适应性放射治疗 (ART) 是美国放射肿瘤学会发布的一系列白皮书中的最新主题，该系列白皮书涉及质量流程和患者安全。 ART 通过提高目标放射剂量的精确度来扩大治疗指数，从而允许剂量递增和/或最小化对正常组织的剂量。 ART 通过离线或在线方式进行；离线 ART 是在分次之间重新规划患者治疗计划的过程，而在线 ART 涉及患者在治疗台上调整计划。这是通过室内成像来实现的，该成像能够评估解剖变化并能够在治疗期间快速重新优化治疗计划。尽管 ART 几十年来一直以最简单的形式出现在临床实践中，但最近的技术发展使得 ART 能够在更多临床应用。随着临床患病率的增加、时间的压缩以及 ART 的相关复杂性，质量和安全考虑成为一个重要的重点领域。ASTRO 召集了一个跨学科工作组，就 ART 的关键工作流程和流程提供专家共识。建议是使用建立共识的方法制定的，工作组成员根据李克特 5 点量表（从“强烈同意”到“强烈不同意”）表示了他们的同意程度。 ≥75% 的评估者选择“强烈同意”或“同意”的预设阈值表示达成共识。不符合此阈值的内容将被删除或修订。建立和维护适应性计划需要基于团队的方法、经过适当培训和认证的专家以及大量资源、专业技术和实施时间。必须使用既定指南制定全面的质量保证计划，以确保以安全有效的方式进行所有形式的 ART。提供 ART 时的患者安全是每个人的责任，专业组织、监管机构、供应商和最终用户必须明确承诺共同努力，提供最高水平的质量和安全性。版权所有 © 2024。由 Elsevier Inc. 出版。

Adaptive radiation therapy (ART) is the latest topic in a series of white papers published by the American Society for Radiation Oncology addressing quality processes and patient safety. ART widens the therapeutic index by improving precision of radiation dose to targets, allowing for dose escalation and/or minimization of dose to normal tissue. ART is performed via offline or online methods; offline ART is the process of replanning a patient's treatment plan between fractions, whereas online ART involves plan adjustment with the patient on the treatment table. This is achieved with in-room imaging capable of assessing anatomical changes and the ability to reoptimize the treatment plan rapidly during the treatment session. Although ART has occurred in its simplest forms in clinical practice for decades, recent technological developments have enabled more clinical applications of ART. With increased clinical prevalence, compressed timelines and associated complexity of ART, quality and safety considerations are an important focus area.ASTRO convened an interdisciplinary task force to provide expert consensus on key workflows and processes for ART. Recommendations were created using a consensus-building methodology and task force members indicated their level of agreement based on a 5-point Likert scale, from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters selecting "strongly agree" or "agree" indicated consensus. Content not meeting this threshold was removed or revised.Establishing and maintaining an adaptive program requires a team-based approach, appropriately trained and credentialed specialists as well as significant resources, specialized technology, and implementation time. A comprehensive quality assurance program must be developed, using established guidance, to make sure all forms of ART are performed in a safe and effective manner. Patient safety when delivering ART is everyone's responsibility and professional organizations, regulators, vendors, and end-users must demonstrate a clear commitment to working together to deliver the highest levels of quality and safety.Copyright © 2024. Published by Elsevier Inc.