Clinical experience with a same-day simulation and treatment program for stereotactic radiation therapy on a C-arm linac - Research article

Sep 28, 2026

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Purpose: Report experience implementing a same-day simulation and treatment program using a C-arm linear accelerator for patients with intracranial and extracranial metastatic disease. Methods: From May 2021 to October 2023, patients received linac-based SRS/SBRT within the same-day workflow; expedited candidates met simulation and planning constraints. Extracranial cases required automated IMRT optimization standards, while intracranial cases were limited to 1–3 lesions and 1–2 isocenters. Results and timing analyses evaluated workflow step durations. Conclusions: Establishing and selecting planning techniques plus adding automation supports effective expedited delivery.

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Introduction

Key workflow concepts for same-day treatment

DOI: 10.1002/acm2.70449 RESEARCH ARTICLE Clinical experience with a same-day simulation and treatment program for stereotactic radiation therapy on a C-arm linac Michalis Aristophanous1 Sernger Shen1 Dylan G. Hsu1 Dongxu Wang1 Ase Ballangrud1 Jean M. Moran1 Anyi Li1 Sean M. McBride2 Daniel Gomez2 Luke R. G. Pike2 Kathryn Beal2 Jonathan T. Yang2 Laura Cervino1 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA 2 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA Correspondence Michalis Aristophanous, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 Yorke Avenue, Box 84, New York, NY 10065, USA. [Email:](Email: aristopm@mskcc.org)[ aristopm@mskcc.org](Email: aristopm@mskcc.org) Abstract Purpose: We report our experience with the implementation of a same-day simulation and treatment C-arm linear accelerator (linac)-based stereotactic program for patients with intracranial and extracranial metastatic disease. Methods: Between May 2021 and October 2023, patients were treated in our same-day program with linac-based SRS/SBRT. Two slots per week were offered. Patients with expedited clinical needs, able to undergo SRS/SBRT simulation and treatment, were considered. Extracranial treatments were required to meet standards for automated intensity modulated radiation therapy (IMRT) optimization. Intracranial treatments were limited to 1–3 lesions and 1–2 isocenters. The day before treatment, the patient needed to be identiﬁed, and any diagnostic imaging had to be available for the physician and dosimetrist to discuss the plan. On the day of treatment, simulation was scheduled for 8 AM and treatment at 4 PM by default, with the goal to complete treatment by 6 PM. We analyzed information about each patient’s treatment plan and time spent on each step of the workﬂow. Results: Ninety-seven patients followed our same-day workﬂow and were included in the analysis. Seventy-ﬁve patients received intracranial SRS (57% to 1 lesion), while 22 patients received extracranial treatments (50% to the extremities). Simulation often required additional time to be completed,ﬁnishinga median 18 min (IQR 5–40) after the goal end time. The median time between simulation completion and end of the same-day treatment was 7 .8 h (IQR 7 .4– 8.6) . Treatment technique and the number of target volumes had a signiﬁcant impact on planning time. The median treatment end time was 5:13 PM (IQR 4:46 PM–6:01 PM), with 74% ending by 6 PM. Conclusions: A linac-based program to treat patients with SRS/SBRT in an expedited fashion was established and successfully treated patients in a sameday timeline. Careful selection of planning techniques to limit plan complexity and adding automation in time-consuming parts of the process are crucial when developing expedited workﬂows. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2026 The Author(s) . Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine. JAppl Clin Med Phys. 2026;27:e70449 . [https://doi.org/10.1002/acm2.70449](https://doi.org/10.1002/acm2.70449) [wileyonlinelibrary.com/journal/acm2](wileyonlinelibrary.com/journal/acm2) 1 of 10 KEYWORDS SRS, SBRT, same-day 1 INTRODUCTION Stereotactic treatments for metastatic disease have seen a dramatic increase in the last 10 years.1,2 In general, there has been shift in practice away from simple parallel-opposed beams towards focal targeting with SRS for intracranial disease and stereotactic body radiation therapy (SBRT) for extracranial disease. These modalities deliver higher doses with tighter spatial margins to achieve improved local control with fewer toxicitie

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What were the key findings regarding workflow time?

Ninety-seven patients followed the same-day workflow. Simulation completion often exceeded the planned end time, and the time from simulation completion to end-of-treatment had a median of about 7.8 hours, with technique complexity affecting planning time.

Sep 28, 2026

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