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Open research questions in Advanced Radiotherapy Techniques

473 gap statements mined from Advanced Radiotherapy Techniques papers in our 7.9M-paper local library, which holds 4,452 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • A limitation of this study is the use of virtual patient models. Consequently, further prospective studies incorporating independent physical simulations are warranted to validate the software’s robustness across a wider clinical spectrum.

    Game engine–driven high-precision collision simulation system for radiation therapy: development and clinical evaluation · 2026 · DOI

  • The gap is the limited image quality of CBCT compared to CT, which is the main modality for accurate dose planning. The study aims to narrow the gap between CT and CBCT using the HyperSight technique.

    Evaluating Image Quality of Cone Beam Computed Tomography Using HyperSight® on the Varian TrueBeam · 2026 · DOI

  • Second, dose calculations were performed using the TG-43 formalism, which does not account for tissue heterogeneities or applicator attenuation. Prospective studies including clinical endpoints are warranted to confirm whether the observed dosimetric advantages translate into improved patient outcomes.

    Updated dosimetric comparison of HDR interventional radiotherapy including 60Co sources versus VMAT and electron beam therapy for NMSC · 2026 · DOI

  • Several limitations of this study should be acknowledged. Therefore, the anatomical parameters identified in this study have not yet undergone external validation, and their generalizability to broader patient populations remains uncertain.

    Dosimetric benefits of deep inspiration breath-hold in postoperative radiotherapy for left-sided breast cancer after breast-conserving surgery: an anatomical parameter-based analysis · 2026 · DOI

  • Prospective, multicenter studies with larger patient populations, a predefined equivalence margin, and a fully tattoo-free design are warranted to validate these results and assess long-term clinical outcomes. SGRT was associated with a vertical offset of about 5 mm that warrants attention to reference-surface and ROI definition.

    ExacTrac Dynamic Surface-Guided Setup Versus Tattoo-Based Positioning in Breast Cancer Radiotherapy: A Retrospective Comparison of Setup Accuracy and Preparation Time · 2026 · DOI

  • These findings support a new concept of machine-state-aware PSQA, in which evaluation is not limited to a single pretreatment measurement of the approved plan but could be extended toward assessing delivery quality for individual fractions during fractionated radiotherapy.

    A deep learning approach for EPID-based patient-specific quality assurance incorporating daily machine-state variations · 2026 · DOI

  • Future research should focus on comparing two-arc RAD, nine-field IMRT, and three-arc VMAT plans utilizing a reduced margin size to better balance target coverage and OAR sparing. Future research should focus on comparing RAD, nine-field IMRT, and three-arc VMAT plans.

    RapidArc dynamic versus IMRT and VMAT for endometrial cancer SIB radiotherapy · 2026 · DOI

  • Residual geometric MRI distortions following the vendor’s corrections were not investigated in this dataset and masking the scans with a union of CT and MRI patient outline masks may further obfuscate their impact on dose calculations.

    DoseRAD2026: A benchmark dataset for AI‐accelerated photon and proton dose calculation in radiotherapy · 2026 · DOI

  • Several limitations of the present study should be acknowledged. Finally, the generalizability of the morphology–VPDR correlations may be limited by the anatomical and volumetric heterogeneity of the cohort.

    Dosimetric feasibility of lattice radiotherapy for bulky tumors: a paired VMAT vs. helical tomotherapy comparison - the STRYKE trial · 2026 · DOI

  • Nevertheless, the current evidence is limited by heterogeneous study quality, inconsistent prediction endpoints, and a lack of standardized methodologies, and the pathway from model development to clinical translation has not yet been established.

    Patient selection strategies for deep inspiration breath-hold in left-sided breast cancer: a review of current evidence and future directions · 2026 · DOI

  • A major limitation in the current body of evidence is the lack of randomized controlled trials directly comparing 3D-printed moulds with standard devices.

    3D-Printed Devices in Interventional Radiotherapy (Brachytherapy) Applications: A Literature Review · 2025 · DOI

  • Future research should focus on validating these findings in more ethnically and anatomically diverse populations to ensure broader applicability of the tools across different clinical environments.

    Automated Organ Segmentation for Radiation Therapy: A Comparative Analysis of AI-Based Tools Versus Manual Contouring in Korean Cancer Patients · 2024 · DOI

  • However, inverse treatment planning for fVHEE remains unexplored in clinically motivated scenarios.

    Treatment planning comparison of focused very high energy electron and volumetric modulated arc therapy · 2026 · DOI

  • Respiratory baseline, motion and target position reproducibility interact and remain uncertainty sources.

    Internal target volume reproducibility and dose coverage for lung stereotactic body radiotherapy using spine-based positioning and tracking · 2026 · DOI

  • A major limitation of standard amorphous Silicon EPID detectors for usage IVD is their non-linear detector response to water equivalent dose.

