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Open research questions in Advanced Radiotherapy Techniques

145 unresolved questions extracted from the limitations and future-work sections of 585 Advanced Radiotherapy Techniques papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Evaluate PlanningCopilot for other types of cancer, - Compare PlanningCopilot to human-generated plans, - Investigate the use of PlanningCopilot in other treatment planning systems

    PlanningCopilot: An agentic framework integrating ESAPI modules for autonomous treatment planning in lung radiotherapy · 2026 · DOI

  • The lack of a mechanism to execute complex planning actions within the treatment planning system. The need for a system that can integrate clinical reasoning capability with ESAPI modules.

    PlanningCopilot: An agentic framework integrating ESAPI modules for autonomous treatment planning in lung radiotherapy · 2026 · DOI

  • Most plans were already compliant on most metrics at baseline, - The Planning Copilot was applied to a limited number of cases (62 retrospective locally advanced NSCLC cases), - The larynx was contoured in only 5 of 62 cases

    Improving portability of knowledge‐based planning using an LLM‐driven plan refinement framework in lung radiotherapy · 2026 · DOI

  • Further evaluation of the Planning Copilot with a larger number of cases, - Investigation of the Planning Copilot's performance with different KBP models, - Exploration of the Planning Copilot's potential applications in other radiotherapy treatment planning contexts

    Improving portability of knowledge‐based planning using an LLM‐driven plan refinement framework in lung radiotherapy · 2026 · DOI

  • Further research is needed to investigate the sensitivity of gamma index criteria to other types of mechanical errors, - The study's findings should be validated using a larger sample size and more diverse patient population, - Research should be conducted to compare the performance of different dosimetric systems in detecting clinically relevant geometric deviations

    Assessing Gamma Index Sensitivity to Selected Linear Accelerator Mechanical Errors Using Various Dosimetric Systems · 2026 · DOI

  • The sensitivity of gamma index analysis to small systematic mechanical errors in VMAT for SBRT remains controversial. There is a need to evaluate the sensitivity of various gamma index criteria to mechanical errors using different dosimetric systems.

    Assessing Gamma Index Sensitivity to Selected Linear Accelerator Mechanical Errors Using Various Dosimetric Systems · 2026 · DOI

  • Future research should explore innovative combinations of immobilization and monitoring to further improve RT outcomes and ensure precise treatment while increasing patient comfort.

    Open-Face Masks in Radiotherapy: Enhancing Therapeutic Strategies for Head and Neck and Brain Cancer Patients—A Comprehensive Scoping Review · 2024 · DOI

  • The study had a limited sample size of 48 patients. The study only evaluated the RAD solution for oropharyngeal cancer patients.

    Can knowledge-based autoplanning keep up with advances in radiotherapy optimization for oropharyngeal cancer? · 2026 · DOI

  • The study identifies a gap in the current literature regarding the evaluation of the RAD solution for head and neck cancer patients. The study aims to address this gap by evaluating the performance of the RAD solution in terms of plan quality and deliverability.

    Can knowledge-based autoplanning keep up with advances in radiotherapy optimization for oropharyngeal cancer? · 2026 · DOI

  • The increasing use of intensity-modulated radiation therapy (IMRT) requires more conformal dose distributions and improved dose homogeneity. Conventional whole-breast radiotherapy typically incorporates a skin-outside margin of approximately 2.5 cm to account for uncertainties. There is a need for more robust breast IMRT planning strategies that can account for setup errors and other uncertainties.

    Evaluation of External Margin Generation Techniques for Robust Breast Intensity-Modulated Radiation Therapy Planning · 2026 · DOI

  • Further studies can be conducted to validate the results using experimental measurements. The method can be applied to other types of radiation therapy treatments.

    Prediction of Therapeutic and Imaging Doses in the Gonadal Shielding Block Using Monte Carlo Simulation · 2026 · DOI

  • The need for accurate prediction of therapeutic and imaging doses in the gonadal shielding block. The lack of a method for estimating the dose absorption in the gonadal shielding block.

    Prediction of Therapeutic and Imaging Doses in the Gonadal Shielding Block Using Monte Carlo Simulation · 2026 · DOI

  • The study uses a retrospective analysis of patient data. The number of patients is limited to 96. The study does not investigate the long-term effects of total body irradiation.

    Machine learning approach to estimation of in vivo measured dose and treatment planning for total body irradiation · 2026 · DOI

  • The study is limited to an institutional experience with a small number of patients. The use of Synchrony Technology may not be widely available or accessible to all patients.

    Stereotactic Body Radiotherapy in Ultra-Central Lung Tumors using Radixact-X9 Tomotherapy with Artificial Intelligence based Synchrony Technology: An Institutional Experience · 2026 · DOI

  • Conventional SBRT techniques have limitations, including patient discomfort and large Internal Target Volume (ITV) margins. There is a need for more precise and effective treatment approaches for UCLT. The use of Synchrony Technology addresses this gap by enabling real-time tumor tracking and adaptive beam delivery.

