ESTRO 2024 - Abstract Book

S3 ESTRO 2024 malware. It may also be possible, that all servers and the entire network are shut down preventively by the central IT department to prevent further spread of the malware. In both cases, "normal" treatment of patients is no longer possible. Past events showed, that such a situation can last up to several weeks. To ensure that treatment can still continue during such an event, 6 things need to be considered – some preventative, others during this extraordinary situation: 1. Preparedness in the event of a cyberattack (having a business continuity and recovery plan (BCP), identify systems and affected personnel, hold backups, regular testing of BCP) 2. Preventive measures (User awareness, antivirus policy, system patching) 3. Detection and reaction (detection tools, data breach identification, system isolation) 4. Respond (activation of a BCP: communication, treatment and data handling in case of an event) 5. Recovery (activation of recovery plan, check recovered data, merge recovered and during event created data) 6. Debriefing (recap past events, adapt reaction and recovery plan) The key inquiries that every department must address are: What preparations and measures are currently in place? How can we guarantee the safe treatment of patients? To streamline the approach to this often challenging task, we present a few user-friendly methods, primarily focusing on preparedness and the steps to be followed during the response phase. Preparedness involves the development of strategies, implementation of security measures, and creation of incident response plans to mitigate the impact of cyber threats. This encompasses activities like creating data backups (online, offline, even on paper) and establishing a clear plan for detecting, responding to, and recovering from cyberattacks. The response phase entails activating the previously defined business continuity plan. This initiation follows predetermined procedures and protocols to ensure that patient treatment can resume swiftly, minimizing downtime. It includes tasks such as informing relevant parties like employees and patients, conducting regular meetings and treatments with limited (or no) access to initial data. This may involve redirecting patients to other facilities temporarily or suspending treatments. Rigorous documentation of all actions taken is imperative during this phase. Invited Speaker

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Accumulation across different modalities

Monica Serban

Radiation Medicine Program, Princess Margaret Cancer Centre, Department of Radiation Oncology / Medical Physics, Toronto, Canada

Abstract:

The integration of EBRT and BT significantly enhances the therapeutic outcomes for gynecological cancer patients. Accurately accumulating radiation doses from BT and EBRT modalities, whether delivered sequentially over a single course of multi-fractionated RT or in the context of re-irradiation, has become increasingly important. However, the prevailing solutions for dose accumulation, typically done via rigid or deformable image registration, suffer from large uncertainties. This presentation reviews the complexities associated with dose summation between BT and EBRT and offers practical clinical solutions while exploring emerging methodologies and future directions We discuss the challenges inherent in dose summation between EBRT and BT, focusing on two components. The first component covers the uncertainties in current image registration methods between EBRT and BT images due to difference in patient setup, changes in soft tissue in the presence or absence of applicators, physiological changes in