I – Break (16:00-16:15)
Day I – Break-out Session (16:15-17:00)
 • Split participants into two workstreams (panel topics) for an interactive brainstorming
 • Discussion on:
  1) What are the current obstacles and how can we address them?
  2) Which topics should be highlighted in the in-person workshop?
  3) Action items for the time between online pre-meeting and in-person workshop
Day I – Interactive Corner (17:00-17:15)
Day I – Wrap up (17:15-17:30)

Day II – General Gathering (14:00-14:15)
Day II – Interactive Corner (14:15-14:45): Future of CT in Radiotherapy (CT innovations, research,
Day II – Panel Discussion (14:45-15:45): CT innovations in Radiotherapy
 • Vision talks and expert statements from physicians and physicists about CT innovations
 • Panel discussion with Q&A
Day II – Break (15:45-16:00)
Day II – Break-out Session (16:00-16:45)
 • Split participants into two workstreams for an interactive brainstorming about:
  1) Clinical translation of CT innovations
  2) CT beyond morphology – tackle tumour environment
 • Discussion on:
  o What are requirements for clinical implementation?
  o How can we facilitate the use of CT innovations?
  o Which topics should be highlighted in the in-person workshop?
  o Action items for the time between online pre-meeting and in-person workshop
Day II – Interactive Corner (16:45-17:00)
Day II – Wrap up (17:00-17:15)
Day II – Outlook (17:15-17:30)


In-Person Workshop on October 22-23 in Budapest, Hungary

Day I – Session I (10:30-12:30): Introduction and Status of CT Commissioning and Quality Assurance

  • Workshop overview presentation
  • Introduction of participants
  • Current clinical status of CT commissioning, calibration, quality assurance & phantom design

Day I – Session II (13:30-15:30): CT Implementation, Calibration and Validation

  • Keynote lecture on standardisation efforts for CT calibration within the European Particle Therapy Network
  • Selected participant pitches
  • Discussion topics:
    • Strategies for CT calibration
    • Standardisation of image acquisition & reconstruction settings for treatment planning
    • Phantoms and tissue-equivalent materials for CT calibration
    • Validation strategies to assess accuracy and robustness
  • Summary of requirements and recommendations

Day I – Think Tank (16:00-17:00): Industrial Standardisation or Institutional Individualisation

  • Discussion topics:
    • Industrial standardisation of settings, tools and workflows in radiation oncology
    • Fully automated and supportive assistant systems provided by industry
  • Summary of requirements and desired developments


Day II – Session I (8:00-10:00): Innovations in CT Imaging

  • Keynote lectures on dual-energy CT and innovations in 4DCT imaging for tumour delineation and treatment planning
  • Selected participant pitches
  • Discussion topics:
    • Technical parameters of dual-energy CT (field of view, spectral separation, temporal resolution, image processing, 4D capability)
    • Expected clinical benefits of dual-energy CT
    • Assessment of motion-induced anatomical changes (4DCT)
  • Summary of requirements and joint research strategies

Day II – Session II (10:30-12:30): Clinical Application of Dual-Energy CT and other CT Innovations

  • Selected participant pitches
  • Discussion topics:
    • Current obstacles and requirements for routine application
    • Guidelines for commissioning and quality assurance of DECT and CT innovations
    • Assignment of priorities

Day II – Wrap up (13:30-14:30)

  • Summary of workshop results and follow-up agreements
  • Definition of next steps and further collaborations
  • Establishment of an international consortium of experts