Radiotherapy treatment planning workstation: Overview, Uses and Top Manufacturer Company

Posted on February 28, 2026 | by drthomas

Introduction

A Radiotherapy treatment planning workstation is a specialized computer system (hardware plus software) used to design and verify radiotherapy treatment plans before any radiation is delivered to a patient. It is a safety-critical part of radiation oncology: decisions made at the workstation directly influence how a linear accelerator (LINAC) or other radiotherapy delivery system will shape and deliver dose to the tumor while limiting dose to normal tissues.

Although it is “just a workstation” in the physical sense, it is best understood as the human-facing control point for a complex clinical computation pipeline. Modern radiotherapy plans can include thousands of parameters (control points, multileaf collimator leaf positions, dose rates, gantry speeds, and more). The workstation is where these parameters are created and checked against clinical intent, machine limits, and department protocols. Any mismatch—wrong patient data, wrong beam model, wrong technique, or wrong export—can translate into under-treatment (risking tumor control) or over-treatment (increasing toxicity).

In day-to-day hospital operations, this medical equipment sits at the center of a multidisciplinary workflow involving radiation oncologists, medical physicists, dosimetrists, radiation therapists, biomedical engineers, and IT teams. The workstation also touches governance areas that matter to administrators and procurement leaders: licensing, cybersecurity, data storage, uptime expectations, vendor support, and change control.

Planning workstations are also increasingly tied to broader digital health initiatives. They often sit in the same ecosystem as oncology information systems (OIS), electronic medical records, imaging archives, and quality management tools. Some departments use centralized planning servers with multiple client workstations; others use virtualized environments; some support controlled remote planning for peer review or networked service models. Each approach changes the risk profile and the operational responsibilities for IT and clinical leadership.

This article explains what a Radiotherapy treatment planning workstation does, when it is used (and when it should not be used), what a facility needs before starting, basic operation, patient safety practices, output interpretation, troubleshooting, cleaning principles, and a practical global market overview for planning systems and related services. It is written as a general overview; it does not replace local training, local commissioning documentation, or manufacturer instructions for use.

What is Radiotherapy treatment planning workstation and why do we use it?

Clear definition and purpose

A Radiotherapy treatment planning workstation is the primary computing environment where a radiotherapy treatment plan is created, evaluated, approved, and prepared for transfer to the treatment delivery system. In many institutions, the workstation is a client connected to a centralized planning server and database; in others, it may be a standalone workstation. The software component is commonly referred to as a treatment planning system (TPS), and it is typically regulated as medical device software (classification varies by jurisdiction).

In practical terms, the “workstation” includes much more than a single PC. Typical architectures include:

Client workstations used for contouring, planning, and review (often multiple monitors).
A planning database holding images, structures, plans, and dose objects.
Dose calculation engines running locally or on dedicated servers/compute nodes (sometimes with GPU acceleration).
License services (floating or named-user licensing) that can be a single point of failure if not designed with redundancy.
Integration services for DICOM import/export and connectivity to OIS, PACS, and QA systems.

Departments sometimes separate use cases into different workstation types (even if the software is the same): contouring stations, planning stations, physician review stations, and physics QA/review stations. This segregation can be a safety and workflow benefit when it is matched with clear role-based access and permissions.

Its core purpose is to translate a clinical prescription (for example, dose per fraction and number of fractions) into a deliverable plan: beam arrangements, machine parameters, and dose distributions that can be executed by a LINAC or other modality under a record-and-verify/onco-information system.

“Deliverable” is a key word. A plan is not only a set of dose pictures. It is a structured set of machine instructions that may include:

Photon/electron plans: control points, segment shapes, monitor units (MU), jaw and MLC positions, couch/gantry/collimator angles, and sometimes gating instructions.
Proton/heavy ion plans: spot maps, energy layers, scanning patterns, and robust parameters for setup/range uncertainty.
Brachytherapy plans (when supported): applicator definitions, source dwell positions and dwell times, and dose prescriptions tied to anatomical points/volumes.

Because the plan is an executable instruction set, the workstation is tightly linked to commissioning status, machine constraints, and the record-and-verify system’s ability to interpret and lock the intended parameters.

Common clinical settings

You will find this clinical device in:

Hospital-based radiation oncology departments
Comprehensive cancer centers and academic hospitals
Private radiotherapy clinics
Proton/heavy ion centers (with modality-specific planning requirements)
Networked health systems that support remote or centralized planning (varies by manufacturer and local policy)

In addition, planning workstations are often present in:

Satellite or hub-and-spoke networks, where complex planning is centralized and delivery occurs across multiple sites.
Training and education labs that use de-identified datasets or vendor-provided sample cases.
Research environments where planning is performed under ethics approvals and strict data governance.

Physically, the workstation is commonly located in a dosimetry office or planning room designed for sustained computer work: controlled lighting (to reduce glare), ergonomic seating, and sufficient privacy to protect patient information displayed on screens. Some centers also maintain a dedicated “quiet zone” or protected time for complex planning tasks to reduce interruptions and cognitive errors.

Key benefits in patient care and workflow

A Radiotherapy treatment planning workstation supports patient care by enabling:

Personalized dose shaping around complex anatomy
Plan evaluation tools that make trade-offs visible (tumor coverage vs. organ-at-risk sparing)
Standardization through templates, protocols, and naming conventions (site-dependent)
Collaboration via review workflows, peer review, and multidisciplinary discussion
Traceability with plan reports, approvals, and audit trails (features vary by manufacturer)

Operationally, it helps teams manage throughput and quality by organizing cases, tracking plan status, and supporting exports to downstream systems.

Additional practical benefits—especially in modern high-complexity radiotherapy—include:

Ability to compare multiple techniques (e.g., 3D-CRT vs. IMRT vs. VMAT) for the same patient to inform the most appropriate approach.
Support for hypofractionation and stereotactic techniques, where high dose per fraction increases the importance of precision and plan evaluation tools.
Integration with motion management workflows (when available), such as 4DCT-based planning, gating, or breath-hold strategies.
Structured plan documentation, helping downstream staff understand immobilization, image guidance requirements, bolus use, and special instructions.

