The goal of the meeting is to bring together the world’s best scientists and clinicians in the area of real-time image-guided radiotherapy to forge the path from the current status to future widespread implementation. The focus of the presentations will be forward looking: what are the future directions and future challenges for real-time localization and adaptive radiotherapy in each particular area? Common themes and issues will be identified throughout the day with a broad discussion to close the day. A white paper summarizing proceedings will be compiled and if appropriate submitted for publication.

Introduction to real-time tumour localization and adaptation in cancer radiotherapy

 A Real-time tumour localisation

• The role of optical imaging for intrafraction guidance
• Quantifying intrafraction motion with kilovoltage and megavoltage x-ray methods
• Combining optical and x-ray imaging for low dose real-time guidance
• Cyberknife guidance systems
• Electromagnetic guidance
• Intrafraction ultrasound guidance
• Tracking implanted radioisotopes
• Markerless tracking of lung tumors
• MRI intrafraction imaging
• Real-time volumetric imaging estimation from x-ray projections and priors

 Real-time radiotherapy adaptation

• Planning on 3D and 4D geometries for real-time adaptation
• The 2nd generation real-time radiotherapy (RTRT) system
• Robotic adaptation
• Couch tracking
• Multileaf collimator adaptation
• Tomotherapy real-time management solutions
• Gimbaled linac adaptation
• Quality assurance for real-time radiotherapy adaptation

 Looking forward

• Challenges of real-time tumor tracking with particles
• Accounting for tumour rotation and deformation via multileaf collimator adaptation
• Real-time dose painting