Advances in Surface-Guided Radiotherapy
ORAL · Invited
Abstract
Surface Guided Radiation Therapy (SGRT) represents a major step forward in precision radiation oncology, transforming how patient positioning, motion monitoring, and treatment verification are performed. Over the past several years, SGRT has evolved from a supplementary alignment tool into a central component of Image-Guided Radiation Therapy (IGRT), offering real-time, non-ionizing optical tracking that enhances geometric accuracy while improving patient safety and clinical efficiency
As of 2022, over 60% of radiotherapy centers worldwide had integrated SGRT into at least one workflow, indicating rapid global adoption. In 2025, this figure continued to rise, driven by clinical evidence across multiple tumor sites—particularly in breast, lung, cranial, and head-and-neck radiotherapy. Tattoo-free setups and open-face mask workflows have enhanced patient satisfaction, particularly for breast and head-and-neck cancer patients, while maintaining geometric and dosimetric precision comparable conventional image-guidance systems
From 2023 – 2025 advances in SGRT technologies focused on automation, connectivity, and real-time dose visualization capabilities designed to streamline data flow, minimize manual planning steps, and enable predictive visualization of beam paths before irradiation. In 2024 the first real-time Cherenkov-based dose visualization systems were introduced to the clinic. These systems allow visualization of Cherenkov light emitted from the patient’s surface during irradiation, mapping dose delivery dynamically across a real-time image of the patient. In practice, this allows radiation oncologists and therapists to detect unpredictable deviations in delivery in real time—arising from changes in body habitus, respiratory motion, patient non-compliance, or treatment complexity issuus—and intervene immediately
In summary, SGRT represents a maturation point in precision radiotherapy. Its advanced optical tracking, automation, and multimodal integration are enabling faster, safer, and more patient-centered treatments. Continuing advances in workflow connectivity, algorithmic correction, and dose visualization promise to further elevate treatment fidelity and expand SGRT’s role across conventional, particle, and adaptive therapy landscapes.
As of 2022, over 60% of radiotherapy centers worldwide had integrated SGRT into at least one workflow, indicating rapid global adoption. In 2025, this figure continued to rise, driven by clinical evidence across multiple tumor sites—particularly in breast, lung, cranial, and head-and-neck radiotherapy. Tattoo-free setups and open-face mask workflows have enhanced patient satisfaction, particularly for breast and head-and-neck cancer patients, while maintaining geometric and dosimetric precision comparable conventional image-guidance systems
From 2023 – 2025 advances in SGRT technologies focused on automation, connectivity, and real-time dose visualization capabilities designed to streamline data flow, minimize manual planning steps, and enable predictive visualization of beam paths before irradiation. In 2024 the first real-time Cherenkov-based dose visualization systems were introduced to the clinic. These systems allow visualization of Cherenkov light emitted from the patient’s surface during irradiation, mapping dose delivery dynamically across a real-time image of the patient. In practice, this allows radiation oncologists and therapists to detect unpredictable deviations in delivery in real time—arising from changes in body habitus, respiratory motion, patient non-compliance, or treatment complexity issuus—and intervene immediately
In summary, SGRT represents a maturation point in precision radiotherapy. Its advanced optical tracking, automation, and multimodal integration are enabling faster, safer, and more patient-centered treatments. Continuing advances in workflow connectivity, algorithmic correction, and dose visualization promise to further elevate treatment fidelity and expand SGRT’s role across conventional, particle, and adaptive therapy landscapes.
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Presenters
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Michael Tallhamer
- Advent Health