From a patient outcome perspective, these capabilities can contribute to better target coverage and reduced dose to sensitive organs—one of the main ways radiotherapy has reduced side effects over time while maintaining or improving tumor control.

Plain-language “how it functions”

At a high level, the workstation:

Imports patient imaging—most commonly CT (computed tomography) simulation images, and sometimes MRI (magnetic resonance imaging) or PET (positron emission tomography).
Aligns datasets using image registration (e.g., CT-to-MRI fusion) when needed.
Supports contouring (delineation) of target volumes and organs at risk (OARs).
Calculates dose using physics-based algorithms on a 3D patient model derived from imaging.
Optimizes beam modulation for advanced techniques such as IMRT (intensity-modulated radiotherapy) and VMAT (volumetric modulated arc therapy).
Displays outputs such as isodose lines and DVHs (dose–volume histograms).
Exports a final plan (often using DICOM RT, a radiotherapy extension of the DICOM imaging standard) to the oncology information system/record-and-verify for treatment delivery.

To make this more concrete for non-specialists: the CT scan provides a 3D map of the patient anatomy. The workstation uses that map to build a model of how radiation will interact with tissues. Planners then choose beam directions (or arcs), define targets and sensitive structures, and ask the computer to shape the beams so the tumor gets the intended dose while normal tissues get as little as possible. The software’s optimization is typically “inverse planning”: instead of drawing beam shapes by hand, the planner sets goals (coverage and organ constraints), and the system iteratively adjusts beam fluence/MLC motion to meet those goals.

In many workflows, the workstation also generates outputs used by therapists during treatment, such as:

Reference images (for example, digitally reconstructed radiographs) to help verify patient setup.
Structure sets and couch models that influence clearance and collision considerations.
Plan versions and approval states that help ensure only the correct final plan is treated.

How medical students typically encounter or learn this device

Medical students and residents most often meet the workstation during a radiation oncology rotation, a medical physics lecture, or a contouring workshop. Early learning usually focuses on:

Understanding targets vs. organs at risk and why delineation matters
Reading plan displays (axial/sagittal/coronal views and isodose lines)
Interpreting DVHs and recognizing common pitfalls
Observing the plan approval pathway (physicist checks, physician approval, and therapist verification)

Hands-on use is typically supervised and may occur in a training environment rather than on live patient cases, depending on local policy.

As trainees advance, they may also be introduced to concepts that connect planning decisions to clinical outcomes and safety, such as:

The difference between GTV/CTV/PTV (and why margins exist).
How immobilization and image guidance affect planning margins and plan robustness.
Why certain sites rely heavily on protocol constraints (for example, lung, head-and-neck, prostate) and how trade-offs are made.
How plan complexity (high modulation) can affect deliverability and QA burden.

Even without doing hands-on optimization, simply watching planners and physicists review a case can teach how multidisciplinary decision-making works in radiation oncology.

When should I use Radiotherapy treatment planning workstation (and when should I not)?

Appropriate use cases

A Radiotherapy treatment planning workstation is typically used for:

Creating treatment plans for external beam radiotherapy (e.g., 3D-CRT, IMRT, VMAT, SBRT/SRS where available)
Planning for specialized modalities (e.g., electron therapy, brachytherapy, proton therapy), when supported and commissioned
Re-planning after changes in anatomy or setup, including adaptive workflows (capabilities vary by manufacturer and department)
Plan comparison and peer review (for quality improvement and safety)
Education, simulation, and research planning with appropriate approvals and data governance

Additional common clinical scenarios where the workstation is central include:

Palliative radiotherapy, where speed is important but safety checks remain essential (e.g., spine, brain, bone metastases).
Re-irradiation planning, which may require composite dose evaluation, careful summation strategies, and conservative constraints.
Multi-phase or sequential plans (for example, initial fields followed by a boost), where plan naming, dose summation, and version control are critical.
Special techniques such as total body irradiation (TBI) or craniospinal irradiation (CSI) in centers that have implemented and commissioned them.

The workstation may also be used for non-treatment tasks like generating dose estimates for multidisciplinary discussions, trial feasibility assessments, or protocol development—provided these activities do not blur into unapproved clinical use.

Situations where it may not be suitable

It may be inappropriate or unsafe to use the workstation for clinical planning when:

The planning system or beam model is not commissioned for the intended technique or machine configuration
The workstation is outside of its validated configuration (e.g., unapproved software update, unverified patch, untested GPU/driver changes)
Patient imaging is incomplete, incorrectly identified, or mismatched (wrong patient, wrong study, wrong orientation)
The workflow bypasses required checks (e.g., independent plan review, physics QA steps, or local approval policies)
The case requires capabilities not available at that site (for example, motion management or specific dose calculation methods not implemented locally)

Additional “not suitable” situations often relate to scope creep—using the workstation for tasks it was not validated to perform in that department. Examples include:

MR-only planning or synthetic CT workflows in departments that have not validated the end-to-end process.
Unvalidated adaptive radiotherapy approaches (for example, making on-the-fly plan changes without a defined, approved adaptive protocol).
Using the planning workstation as a general-purpose PC (email, web browsing, personal storage). This increases cybersecurity risk and can violate hospital policy for systems handling patient data.
Planning with incomplete clinical context, such as missing operative notes, missing laterality confirmation, or unclear prescription intent. The workstation cannot compensate for missing upstream clinical decisions.

Safety cautions and general contraindications (non-clinical)

General cautions include:

Do not treat planning outputs as “self-validating”; the workstation is a tool, not an independent authority.
Do not rely on templates or copied plans without careful review; “copy-forward” errors are a known risk pattern in complex workflows.
Do not proceed when there is uncertainty about system status (commissioning, version control, database integrity, or network transfer).

Additional practical cautions include:

Be cautious with automation features (auto-contouring, knowledge-based planning, script-driven planning). These can improve efficiency but can also propagate systematic errors if templates, training data, or defaults are wrong for the patient anatomy.
Avoid making “small quick edits” late in the process without re-running required checks. Minor-seeming changes (e.g., margin edits, density overrides, normalization changes) can materially affect dose metrics.
Treat any uncertainty in laterality, orientation, or coordinate system as a hard stop. Wrong-side planning errors are rare but high-severity events.

