Integrated planning-and-delivery system for online adaptive radiotherapy
Online adaptive radiotherapy platforms · planning software built into the linac console, so the plan is regenerated on the day's image while the patient stays on the couch
In conventional radiotherapy the plan is made days before treatment on a separate planning workstation and then sent to the linac. An integrated planning-and-delivery system puts planning, plan checking and treatment management on the treatment machine's own console, so that at each fraction the day's image is acquired, the anatomy is re-contoured, a new plan is generated and checked, and the beam is delivered while the patient lies in position. The questions for a buyer are how long that loop takes, which imaging it runs on, and how the planning and delivery parts are verified as one system.
Linac-based radiotherapy systems in which treatment planning and treatment management software are part of the delivery system and are used during the session for online adaptive radiotherapy, guided by cone-beam CT or by an integrated MRI. Stand-alone treatment planning systems and workstations, their commissioning and CT-to-density tables, are covered on the Treatment planning stations (radiotherapy TPS) page.
CNFX editorial research · Sources checked October 12, 2026 · 3 sources
Re-planning with the patient on the couch: 24.3 minutes of adaptation in a 30.7-minute CBCT-guided session
The best-documented measure of an integrated system is session time, because the patient waits in treatment position while the plan is rebuilt. Heidelberg University Hospital and DKFZ reported every step for 31 patients and 737 adaptive fractions on a Varian Ethos between February and November 2023. [1]
The adapted plan was chosen over the scheduled plan in 97.7% of fractions. The authors cite earlier Ethos studies reporting adaptation sessions around 20 minutes per fraction and total treatment times around 35 minutes including set-up and delivery. [1] Editorial calculation: the 24.3-minute median adaptation is 79% of the 30.7-minute median session; medians of separate steps do not add exactly to the median total.
Because CBCT gives less soft-tissue contrast than MRI, the same group added weekly MRI in treatment position, moving the patient to the linac on a shuttle; the median time from MRI acquisition, including transport and positioning, to the start of the adaptive session was 53.6 minutes (IQR 46.5–63.4). [1]
Step in each fraction
What the system and staff do
Median time (IQR)
Image and contour
kV-CBCT is acquired; AI contours disease-site-specific organs (influencer structures), staff review them; target and organ contours are propagated from the reference image, producing a synthetic CT with Hounsfield units taken from the reference image. [1]
Part of adaptation
Adaptation
Contours reviewed and accepted; the system's planning software generates an adapted plan to compare with the scheduled plan. [1]
Ask for session-time data by disease site from sites using the same software version, and plan staffing for a physician or trained reviewer at the console during the adaptation step.
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Planning, treatment management and the 6 MV FFF linac reviewed as one bundle
Varian's 510(k) K192377 shows how the parts of one integrated system are regulated: three devices bundled into a single review because they perform management, planning and delivery within one workflow. [2]
The summary lists conformity to IEC 62083 for the planning and management software, IEC 62274 and IEC 61217 across software and linac, IEC 62304 for all, and IEC 60601-1, 60601-1-2, 60601-2-1 and 60601-2-68 for the linac. Software was treated as a major level of concern because a failure could directly result in serious injury or death; no animal or clinical studies were included. [2]
The predicates were separate products: a radiation therapy management system, a stand-alone planning system and the earlier Halcyon linac, each cleared in its own 510(k). [2] Editorial note: when the planning software is bound to one delivery machine, ask whether plans can also be exported to other linacs in the department and whether the system's dose engine has been commissioned against the department's own measurements.
Part
Cleared function
Published characteristics
Treatment management software
Managing and monitoring treatment plans and sessions; intended for use with a treatment planning system. [2]
Stand-alone software; records treatment parameters and course progression. [2]
Treatment planning software
Generating and modifying plans and guiding users within adaptive sessions. [2]
Supports IGRT, IMRT, IMRS and VMAT planning, adaptive planning and automated plan generation. [2]
Linac and couch
Stereotactic radiosurgery and precision radiotherapy anywhere in the body, adults and children. [2]
6 MV flattening-filter-free; dose rate up to 800 MU/min; treatment and imaging consoles, MLC, kV imager, patient camera; patient motion monitoring. [2]
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MR-guided integrated systems: 0.345 T imaging at the isocentre during the beam
ViewRay's MRIdian Linac 510(k) K181989 describes the MR-guided form, in which planning and delivery software, an MRI unit and a ring-gantry linac work concurrently. [3]
The MR images add T1, T2 and diffusion-weighted contrast that can be acquired on the machine itself and used for planning, positioning and delivery, with no imaging dose. [3] Compared with the CBCT route in the Heidelberg study, where MRI had to be brought in on a shuttle, this design images the patient at the treatment isocentre before and during each fraction. [3][1]
Item
MRIdian Linac (K181989)
Software
Treatment Planning and Delivery System (TPDS) with two roles, planning and delivery; Monte Carlo dose calculation. [3]
Linac and collimation
6 MV linac on a ring gantry; 138-leaf MLC; radiation isocentre in the middle of the imaging field of view. [3]
Magnet
0.345 T superconducting, 14.7 MHz, 700 mm bore, homogeneity < 25 ppm over 450 mm DSV, stability ≤ 0.1 ppm/h. [3]
Imaging during delivery
One plane at 8 frames per second, or up to three planes at 2 frames per second, in-plane resolution 2.5 × 2.5 mm or less. [3]
Positioning volume
Up to 540 × 540 × 480 mm, in-plane 3.0 × 3.0 mm or less, acquired in under 60 s. [3]
Planning volume
540 × 465 × 430 mm, in-plane 1.5 × 1.5 mm or less. [3]
Geometric accuracy
2 mm over a 35 cm field of view; 1 mm over 20 cm. [3]
For an MR-guided system, check room shielding, MR-safe patient equipment and the geometric accuracy over the field of view you will treat.
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Information for an adaptive planning-and-delivery quotation
Paste it into your enquiry below or into an email to a maker, then replace every bracket.
Clinical use: [disease sites; fractions per day; share adapted online]
Guidance: [CBCT or MRI; need for offline MRI]
Planning: [techniques; automated planning; plan export to other linacs]
Delivery: [energy; dose rate; MLC; motion monitoring]
Workflow: [staff at console; target session time]
Regulatory: [clearance numbers; IEC 62083 and 60601-2-1 conformity]
Room: [vault; shielding; MRI siting if applicable]
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Compiled and source-reviewed by the CNFX editorial team.
Each manufacturer above links to the page on that company's own website where the product is listed, with the date we checked it. How we source and review
· Page last updated 13 October 2026
Buyer questions
How long does an online adaptive radiotherapy session take?
In 737 CBCT-guided fractions at Heidelberg the median was 30.7 minutes, of which adaptation took a median 24.3 minutes and delivery 5.3 minutes. [1]
Is the planning software in an integrated system a separate medical device?
In Varian's K192377 the treatment management software, treatment planning software and linac are three devices bundled into one 510(k) because they share one workflow. [2]
What field strength does an MR-guided integrated system use?
ViewRay's MRIdian Linac uses a 0.345 T superconducting magnet with a 700 mm bore and images one plane at 8 frames per second during delivery. [3]
Sources and what still needs a direct check
Sources checked 2026-10-12. Two FDA 510(k) summaries written by the device makers (Varian and ViewRay) give the cleared functions and specifications; the session times come from a peer-reviewed clinical workflow study by Heidelberg University Hospital and DKFZ.
