For the large majority of our adaptive plans (>95%), there is no change to the GTV/CTV/PTV. So, correct, we would just bring in a physician at the time of contour review, plan review and plan approval. Good point, as always.
We wouldn't do this for every patient, every fraction. We would look at starting on 2nd-5th fractions for things we do a lot of, like pancreas. And some patients are not going to have good enough imaging; the docs would be called. Or when we treat something we don't treat a lot of.
The doc would be responsible for reviewing the new contours, the plan and the dosimetry. Would they take the time to review everything in detail? We all know the answer to that... some do, and some don't - same with films, plans, OTVs etc. Same with our therapists and physicists! Everyone here is either a resident or has been through a residency; and has the same stories to tell that I do! We have been selective on the staff supervising this to date, similar to how we staff SRS/SBRT/brachy.
@MegaVoltagePhoton With regards to make the machinery faster... so we will be waiting for better adaptive contour propagation, plan generation? And we would trust this 'more' then specialized therapists and physicists?
@ROforbetterorworse And to need a residency to contour normal tissue structures; on a subsequent volumetric image? I know we talk about 'hellpit residencies' on this site; but I never had to draw all the normal structures in residency - we had either dosimetrists or the software do that; and we would edit it in those edge cases. But it quickly became like that call when you were an intern to 'start an IV on a hard stick'... the nurse with way more experience than you couldn't do it; and you're not that likely to be better than him at it!
The adaptive SBRT time slots are coming down to 60 minutes each right now for the abdomen; faster for simpler anatomy that doesn't move (like prostate). But there is definitely more room for improvement.
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