Clinical decisions should be made by qualified professionals using local protocols, with appropriate supervision for trainees.

What do I need before starting?

Required setup, environment, and accessories

Most departments need the following before routine use:

Hardware capable of dose calculation and 3D visualization, often including high-performance CPU/GPU resources (requirements vary by manufacturer)
Diagnostic-quality displays appropriate for contouring and plan review, with consistent calibration practices per local policy
Stable power (often with an uninterruptible power supply for clean shutdowns)
Secure networking to connect with CT simulation, PACS (picture archiving and communication system), oncology information system (OIS), and backup storage
User authentication integrated with hospital IT where feasible (role-based access is a common expectation)

Common peripherals include keyboard/mouse, multi-monitor setups, and sometimes specialized input devices. Licensing may be node-locked, floating, or server-based (varies by manufacturer).

In addition, departments often plan for operational realities that are not obvious in a basic requirements list:

Performance headroom: dose calculation and optimization can be computationally heavy. Underspecified workstations create bottlenecks and encourage unsafe shortcuts (e.g., avoiding final high-accuracy calculations due to time).
Storage and archiving capacity: CT/MRI/PET datasets, multiple plan iterations, dose objects, and logs add up quickly. Retention policies should align with legal requirements and clinical need.
Ergonomics and environment: planning is high-concentration work. Good seating, adjustable monitor positioning, and controlled lighting reduce fatigue-related errors.
Physical security: workstations displaying patient data should be positioned to reduce shoulder-surfing and should follow local rules for screen locking and unattended sessions.

Where virtual desktops or remote access are used, facilities must also ensure image rendering performance, acceptable latency, and secure identity controls (often including multi-factor authentication, depending on policy).

Training and competency expectations

Because the workstation influences radiation dose delivery, training is typically formalized:

Radiation oncologists: prescription review, contouring standards, plan evaluation, and approval responsibilities
Dosimetrists/planners: plan creation, optimization, documentation, and adherence to protocols
Medical physicists: commissioning, QA program oversight, independent plan checks, and change control
Radiation therapists (RTTs): downstream plan verification and treatment execution in the record-and-verify environment
Biomedical engineering and IT: uptime, hardware lifecycle, cybersecurity, backups, and vendor coordination

Local competency sign-off and periodic refreshers are common, especially after software upgrades or technique expansions.

For many departments, “competency” is not a single event but a layered model:

Baseline TPS navigation (opening cases, viewing dose, checking identifiers).
Site-specific planning competency (e.g., breast vs. prostate vs. head-and-neck).
Technique-specific authorization (e.g., IMRT/VMAT vs. SBRT/SRS), often requiring supervised cases and documented sign-off.
Clinical trial credentialing (where applicable), because trials may impose strict planning and reporting rules.

It is also common to run internal workshops after major upgrades to highlight changes in defaults, new warnings, new optimization behavior, or revised plan export procedures.

Pre-use checks and documentation

Before planning begins (and often at defined intervals), teams typically verify:

System availability, correct login role, and correct software version
Beam model selection and machine configuration for the intended unit
Access to the correct patient dataset, with patient identifiers verified
Imaging integrity (orientation, slice spacing, and presence of relevant series)
Required approvals present in the workflow (e.g., prescription and simulation documentation)

Documentation expectations vary, but many sites maintain a planning checklist, plan report standards, and audit trails for approvals and plan exports.

Departments frequently add additional “pre-use” controls to reduce preventable errors, such as:

Verifying the CT-to-electron density calibration in use is current and appropriate for the scanner/protocol.
Confirming that any couch model, immobilization device modeling, or bolus workflow matches departmental practice.
Checking that the plan is being created under the correct course or treatment intent (curative vs. palliative) if the TPS/OIS uses such categorizations.
Ensuring the correct structure set is active (especially when multiple structure sets exist due to re-contouring or adaptive workflows).

These checks are not “extra bureaucracy”; they are practical defenses against common failure modes like wrong image series selection, wrong machine selection, and unintended changes in defaults.

Operational prerequisites: commissioning, maintenance readiness, consumables, and policies

Operational readiness usually includes:

Acceptance testing after installation to confirm the workstation performs as specified
Commissioning (medical physics-led) to validate dose calculation and workflow for each machine/energy/technique
End-to-end testing that simulates the full pathway from imaging through planning, export, QA, and delivery verification
A change control process for updates, patches, templates, and beam model changes
Backup and disaster recovery planning for databases and critical configuration files
Service arrangements (vendor support, spare parts, remote access policies) coordinated across procurement, biomed, and IT

Consumables are usually minimal, but printing, secure storage, and archival infrastructure may be relevant.

Commissioning and end-to-end testing deserve special emphasis because they define what “safe to use” means locally. Depending on modality and technique, commissioning commonly includes:

Beam model verification across field sizes (including small fields where applicable), depths, and off-axis positions.
Validation of heterogeneity corrections in representative anatomical scenarios (lung, bone, air cavities).
Tests for MLC modeling parameters that strongly affect IMRT/VMAT accuracy (e.g., leaf transmission and leaf-end effects).
Verification of DICOM RT export/import integrity to the OIS and, where relevant, to QA systems.

Maintenance readiness also includes planning for “quiet failures”—conditions that do not crash the software but degrade safety or accuracy, such as:

Gradual storage saturation causing database instability.
Time synchronization problems between servers leading to confusing audit trails.
Operating system changes that alter printer drivers, GPU drivers, or security settings.

Policies are the glue that keeps a high-tech tool safe over time. Effective departments document at least:

Standard naming conventions for plans, beams, and structures.
Approved algorithm settings and grid sizes per technique/site.
A defined plan approval state model (what “approved” means, who can approve, and how changes are controlled).
Downtime procedures when servers or networks are unavailable.

