The Platform: ChartCheck
ChartCheck actively monitors patient data to ensure quality and safety for ongoing treatments. Using data pulled directly from ARIA, weekly check results are displayed on a single page in an intuitive, easily-digestible format. ChartCheck spots treatment discrepancies as they occur, making routine weekly checks proactive and simple while facilitating compliance with AAPM TG-275. Critical patient treatment information is available on-demand to confirm the accuracy of treatment delivery. With automatic notifications for failing checks, plan errors can be investigated and resolved faster, resulting in higher quality patient care.
Building on the seamless integration of ChartCheck with ARIA, Radformation has released ChartCheck Adaptive™: a zero-click automated offline adaptive assessment solution designed to help radiotherapy clinics consistently evaluate anatomy changes and dose delivery (daily and accumulated) using the daily CBCT images acquired during treatment.
Offline Adaptive and Replanning Decisions
Offline adaptive radiotherapy is gaining traction as clinics recognize the clinical value of responding to anatomical changes during treatment. However, current decision-making relies heavily on subjective visual assessment of daily CBCT images and institution-specific protocols that vary widely in their criteria and implementation.
Even the best treatment plan is only as good as a patient’s anatomical match on any given day. Over the course of therapy, trends such as patient weight loss, mask fit, or tumor regression can alter dose distribution and compromise the original plan’s accuracy. Determining if a replan is appropriate often remains limited to visual review of daily CBCTs to identify deviations—a process with an inherent degree of subjectivity.
Establishing a more quantitative picture of plan fit requires considerably more time and resources: exporting image sets, generating deformed structures, recalculating dose distributions, and analyzing new DVHs. This process demands time and expertise, depends heavily on data quality and workflow consistency, and is impractical to perform routinely for every patient at every fraction.
Introducing ChartCheck AdaptiveTM
Radformation’s answer is ChartCheck Adaptive, an addition to the existing ChartCheck platform designed to make automated adaptive radiotherapy assessment a reality. This offline adaptive decision support tool monitors daily CBCT data and evaluates treatment delivery on each fraction, applying quantitative dose-volume histogram (DVH) and volumetric assessment criteria to calculate how well the delivered dose aligns with the original plan.
The zero-click process operates in the background without interrupting clinical throughput. The system leverages data acquired during standard treatment like pre-treatment imaging, daily CBCTs, and optional machine log files, eliminating the need for additional simulations or manual setup. By integrating automated contouring, Monte Carlo dose calculation, and constraint checking into a unified workflow, ChartCheck Adaptive provides the comprehensive quantitative picture that has historically been too time-intensive to obtain routinely.
The result: systematic decision support based on objective dosimetric criteria rather than subjective visual assessment alone. Clinicians receive a complete view of both fractional and cumulative dose assessment, enabling confident, data-driven replanning decisions while maintaining clinical efficiency throughout the treatment course.
Putting the Pieces Together
This new adaptive assessment functionality leverages existing Radformation solutions, working behind the scenes within the ChartCheck platform to provide a crisp dosimetric assessment of each treatment fraction delivery.
Together, these components enable departments to track the true delivered dose throughout the treatment course and to identify when anatomical or positional changes begin to impact plan quality.
Every patient’s anatomy changes over the course of treatment. Traditionally, evaluating these changes offline has been complex, slow, and hard to scale: relying on subjective visual assessment or labor-intensive manual workflows that are impractical to perform routinely.
ChartCheck Adaptive™ changes this. With a zero-click workflow that automatically recalculates dose, verifies constraints, and flags when adaptation may be needed, offline adaptive assessment becomes a seamless, daily process rather than an occasional burden. Continuous patient monitoring with automated notifications ensures clinicians can intervene precisely when it matters.
The result is a shift from reactive, experience-based decisions to proactive, data-driven patient monitoring. ChartCheck Adaptive provides the dosimetric insights needed to make confident replan decisions while maintaining clinical efficiency, making quantitative adaptive assessment a practical reality for every patient, every fraction.
To get more information about our approach to offline adaptive assessment with ChartCheck, schedule a demo to learn more.
ChartCheck 1.6 is CE Marked and available now where CE Mark is recognised. US FDA 510(k) cleared.
Sara La Civita, MS, MPE, is a Medical Physicist at Radformation, where she serves as a Clinical Research Coordinator, helping bridge the gap between industry innovation and clinical practice. Prior to joining Radformation, she practiced as a clinical medical physicist in Italy before transitioning to industry. Over the past 15 years, she has held diverse roles spanning sales, clinical applications, and research collaboration, bringing both clinical and commercial insight to her work.