In today’s healthcare landscape, radiation oncology departments are under increasing strain, facing a surge in patient volume, more complex cases, tighter reimbursement models, and limited resources. At the American Association of Physicists in Medicine (AAPM) 2025 conference in Washington, DC, new research offered early promising insights into how technology can help address these pressures.
Notably, Varian-funded abstracts received high honors, underscoring their clinical relevance and early impact on emerging trends in cancer care. The prestigious “Best in Physics” award was presented to The University of Texas Southwestern for findings on next-generation cone-beam computed tomography (CBCT) reconstruction techniques.1 These findings suggest the potential to improve radiotherapy image quality for patients requiring motion-adapted treatment — a step toward expanding access to advanced care.
Additionally, two “Blue Ribbon” awards were presented to researchers at Johns Hopkins University for studies funded by Varian. One of these studies leverages a deep learning model to predict xerostomia in patients with head and neck cancer. By identifying risk before treatment begins, clinicians can proactively tailor radiation plans to spare salivary glands.2 The other study, also from Johns Hopkins University, used a model of abdominal motion to demonstrate that HyperSight* CBCT imaging may improve image quality and improve auto-contouring accuracy for patients receiving adaptive radiotherapy with significant organ motion.
Enhancing cancer care precision through advanced imaging
HyperSight imaging
Several abstracts at AAPM 2025 spotlighted Varian's Ethos adaptive radiotherapy system with optional HyperSight CBCT advanced imaging. Collectively, these studies presented abstracts providing an illustrative view of HyperSight’s ability to improve image quality, reduce artifacts, and enable daily dose calculation — all critical for delivering more precise and personalized cancer care.
Investigators at Princess Margaret Cancer Centre compared different techniques for using HyperSight CBCT imaging to calculate radiation doses during treatment on the TrueBeam radiotherapy delivery system.3 Their findings suggest that clinicians could rely on HyperSight CBCT images captured daily, rather than older CBCT scans, to guide treatment decisions. This capability may allow radiation delivery to be adjusted in real-time to match a patient’s changing anatomy, enabling individualized tumor treatment throughout the course of care.
Researchers at Nova Scotia Health presented early evidence that combining Ethos adaptive radiotherapy with HyperSight CBCT imaging can improve tumor target coverage and reduce exposure to critical structures in head and neck cancer patients. Their study showed significantly increased planning tumor volume (PTV) coverage and decreased dose to parotids and oral cavities compared to conventional radiotherapy plans — rendering six of seven conventional radiotherapy plans clinically unacceptable. These findings highlight new opportunities for precision in treating head and neck cancers, where tumors often lie close to sensitive anatomy.4
Motion monitoring
Motion monitoring emerged as a key theme among abstracts focused on improving radiotherapy planning image quality in the face of dynamic anatomic motion. At Washington University School of Medicine, researchers used millimeter wave technology to track respiratory and cardiac motion with greater precision, enhancing visibility of vital organs in patients receiving radiation for thoracic tumors.5
The University of Texas Southwestern showcased an innovative technique called “PCD Liver,” which tracks liver motion from a single x-ray projection, reducing the need for multiple scans. This method outperformed a graph neural network (GNN)-based model across multiple metrics for liver tumor localization error. Given that the American College of Surgeons estimates that fewer than 20% of patients with liver metastases are eligible for surgery because of tumor location, size, or medical inoperability, this technique suggests new hope for expanding access to effective treatment for this patient cohort.6
Operational efficiency through streamlined workflows
With cancer cases projected to rise by 70% by 20507 — and 50–70% of these requiring radiation therapy8 — oncology departments face mounting pressure to serve more patients each day. Achieving shorter planning cycles and faster treatment delivery will be essential, especially as staffing shortages and burnout continue to challenge care teams.9
HyperSight imaging
Investigators at University of Pennsylvania evaluated an offline adaptive CBCT planning workflow using Varian’s Halcyon system with optional HyperSight CBCT advanced imaging. In their study involving 27 patients, appointment times ranged from just 12 to 33 minutes — all without compromising image quality.10 These efficiency gains suggest a scalable strategy to increase daily patient throughput. This is especially impactful given that the Halcyon system is designed as a cost-effective, user-friendly platform tailored for high-demand clinical environments.