Roles and responsibilities (clinician vs. biomedical engineering vs. procurement)

A practical division of responsibilities often looks like:

Clinicians (radiation oncologists): clinical intent, contouring oversight, plan approval, and clinical governance decisions
Medical physicists: commissioning, periodic QA, independent checks, and safety sign-off for system changes
Dosimetrists/planners: day-to-day plan creation and documentation under department protocols
Biomedical engineering: hardware lifecycle, device inventory, service coordination, and preventive maintenance planning
IT/cybersecurity: identity management, patching strategy, network segmentation, backups, and incident response readiness
Procurement/administration: contracting, licensing, total cost of ownership planning, and ensuring staffing/training resources

Clear ownership is a safety feature: ambiguity increases the risk of unreviewed changes and delayed incident response.

Many organizations formalize these responsibilities through a governance group (for example, a radiotherapy technology steering committee) that reviews upgrades, major workflow changes, incident trends, and capacity planning. This multidisciplinary oversight helps align clinical priorities with technical risk management—particularly important when a new technique (SBRT, SRS, adaptive planning) is introduced.

How do I use it correctly (basic operation)?

Workflows vary by model and departmental policy, but many steps are broadly universal.

Basic step-by-step workflow (commonly universal)

Confirm clinical inputs: prescription intent, laterality, and required technique/site protocol.
Select the correct patient in the planning database and verify identifiers.
Import imaging (usually CT simulation) and confirm correct study/series.
Review image quality: orientation, artifacts, scan extent, and immobilization context as documented.
Register additional datasets (CT–MRI, CT–PET) if used, and verify alignment visually in multiple planes.
Contour structures: targets and organs at risk; apply institutional naming conventions.
Assign density information via CT calibration and any approved overrides (if applicable by local policy).
Choose technique and machine model (LINAC, energy, modality) that matches the clinical intent and commissioning scope.
Create beam geometry (fields or arcs), including isocenter placement and basic collimation/MLC setup.
Set planning objectives/constraints consistent with departmental protocols.
Optimize and calculate dose, then re-calculate final dose with the approved algorithm settings.
Evaluate the plan using isodose distributions, DVH metrics, and deliverability checks.
Complete required checks and approvals (planner check, physicist review, physician approval, peer review as applicable).
Export the plan to the OIS/record-and-verify and confirm successful transfer and correct plan version.
Archive and document the final plan report and any required QA artifacts.

In practice, each of these steps contains sub-steps that are worth making explicit, especially for high-complexity techniques:

Before contouring, many departments verify that the CT includes full anatomical extent needed for both targets and OARs. Missing superior/inferior scan extent can force unsafe assumptions.
During contouring, planners often check for structure overlaps (e.g., PTV overlapping an OAR) because overlaps can distort DVH metrics and optimization behavior.
When selecting technique and machine model, teams confirm not only the machine name but also the correct energy and delivery mode, because small differences (flattening-filter-free vs. standard, different MLC models) can change deliverability and dose.

For advanced workflows, additional steps often included (site-dependent and policy-dependent) are:

Motion management review (e.g., 4DCT phase selection, internal target volume creation, gating window definition).
Plan robustness evaluation (particularly in proton therapy and some stereotactic workflows).
Patient-specific QA preparation, such as exporting to a QA phantom workflow or generating log-file–based QA tasks, depending on local practice.
Creation of treatment setup documentation, including image guidance instructions (matching anatomy, use of implanted markers, tolerance thresholds) so therapists have clear, standardized guidance.

Typical settings and what they generally mean (high-level)

Common planning settings include:

Dose calculation algorithm (e.g., convolution/superposition, Monte Carlo, or other approaches): affects accuracy in heterogeneous regions; selection must be locally validated.
Calculation grid resolution: smaller grid can improve detail but increases computation time; departments standardize this per site/technique.
Heterogeneity correction: accounts for tissue density differences; use follows commissioning scope and protocol.
Optimization priorities and constraints: weights that guide how the system balances competing goals (target coverage vs. organ sparing).
Machine/beam model: the commissioned representation of the treatment unit, including multileaf collimator (MLC) behavior.

A consistent theme: defaults are not the same as “approved.” Settings should follow commissioning outcomes and departmental policy.

To add more context, settings that commonly affect plan quality and safety—sometimes in subtle ways—include:

Dose reporting mode (for systems that distinguish dose-to-water vs. dose-to-medium). This can influence reported DVH numbers and should be consistent with departmental standards.
Monte Carlo statistical uncertainty settings (when used): lower uncertainty improves accuracy but requires more computation; departments standardize acceptable uncertainty for clinical use.
Leaf motion constraints and smoothing in IMRT/VMAT optimization: overly permissive settings can create plans that are theoretically optimal but difficult to deliver accurately.
Control point spacing and arc resolution for VMAT: affects plan modulation detail, delivery time, and sometimes QA pass rates.
Inclusion of support structures (couch tops, rails, immobilization devices) and bolus modeling: these can materially affect surface dose and beam attenuation for certain angles.

Understanding which settings are “clinical knobs” and which are “physics-validated constants” is part of safe TPS operation.

How do I keep the patient safe?

A Radiotherapy treatment planning workstation is not physically connected to the patient, but it can still introduce patient harm through incorrect plans, incorrect data transfer, or workflow failures. Safety depends on layered controls.

A useful way to think about planning safety is that most serious incidents are not caused by a single dramatic error. They are usually a chain: an upstream ambiguity (wrong series), combined with an assumption (copied template), combined with a missed check (export not verified), leading to treatment mismatch. The workstation is where many of these chains can be broken—if the workflow is designed to make the right action easy and the wrong action hard.

Core safety practices across the planning lifecycle

Patient identity controls: verify patient name/ID at import, during planning, and at export; avoid working from ambiguous worklists.
Right image, right orientation: confirm laterality markers, head-first/feet-first orientation, and correct scan series.
Standard naming conventions: consistent structure and plan naming reduces downstream confusion and wrong-plan selection.
Independent review: second checks and peer review catch errors that the primary planner may miss (local policy varies).
Deliverability and machine constraints: ensure the plan respects mechanical limits, collision risks, and approved delivery modes.
Transfer verification: confirm the exported plan matches the approved plan version in the record-and-verify system.