    Stereotactic Body Radiotherapy in Ultra-Central Lung Tumors using Radixact-X9 Tomotherapy with Artificial Intelligence based Synchrony Technology: An Institutional Experience · 2026 · DOI

  • The increasing adoption of advanced techniques has further increased the number and complexity of structures requiring contouring. The growing burden of contouring represents a significant operational cost in terms of highly skilled clinician time.

    Economics achieved through the use of artificial intelligence–powered contouring solutions in a network of oncology clinics in low- and middle-income countries · 2026 · DOI

  • The growing burden of contouring represents a significant operational cost in terms of highly skilled clinician time. There is a need for scalable and economically viable solutions to improve efficiency in radiation oncology workflows.

    Economics achieved through the use of artificial intelligence–powered contouring solutions in a network of oncology clinics in low- and middle-income countries · 2026 · DOI

  • Data quality and bias are limitations of AI models, requiring diverse, high-quality datasets for generalizability. Most studies remain retrospective, and prospective multicenter validation is needed. Incorporating AI into clinical systems is technically demanding.

    Artificial Intelligence–driven adaptive radiotherapy: Current developments, clinical applications and future perspectives · 2026 · DOI

  • Conventional RT planning relies on a single pre-treatment CT scan, limiting its effectiveness. Adaptive radiotherapy addresses these limitations, but conventional ART workflows are time-consuming and labor-intensive. -

    Artificial Intelligence–driven adaptive radiotherapy: Current developments, clinical applications and future perspectives · 2026 · DOI

  • release of potentially hazardous This study used PLA as the primary material for 3D-printed bolus fabrication, which was selected based on a balance of radiological equivalence, mechanical performance, and manufacturing efficiency. While PLA offers advantages such as low ultrafine particle emissions compared with ABS and avoids the thermal decomposition byproducts, alternative materials may provide distinct benefits depending on clinical priorities.43 For example, silicone-based polymers processed via direct ink writing offer improved flexibility and tissue conformity, but their slow build speeds and limited spatial resolution constrain routine clinical use.16 Additionally, previous comparative studies have shown that although PLA demonstrates favorable radiation transmission characteristics, materials such as PETG may provide superior mechanical strength and flexibility.15 Accordingly, future work will systematically evaluate a broader range of printable materials to better balance radiological equivalence, mechanical performance, and manufacturing efficiency. Another limitation of this study is the use of only one FDM printer model and a specific PLA filament.

    Fabrication and evaluation of 3D-printed customizable boluses for optimized radiotherapy applications · 2026 · DOI

  • The study identifies a gap in the assessment of IGRT imaging doses. The gap is in determining whether the cumulative dose exceeds 5% of the prescribed treatment dose.

    Assessment of imaging radiation dose from tomotherapy systems · 2026 · DOI

  • twice This study has several limitations. Firstly, dose measurements were performed for each imaging condition, which may underestimate random uncertainty; additional repetitions would be required for a more robust characterization of measurement variability and for supporting statistically significant analysis. Secondly, kVCT doses were measured using a fixed 10 cm scan length with a 100 mm pencil ionization chamber, which may underestimate the absolute dose due to incomplete scatter integration. Thirdly, the imaging protocols evaluated were limited to those used at three centers, which may not fully represent the range of clinical practices. Fourthly, dose measurements were based on a phantom-derived MSADw, which may not reflect patient-specific scan lengths and body sizes in clinical practice, affecting dose estimations. Finally, all measurements were performed at the isocenter, which may not accurately reflect patient positioning in clinical settings and could lead to variations in delivered dose.

    Assessment of imaging radiation dose from tomotherapy systems · 2026 · DOI

  • The study uses a specific type of applicator and beam current transformer. The experimental validation is limited to a microchip phantom for tumor spheroid culture.

    Design, optimization, and validation of a novel applicator integrating real-time dose monitoring for ultra-high dose rate (FLASH) electron radiotherapy · 2026 · DOI

  • Further experimental validation in preclinical and clinical settings. Investigation of the applicator's performance with different beam energies and types.

    Design, optimization, and validation of a novel applicator integrating real-time dose monitoring for ultra-high dose rate (FLASH) electron radiotherapy · 2026 · DOI

  • The need for more efficient and accurate PSQA methods. The lack of standard evaluation criteria for EPID-based PFF-PSQA.

    Analysis of IMRT patient specific quality assurance using EPID measurement data from the Halcyon linear accelerator · 2026 · DOI

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145 open questions have been extracted from the limitations and future-work passages of 585 Advanced Radiotherapy Techniques papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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