Metal artifact reduction
Metal implants — present in approximately 4% of radiotherapy patients — can significantly affect dose distribution and treatment planning, especially when located near or within the radiation field. Conventional imaging methods often struggle to accurately visualize these areas due to image distortion. Varian-sponsored research from Princess Margaret Cancer Centre suggests that HyperSight CBCT advanced imaging can reduce metallic artifacts. Using anthropomorphic pelvic models with metal implants, investigators observed qualitatively improved image clarity, supporting more accurate dose calculations and treatment planning.11
HyperArc
At the University of Kentucky, Varian-funded research explored workflow benefits in stereotactic radiosurgery (SRS) for recurrent head and neck cancers and intraocular malignancies. Leveraging multicriteria optimization and dosimetric scorecards, the team showed work that suggested that automation can make planning more consistent and effective, even in complex cases.12,13 For intraocular cases, automated RapidPlan workflows delivered improved tumor coverage while protecting critical structures like the optic nerve and lens. In their study of 17 patients, automated planning reduced treatment planning time by over 16 minutes and shortened delivery time by nearly a minute compared to manually generated SRS plans.12 These findings underscore the potential of advanced planning tools to simplify highly specialized treatments without compromising quality.
Optimizing and standardizing treatment planning
While image quality and protection of critical normal tissue are essential, the logistics of radiotherapy treatment planning remain a significant barrier in many clinical settings. Traditional planning workflows rely heavily on the availability and expertise of dosimetrists, medical physicists, and other experts — often leading to extended planning times, increased staffing demands, and slower adoption of advanced techniques, especially in resource-limited settings.14
RapidArc Dynamic
Varian's RapidArc Dynamic** optimization aims to streamline treatment planning and delivery through advanced dose prediction algorithms and built-in automation tools. These innovations are designed to reduce manual workload, simplify planning, and accelerate turnaround times – all while maintaining treatment quality.
Complementing this, UC San Diego tested a new approach using RapidArc Dynamic optimization in gynecological cancer cases. The system was used to automatically adjust the radiation beam shape and angles during planning, improving treatment plan quality in the 12 patients re-optimized with RapidArc Dynamic. Notably, the approach showed a reduction of dose to surrounding non-cancerous tissues while simplifying the planning process compared with conventional VMAT — especially beneficial for patients with irregular pelvic anatomy.15
Technology that scales
As healthcare systems continue to grapple with disparities in access to care, scalable technologies that support decentralized delivery of advanced care are gaining momentum.16 This theme was evident across several Varian-funded studies presented at AAPM 2025, highlighting how innovations like HyperSight are helping expand access to high-quality radiotherapy in diverse clinical settings.
Pelvic applications
Researchers at the University of Maryland demonstrated that HyperSight CBCT imaging, used on the TrueBeam platform, streamlines offline adaptive treatment planning for patients undergoing pelvic radiation therapy.17 Their findings suggest that this approach can support the broadening of access to high-quality radiation care.
Head and neck applications
At Nova Scotia Health, researchers demonstrated that HyperSight-enabled Ethos has the potential to improve tumor target coverage and spare organs-at-risk in patients with head and neck cancer. These cases are often complex due to the proximity of tumors to the oral cavity and other critical structures.4 The study highlighted the potential of advanced imaging in overcoming these challenges and extending precision care to a traditionally difficult treatment area.
Abdominal applications
Johns Hopkins University received a “Blue Ribbon” award for its Varian-funded research demonstrating the effectiveness of HyperSight CBCT imaging in abdominal tumor scenarios. Using anthropomorphic abdominal models, the team addressed real-world challenges such as diaphragmatic and bowel motion, as well as interference from metallic implants or surgical hardware. Their findings underscored the potential for HyperSight CBCT imaging to support adaptive radiotherapy for complex abdominal cases.18
Enabling advanced therapies without added complexity
Advanced techniques like lattice therapy and multi-target metastases treatment have traditionally required complex planning workflows, limiting their adoption in routine clinical practice. However, early data from MD Anderson and the University of Chicago suggest that Varian’s platforms can help simplify these approaches — making them more accessible without adding significant planning burden.15,19
At the University of Chicago, investigators evaluated the Ethos treatment planning system (TPS) in 99 patients with thoracic oligometastases. Their findings showed that TPS reduced planning treatment time from 135 to just 32 minutes, while also enhancing tumor target coverage compared to non-TPS workflows.15 These results point to a meaningful opportunity to treat more patients efficiently without compromising quality.
In a separate study, MD Anderson explored the feasibility for lattice radiation therapy of bulky liver tumors using the TrueBeam platform. The team showed that RapidArc Dynamic automated planning workflows can deliver dose distributions in challenging clinical cases. By automating calculations that previously made lattice therapy difficult to implement, this approach opens the door to broader use of advanced techniques in everyday practice.20
Economic validation
As oncology departments face increasing demand and limited resources, technologies that deliver both clinical and operational value are essential. A financial analysis conducted by Washington University School of Medicine suggests that Varian’s Halcyon platform — equipped with on-table simulation — can help meet these demands.