Additional safety practices commonly used in mature departments include:

Prescription-to-plan consistency checks: verify dose per fraction, number of fractions, laterality, and treatment site match the prescription and simulation documentation.
Independent dose/MU verification: use a secondary calculation method or independent check process, especially for high-dose or high-complexity cases (exact method varies by institution).
Plan status control (“locking”): once approved, the plan should be protected from unintended edits, with a clear process for revisions that creates a new version and triggers re-approval.
Structured peer review for complex cases: stereotactic plans, pediatrics, re-irradiation, and unusual anatomies benefit from a formal peer review pathway.

Human factors and alarm handling

Many planning incidents are not “software failures” but human-system interaction failures:

Treat warnings and alerts as prompts to pause and understand, not hurdles to click through.
Reduce interruptions during critical steps (final calculation, export, and approval).
Use checklists for high-risk transitions: plan handoff, physician approval, and plan export.

Human factors improvements often provide large safety gains with little cost. Examples include:

Designing the workflow so that “final calculation” is a deliberate step with an explicit checklist (correct algorithm, correct grid, correct machine, correct dose reporting).
Using “read-back” habits in team communication (e.g., when a physician requests a plan change, the planner repeats back the requested change to confirm intent).
Minimizing ambiguous naming like “Plan 1 copy” or “New plan final final,” which increases the chance of wrong-plan selection.

Change control and cybersecurity as patient safety

Planning systems are increasingly networked and software-dependent:

Use formal change control for software upgrades, patches, new templates, and beam model changes.
Maintain role-based access and audit logs where available.
Plan for backup and recovery and test restoration periodically.
Coordinate antivirus/endpoint security with performance needs and vendor recommendations; overly aggressive scanning can disrupt planning databases.

A robust incident reporting culture (including near-misses) is a practical safety tool: it helps teams improve processes without waiting for harm.

Cybersecurity deserves explicit mention because radiotherapy planning depends on data integrity. A ransomware event, unauthorized access, or silent database corruption can create clinical risk even if “the TPS still opens.” Practical safeguards many departments implement include:

Network segmentation for radiotherapy systems and strict control of external connectivity.
Defined maintenance windows for updates, with post-update verification tests before full clinical return.
Clear downtime procedures so urgent cases can be managed safely if the planning environment is unavailable.

How do I interpret the output?

The workstation produces multiple outputs. Interpretation is a team skill involving clinical judgment, physics understanding, and awareness of limitations.

A high-quality plan is not simply “one that meets DVH numbers.” It is a plan that meets clinical goals, is deliverable, is robust to setup uncertainties (within what the institution assumes), and is clearly communicated to the treatment team. Output interpretation therefore combines dosimetry, anatomy, and workflow considerations.

Types of outputs/readings

Common outputs include:

3D dose distribution displayed on CT/MRI/PET images with isodose lines
DVH (dose–volume histogram) curves for targets and organs at risk
Plan parameter summaries: beam angles, arcs, MLC shapes, monitor units (MU), couch/gantry settings
Plan reports: prescription details, normalization, constraints used, and approval status
Warnings and logs: alerts about constraints, calculation issues, or export status (varies by manufacturer)

Depending on system configuration and departmental workflow, outputs may also include:

Beam’s-eye-view (BEV) visuals and aperture/MLC pattern reviews, useful for understanding where modulation is occurring.
Setup reference images (such as DRRs) used for image guidance.
Deliverability metrics (e.g., modulation complexity indicators) or integrated pre-checks that flag mechanical or delivery concerns.
Composite or summed dose objects when multiple plans/phases are combined, which is particularly relevant in boost workflows or re-irradiation assessments.

How clinicians typically interpret them (general)

Clinicians and physics teams often review:

Whether target coverage aligns with the prescription intent and institutional criteria
Whether organ-at-risk doses are within protocol goals/limits (site-specific)
Where hotspots occur and whether they are clinically acceptable given anatomy and setup
Whether the plan is realistically deliverable on the selected machine and technique

Common evaluation habits include:

Reviewing target DVH metrics alongside spatial views to confirm that “coverage” is not achieved by missing a clinically important sub-region.
Checking dose fall-off around targets for stereotactic plans, where steep gradients are intentional but must be balanced against nearby critical structures.
Ensuring that plan parameters (such as couch kicks or non-coplanar arcs) are operationally feasible given immobilization, patient comfort, collision risk, and local therapist practice.

Common pitfalls and limitations

Key limitations to keep in mind:

DVH limitations: a DVH can hide where dose is located; spatial review is still required.
Contouring variability: small contour differences can meaningfully change metrics; standardization and peer review matter.
Registration errors: image fusion can look plausible in one plane but be wrong in another; verify in multiple views.
Imaging artifacts: metal, motion, or truncation artifacts can distort density and dose calculation.
Algorithm assumptions: dose engines have known strengths and weaknesses (especially in small fields or heterogeneous tissues); local commissioning defines acceptable use.

Additional pitfalls seen in real-world planning include:

Structure set confusion: multiple versions of OARs or targets can exist (e.g., “SpinalCord” vs. “SpinalCord_PRV”). If the wrong one is used for constraints, the DVH can look “acceptable” while the clinically intended structure is overdosed.
Normalization and reporting differences: small changes in normalization points or reference dose definitions can shift DVH metrics. Teams need consistent local standards for what “meeting the prescription” means.
Dose grid effects: a coarse grid can underestimate peak doses or smear gradients, particularly in small stereotactic targets or near steep dose fall-off regions.
Overreliance on a single metric: for example, meeting a Vx constraint while ignoring maximum dose to a small critical structure volume that is clinically meaningful.

Outputs should be correlated with clinical context and local protocols, not interpreted in isolation.

What if something goes wrong?