    Improving patient treatment accuracy using transit dosimetry with Electronic Portal Imaging Device images and deep learning · 2026 · DOI

  • Implementation as a draft-first approach with mandatory physician review appears feasible, although refinement of automated target delineation is warranted.

    Prospective blinded clinical evaluation of a fully automated workflow for prostate radiotherapy · 2026 · DOI

  • The most common reason for a contour being deemed unacceptable was insufficient anatomic accuracy rather than safety concerns.

    Evaluating artificial intelligence versus human-generated contours in the thorax · 2026 · DOI

  • These tools reliably achieve high geometric and dose agreement with manual organ of interest (OOI) contours, but whether such agreement predicts clinical acceptability on structured physician review is not well characterized.

    Evaluating artificial intelligence versus human-generated contours in the thorax · 2026 · DOI

  • Third, the detector-based EPID comparison was limited to the TrueBeam STx platform, as no dosimetry-capable EPID was available on the Versa HD used in this study; extending the comparison to Elekta platforms equipped with dosimetry-capable EPIDs would strengthen the generalizability of the findings obtained here.

    Characterization of high-resolution detector response for stereotactic patient-specific QA across different TPS-linac systems · 2026 · DOI

  • The literature-derived transverse steering-tofocal-spot coefficient cT j ≈ 0:020 mm/mA is retained as a physically interpretable local response scale for future hypothesis testing, with its scope explicitly limited to a figure-derived local coefficient rather than a manufacturer or machine-specific calibration.

    Toward dynamic Monte Carlo source modeling: measurement variability and primary electron source-width sensitivity in very small photon fields · 2026 · DOI

  • The treatment duration in MR-LINAC has been optimized with the added possibility of parallel workflows for ART during each fraction. One debated topic in this optimization has been the requirement of a simulation CT for the calculation of dose distribution, given that Hounsfield units cannot be obtained from MRI.

    MR-LINAC, a New Partner in Radiation Oncology: Current Landscape · 2024 · DOI

  • No biomarkers, immune cell analyses, or prospective controlled data are available to establish an LRT related immune effect; however, it is worth noting that the deliberately created intratumoral high-low dose heterogeneity produced by LRT may exert a synergistic, potentiating effect with subsequent PD-1-blocking immunotherapy represented by tislelizumab, a hypothesis that remains to be validated in larger-scale…

    Lattice radiotherapy boost integrated with thoracic VMAT in bulky stage IIIB non–small cell lung cancer: a case report · 2026 · DOI

  • The paper identifies the challenge of achieving geometric accuracy in AI segmentation, with a mean Dice similarity coefficient of 0.446. The study highlights the issue of inter-observer variability in contouring, particularly for small structures like the IPA. The paper notes the challenge of prioritizing likely protocol deviations for further expert clinician QA.

    Using artificial intelligence for clinical trial quality assurance in a multi-institutional neurovascular-sparing prostate radiotherapy trial · 2026 · DOI

  • The study had a modest geometric accuracy with a mean Dice similarity coefficient of 0.446, - The small structure and notable inter-observer variability of the IPA may contribute to the wider Hausdorff tails, - The clinical utility and impact on workflow burden require further prospective…

    Using artificial intelligence for clinical trial quality assurance in a multi-institutional neurovascular-sparing prostate radiotherapy trial · 2026 · DOI

  • The results support further investigation of ultrasound-based STAR motion management.

    Integration of an echocardiographic motion-management system into photon-based stereotactic arrhythmia radioablation planning · 2026 · DOI

Most-cited papers in Advanced Radiotherapy Techniques

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Open questions raised by papers listed on this page include: (1) Further prospective studies incorporating independent physical simulations are warranted to validate the software’s robustness across a wider clinical spectrum (“Game engine–driven high-precision collision simulation system for radiation…”, 2026); (2) Prospective studies including clinical endpoints are warranted to confirm whether the observed dosimetric advantages translate into improved patient outcomes (“Updated dosimetric comparison of HDR interventional radiotherapy including 60Co…”, 2026); (3) Prospective, multicenter studies with larger patient populations, a predefined equivalence margin, and a fully tattoo-free design are warranted to validate these results and assess long-term clinical outcomes (“ExacTrac Dynamic Surface-Guided Setup Versus Tattoo-Based Positioning in Breast…”, 2026); (4) Future research should focus on comparing two-arc RAD, nine-field IMRT, and three-arc VMAT plans utilizing a reduced margin size to better balance target coverage and OAR sparing (“RapidArc dynamic versus IMRT and VMAT for endometrial cancer SIB radiotherapy”, 2026); (5) The current evidence is limited by heterogeneous study quality, inconsistent prediction endpoints, and a lack of standardized methodologies, and the pathway from model development to clinical translation has not yet been established (“Patient selection strategies for deep inspiration breath-hold in left-sided…”, 2026). 473 gap statements have been mined from Advanced Radiotherapy Techniques papers in our 7.9M-paper local library, which holds 4,452 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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