On-table simulation enables clinicians to plan and deliver treatment in a single session rather than across separate appointments. Using Time-Driven Activity-Based Costing (TDABC) analyses to assess resource utilization across different scenarios, researchers found that Halcyon-enabled on-table simulation resulted in clear cost savings. The integrated system allowed clinics to treat up to two more patients daily while maintaining positive net revenue — all without requiring additional staff or equipment.20
Through strategic investment in early research, Varian is helping to accelerate the development and validation of technologies that make innovation in cancer care not just possible, but practical. The AAPM 2025 scientific agenda served as a showcase of this progress — offering a directional roadmap for how radiation oncology can meet today’s clinical, operational, and economic demands.
*HyperSight is an optional feature on Varian’s TrueBeam, Edge, Halcyon, and Ethos systems.
**RapidArc Dynamic is available as an optional feature on the Eclipse v18.1 and TrueBeam 4.1 systems.
The results achieved by Varian’s customers described here are based on studies performed in the customer’s unique clinical setting. Because there is no “typical” clinical setting and many variables exist, there is no guarantee that other customers will achieve the same results.
- Zhang Y, et al. Motion-resolved dynamic CBCT reconstruction using prior-model-free spatiotemporal Gaussian representation PMF-STGR. UTSW.
- Wan B, et al. Explainable xerostomia prediction with decoupled high resolution class activation map. Johns Hopkins.
- Aubert S, et al. Comparison of CBCT Dose Calculation Accuracy Between TrueBeam HyperSight Image Reconstruction Algorithms. Princess Margaret Cancer Centre.
- Martin PR, et al. HyperSight-ARCHER study improved target coverage and organ-at-risk sparing for head and neck cancer with Ethos adaptive radiation therapy. Nova Scotia.
- Zhu J, et al. 4D-CT based on millimeter wave mmWave respiratory and cardiac phase tracking. WUSM.
- Xie J, et al. A conditional point cloud diffusion model for deformable liver motion tracking via a single x-ray projections PCD-liver. UTSW.
- Ferlay, Jacques, et al. "Global Cancer Observatory: Cancer Tomorrow." International Agency for Research on Cancer, 2022, gco.iarc.fr/tomorrow.
- Atun, Rifat, et al. "Radiotherapy and theranostics: a Lancet Oncology Commission." The Lancet Oncology, vol. 25, no. 11, Nov. 2024, e545-e580. https://doi.org/10.1016/S1470-2045(24)00407-8.
- American Society for Radiation Oncology. "Widespread staff shortages exacerbate pressures facing radiation oncology clinics; ASTRO Advocacy Day calls for action." ASTRO, 23 May 2023.
- Garcia B, et al. Evaluation of an Offline Adaptive CBCT Planning Workflow for Varian Halcyon with HyperSight. UPenn.
- Liang, Yuwen, et al. "The impact of metal implants on the dose and clinical outcome of radiotherapy (Review)." Molecular and Clinical Oncology, vol. 21, no. 4, 18 July 2024, article no. 66. https://doi.org/10.3892/mco.2024.2764.
- McCathy S, et al. Automated Treatment Planning for Stereotactic Recurrent Head and Neck Cancers via Knowledge-based Planning, Multicriteria Optimization, and Dosimetric Scorecards. University of Kentucky.
- Cochran C, et al. Automated Treatment planning for LINAC-based stereotactic radiosurgery of intraocular malignancies via HyperArc Knowledge-based planning. University of Kentucky.
- Wang D, et al. "Medical physicist should be a planner in the treatment planning team." Journal of Applied Clinical Medical Physics, 14 July 2025, https://doi.org/10.1002/acm2.70185.
- Ray X, et al. Evaluating a novel dynamic collimator rotation solution with static angle modulated ports for GYN planning. UCSD.
- Chaurasia, Akash R., et al. "Health Disparities in Radiation Oncology: Our Call to Action." Applied Radiation Oncology, vol. 9, no. 4, 24 Dec. 2020, pp. 6-8, appliedradiationoncology.com/articles/health-disparities-in-radiation-oncology-our-call-to-action.
- Cammin J, et al. Feasibility of efficient offline adaptive replanning with HyperSight High-Performance Cone-Beam CT on TrueBeam for pelvis RT. University of Maryland.
- Adam DP, et al. Novel fast cone-beam CT for adaptive radiotherapy assessment of image distortion, auto-contouring, and dose delivery accuracy in the presence of periodic subject motion. Johns Hopkins.
- Court L, et al. Feasibility of RapidArc Dynamic for Lattice Radiation Therapy of Bulky Liver Tumors. MD Anderson.
- Chen X, et al. Financial viability analysis of on-table simulation enabled Halcyon using time driven activity-based costing. WUSM.