A practical troubleshooting checklist

If the workstation behaves unexpectedly or outputs look inconsistent:

Confirm you are in the correct patient record and correct plan version.
Re-check that the correct image series is selected and oriented properly.
Review whether the correct machine/beam model was chosen for the plan.
Look for recent software updates or template changes that may have altered defaults.
Verify that licensing, database connectivity, and storage space are functioning.
If import/export fails, confirm DICOM connectivity and that the receiving system is available.

Additional practical troubleshooting steps that often save time include:

If calculations are unusually slow, check whether the workstation is using the expected compute resources (CPU/GPU) and whether other jobs are saturating shared calculation servers.
Confirm that the patient dataset is complete and not partially imported (missing slices or corrupted series can produce strange dose results or crashes).
If a previously acceptable plan suddenly fails constraints after a minor edit, verify that no hidden setting changed (grid size, algorithm mode, dose reporting, or structure selection).
Use a known reference case (a non-clinical test dataset) to determine whether the issue is case-specific or system-wide.

When to stop use

Stop and hold the process (do not export for treatment) when:

Patient identification is uncertain or mismatched
Dose calculation settings appear incorrect or outside validated configuration
Plan parameters do not match the intended technique or machine
There are unexplained discrepancies after re-checking inputs and settings
A cybersecurity incident or data integrity concern is suspected

It is also prudent to stop if:

The system shows signs of database instability (missing objects, inconsistent plan histories, or repeated save errors).
The plan export/import process produces warnings that cannot be resolved or explained.
A plan that was previously approved appears changed without a documented, intentional revision (a version-control concern).

When to escalate to biomedical engineering, IT, or the manufacturer

Escalate when issues involve:

Repeated crashes, corrupted databases, or failed backups
Suspected hardware failure (GPU/CPU/storage), overheating, or unstable power
Network/authentication problems affecting multiple users
Any behavior that could compromise dose calculation integrity
Post-update anomalies requiring vendor guidance or rollback

Document the issue with screenshots, error logs (as permitted), timestamps, and the steps that reproduced it. Follow facility incident reporting and vendor ticketing processes.

In many facilities, escalation is fastest and safest when it follows a defined pathway, for example:

Planner/dosimetrist informs the on-duty physicist and pauses export/treatment actions.
Physicist determines whether the issue is workflow/user-error, commissioning/scope, or technical/system-related.
IT/biomed is engaged for infrastructure issues (storage, authentication, server health), while the manufacturer is engaged for software defects or known issues.

This keeps patient safety decisions with clinical leadership while ensuring technical issues are handled by the right support teams.

Infection control and cleaning of Radiotherapy treatment planning workstation

A Radiotherapy treatment planning workstation is usually non-critical equipment (no direct contact with sterile tissue). Infection risk is primarily from shared high-touch surfaces, especially in busy departments.

Even though the infection risk is lower than for patient-contact devices, the workstation often sits in high-traffic staff areas. During seasonal respiratory outbreaks or periods of heightened infection control, departments may increase the frequency of cleaning and emphasize “clean hands before and after workstation use,” especially when multiple staff share the same keyboard and mouse.

Cleaning principles: disinfection vs. sterilization (general)

Cleaning removes visible soil; it is often the first step.
Disinfection reduces microbial load on surfaces (commonly used for workstations).
Sterilization is not typically applicable to planning workstations.

Always follow the manufacturer’s instructions for use (IFU) and the facility infection prevention policy; these determine which products and contact times are acceptable.

High-touch points to prioritize

Keyboard, mouse, and mouse pad
Touchscreens or control knobs (if present)
Desk surface and chair armrests
Headsets, badge scanners, and shared pens (if used in the area)
Frequently handled cables (where safe and permitted)

If the department uses accessories like styluses, 3D mice, or foot pedals, these should be included in the high-touch list and cleaned according to the same policy.

Example cleaning workflow (non-brand-specific)

Perform hand hygiene and wear gloves if required by local policy.
If permitted, log out and place the workstation in a safe state (or power down if instructed).
Use approved wipes (not sprayed liquid) to clean high-touch surfaces, avoiding excess moisture near vents and ports.
Allow surfaces to remain visibly wet for the required contact time (per disinfectant instructions).
Dispose of wipes appropriately and perform hand hygiene again.

For shared workstations, consider “clean before use” practices and clear accountability for daily/shift cleaning.

From a device longevity perspective, it is also important to avoid harsh chemicals that can damage monitor coatings or cause keyboard labels to fade. Departments often coordinate with biomedical engineering to ensure cleaning practices protect both infection control goals and equipment condition.

Medical Device Companies & OEMs

Manufacturer vs. OEM (Original Equipment Manufacturer)

In radiotherapy planning, the manufacturer is typically the company that designs, validates, and supports the planning software and overall clinical workflow. An OEM supplies components that may be rebranded or integrated into the final solution—commonly workstation hardware, GPUs, monitors, operating systems, or database technologies.

OEM relationships matter because they can influence:

Service boundaries (who supports what)
Patch and upgrade pathways (especially for cybersecurity)
Spare parts availability and lifecycle planning
Validation responsibilities after hardware or driver changes

For planning systems, hospitals often need clear contract language that defines responsibilities across software vendor, hardware OEM, and local service teams.

In procurement and governance discussions, it helps to ask practical questions such as:

Who certifies specific operating system versions and GPU drivers for clinical use?
What is the policy when an OEM component reaches end-of-life?
How are cybersecurity patches handled without breaking validation status?

These questions are less about “brand preference” and more about ensuring the system can be safely maintained over its lifecycle.

Top 5 World Best Medical Device Companies / Manufacturers

Example industry leaders (not a ranking). Availability, portfolios, and regional support vary by manufacturer.

