Acceleration of online adaptive workflows for state-of-the-art and emerging radiotherapy treatment solutions

Online adaptive radiotherapy (OART) represents a significant advancement in cancer treatment, enabling plan adaptation to account for daily anatomical variations. However, its clinical implementation faces significant challenges, particularly in achieving time-efficient workflows while maintaining treatment quality. This thesis investigates different but complementary aspects of OART to enhance its clinical viability. This thesis first investigates how to leverage the best value out of two critical steps of current adaptive workflow: the automatic segmentation and the automatic planning. Then it investigates how to bring efficient online adaptive workflow for two emerging treatment techniques the proton arc therapy and the conformal FLASH therapy, each presenting unique challenges for adaptation. Through these investigations, this work contributes to both current clinical practice and emerging radiotherapy technologies, aiming to bridge the gap between OART theoretical potential and practical implementation. The findings emphasize the importance of balancing dosimetric benefits with temporal constraints, particularly for proton therapy-based treatments where adaptation time significantly impacts clinical viability.