Varian (a Siemens Healthineers company)
Varian is widely associated with radiation oncology ecosystems that include treatment planning, oncology information systems, and linear accelerators. Many centers value integrated workflows, although integration depth varies by model and site configuration. Global presence is substantial, but local support experience can differ by region and contract structure. In practice, buyers often evaluate how tightly the planning workstation integrates with imaging, record-and-verify, and departmental reporting, as well as how upgrades are coordinated across the ecosystem.
Elekta
Elekta is a long-established radiation therapy vendor offering delivery systems and planning-related software solutions. Departments considering Elekta commonly evaluate interoperability with existing imaging, OIS, and QA tools. Service models and distributor networks vary by country, which can affect response times and parts logistics. From a workstation perspective, considerations often include algorithm performance in heterogeneous tissues, workflow usability for planners, and how well the vendor supports technique expansion over time.
RaySearch Laboratories
RaySearch is recognized primarily for radiotherapy planning software, including optimization and plan evaluation capabilities. It is often discussed in the context of multi-vendor environments where hospitals want planning software that can connect to different delivery platforms. Regional adoption and integration pathways depend on local procurement and IT constraints. Facilities may also consider scripting, automation options, and how the vendor supports structured plan evaluation and reporting.
Brainlab
Brainlab is known for software platforms spanning radiosurgery planning, surgical navigation, and digital operating room workflows. In radiotherapy contexts, Brainlab may be encountered in stereotactic programs and centers emphasizing image guidance and data integration. Product scope and local availability differ by market. Buyers often look at how well stereotactic planning tools support high-gradient dose shaping, image fusion, and streamlined review processes for multidisciplinary teams.
Accuray
Accuray is associated with specialized radiotherapy delivery platforms and the planning workflows that support them. Centers evaluating Accuray often consider end-to-end workflow fit, from simulation through planning, QA, and delivery. Installed base and service coverage vary by geography and facility type. Planning workstation considerations can include how the system handles non-coplanar deliveries, motion management, and the practicalities of plan QA and documentation.

Vendors, Suppliers, and Distributors

Role differences: vendor vs. supplier vs. distributor

A vendor is the organization selling the product to the hospital; this may be the manufacturer or a third party.
A supplier provides goods or services (hardware, consumables, installation, or maintenance) and may operate upstream of the vendor relationship.
A distributor purchases from manufacturers and resells, often providing logistics, local compliance support, and sometimes first-line service.

For radiotherapy planning workstations, procurement is frequently direct from the manufacturer with local authorized representatives; however, distributors and systems integrators can still be important for importation, installation, and ongoing service depending on the country.

In capital equipment procurement, these roles can overlap. A “vendor” may coordinate site planning, installation, training, and acceptance testing, while a distributor handles importation and local regulatory documentation. Hospitals benefit from clarifying:

Who is responsible for installation qualification and documentation?
Who provides first-line troubleshooting?
Who owns the obligation to provide software updates and security patches?
How are service-level agreements enforced if multiple parties are involved?

Top 5 World Best Vendors / Suppliers / Distributors

Example global distributors (not a ranking). These organizations are broad healthcare distributors; radiotherapy capital equipment channels often involve specialized or manufacturer-direct pathways.

McKesson
McKesson is a large healthcare distribution and services organization, particularly known for pharmaceutical and medical supply logistics. Large hospital networks may already have procurement relationships that influence broader purchasing processes. Direct radiotherapy planning workstation sourcing may still require manufacturer or specialized channels. Where relevant, the value is often in contracting infrastructure, standardized purchasing processes, and supply chain reliability across the broader hospital portfolio.
Cardinal Health
Cardinal Health provides distribution and supply chain services across many hospital equipment and consumable categories. Organizations with centralized procurement may use such distributors for standardized contracting and logistics. Radiotherapy planning systems are typically handled through specialized capital equipment processes. In some settings, distributors can still support ancillary procurement (workstation peripherals, IT accessories) and logistics coordination.
Medline Industries
Medline is widely recognized for medical supplies and hospital equipment distribution, with strong presence in routine clinical consumables. While not a typical route for complex radiotherapy planning systems, Medline-style distributors often shape how hospitals manage warehousing, delivery, and contract compliance for broad equipment portfolios. Their relevance may be indirect but important in integrated procurement environments.
Henry Schein
Henry Schein operates global distribution in healthcare segments, particularly dental and office-based care, and may participate in broader clinic supply ecosystems in some regions. For radiotherapy workstations, hospitals usually require specialized installation and validation services beyond standard distribution. Where involved, the key question is whether the distribution model includes authorized technical support pathways appropriate for regulated radiotherapy software.
DKSH
DKSH is known for market expansion services, including healthcare distribution in parts of Asia and other regions. In countries with high import dependence, such organizations can be relevant for regulatory navigation, logistics, and localized support coordination. Radiotherapy products, when distributed, typically involve manufacturer authorization and strict service requirements. Hospitals often evaluate whether local support teams can meet clinical uptime needs and whether spare parts and licensing support are sustainable.

Global Market Snapshot by Country

India

Demand is driven by expanding oncology services, growth of private hospital chains, and increasing attention to radiation therapy access. Many centers rely on imported planning software and hardware, with service capability concentrated in major cities and academic hubs.

Procurement decisions often weigh total cost of ownership against the need for advanced techniques (IMRT/VMAT/SBRT) and strong training packages. Facilities may also prioritize scalable architectures that can support multi-site networks as hospital groups expand.

China

Large-scale hospital investment and domestic manufacturing capacity shape the ecosystem, alongside imports for certain advanced software and modalities. Urban tertiary centers often lead adoption, while service coverage and training depth can vary outside major metropolitan areas.

Interoperability with local hospital IT systems and data governance requirements can be a significant factor. Some centers also emphasize rapid capacity building, which increases the importance of standardized protocols and workflow automation features.

United States

Adoption is supported by mature radiation oncology networks, established medical physics training pipelines, and strong expectations for documentation and quality systems. Procurement decisions often emphasize integration with oncology information systems, cybersecurity controls, and lifecycle service contracts.

Additionally, reimbursement structures and accreditation expectations can drive rigorous peer review and chart-check processes, increasing demand for planning systems with robust audit trails and reporting.

Indonesia

Planning workstation demand is closely tied to expansion of radiotherapy capacity in major islands and referral centers. Import dependence is common, and buyers often prioritize vendor training, reliable service logistics, and stable connectivity in mixed IT environments.

Geographic distribution challenges can make remote support capability and local spare parts strategies particularly important for maintaining uptime.

Pakistan

Growth is influenced by concentration of radiotherapy services in larger cities and a need to expand public-sector cancer care. Import processes, foreign currency constraints, and limited specialist staffing can make serviceability and training packages key procurement considerations.

Facilities may value planning systems with clear workflows and strong vendor support for commissioning, especially when introducing more advanced techniques.

Nigeria

Radiotherapy infrastructure is developing, with demand strongest in urban tertiary hospitals and large private centers. Planning workstations and related software are typically imported, and long-term uptime depends heavily on local service partners, power stability, and workforce retention.

Because infrastructure constraints can be significant, departments often focus on resilient IT designs, robust backup strategies, and practical training models that reduce reliance on a small number of experts.

Brazil

A mix of public and private oncology services drives procurement, often with structured tendering and compliance requirements. Regional disparities affect access, and facilities may focus on service contracts, local support availability, and interoperability with existing imaging systems.

Long procurement cycles can increase the importance of lifecycle planning so that workstations remain supported and secure over the intended operational period.

Bangladesh

Demand is increasing with the growth of cancer services, especially in major urban hospitals. Many sites depend on imported systems and prioritize training, predictable maintenance, and straightforward workflows that fit limited staffing models.

Departments may also emphasize planning efficiency tools to manage high patient volumes while maintaining quality checks.

Russia

Procurement is shaped by centralized healthcare structures in some regions and a need for robust local support. Availability of imported components and software updates can be influenced by supply chain constraints, making lifecycle planning and spares strategy important.

Some facilities may prioritize solutions that can be maintained with strong local technical capability and predictable upgrade pathways.

Mexico

Radiotherapy service expansion in large cities drives planning workstation demand, with private sector growth and public-sector needs both contributing. Buyers often evaluate distributor capability, training, and integration with diverse hospital IT ecosystems.

Multi-vendor environments are common, so interoperability and DICOM workflow reliability can be key differentiators.

Ethiopia

Radiotherapy services are concentrated in a small number of centers, so planning workstations are typically procured as part of broader capacity-building projects. Import dependence is high, and sustainable operation hinges on training, preventive maintenance planning, and stable infrastructure.

Long-term success often depends on building local expertise for commissioning support, QA routines, and IT maintenance.

Japan

A technologically advanced radiotherapy environment supports sophisticated planning workflows, with strong emphasis on quality processes and interoperability. Procurement often considers long-term vendor support, upgrade pathways, and alignment with established clinical protocols.

Facilities may also emphasize consistency and documentation standards, which can increase demand for structured reporting and robust data management features.

Philippines

Demand is growing through private hospital expansion and increased oncology service offerings in metropolitan areas. Facilities frequently rely on imported planning solutions and may prioritize service responsiveness, training, and support for multi-site networks.

Workforce availability can influence preferences for user-friendly workflows and strong vendor-led education.

Egypt

Large public hospitals and expanding private oncology centers contribute to demand, with procurement often balancing cost, service support, and training. Urban concentration remains common, and local distributor capability can strongly influence uptime and adoption.

Facilities may place particular value on bundled commissioning support and predictable maintenance arrangements.

Democratic Republic of the Congo

Radiotherapy capacity is limited relative to need, so planning workstation adoption often occurs through major projects and external partnerships. Import logistics, infrastructure reliability, and availability of trained staff are major determinants of sustained use.

Projects often prioritize durability, clear workflows, and intensive training to support long-term independent operation.

Vietnam

Investment in tertiary hospitals and cancer centers is increasing planning workstation demand, especially in large cities. Many facilities use imported solutions and emphasize training, integration with CT simulation and OIS, and reliable vendor support.

As services expand, standardization of protocols and naming conventions becomes increasingly important for safe scaling.

Iran

Demand is supported by established medical education and a continuing need to expand and maintain radiotherapy services. Import constraints and software support pathways can influence procurement strategy, including preferences for robust local servicing and upgrade planning.

Facilities may emphasize systems that can be maintained securely and reliably under local supply chain realities.

Turkey

A sizeable network of public and private hospitals drives consistent demand for radiotherapy technology and planning capabilities. Buyers often evaluate integration, service coverage, and training programs, with urban centers leading adoption of advanced workflows.

Competitive procurement environments can increase focus on measurable service performance and transparent lifecycle costs.

Germany

A mature radiotherapy market with strong engineering and quality culture supports advanced planning, documentation, and peer review practices. Procurement often emphasizes compliance, cybersecurity, interoperability, and structured maintenance and upgrade pathways.

Facilities may also place high value on workflow efficiency features that support standardized peer review and audit readiness.

Thailand

Demand is shaped by expanding cancer services in major hospitals and efforts to improve access beyond metropolitan areas. Planning solutions are commonly imported, and facilities often prioritize comprehensive training, service agreements, and resilient IT infrastructure.

Hospitals expanding to regional areas may particularly value remote support capability and standardized planning protocols that can be implemented consistently across sites.

Key Takeaways and Practical Checklist for Radiotherapy treatment planning workstation

Treat the Radiotherapy treatment planning workstation as safety-critical medical equipment, not “just software.”
Confirm commissioning is complete for every machine, energy, and technique you plan to use.
Verify patient identity at import, during planning, and at export to downstream systems.
Check image orientation and laterality early to prevent wrong-side errors.
Use consistent structure and plan naming conventions to reduce selection mistakes.
Avoid copy-forward planning without a deliberate review of every parameter and structure.
Always verify CT series selection and scan extent before contouring begins.
Validate image registrations in multiple planes, not a single “good-looking” view.
Keep contouring standards documented and teach them explicitly to trainees.
Use approved templates only when they match the current protocol and commissioning scope.
Select dose calculation algorithms and grid settings according to local validated policy.
Document any density overrides and ensure they follow departmental rules.
Re-calculate final dose after optimization using the approved “final calculation” settings.
Review isodose distributions spatially; do not rely on DVH alone.
Understand that DVH metrics can hide clinically relevant hotspots and cold spots.
Include an independent check process (second review) as a routine safety layer.
Perform peer review for complex cases when feasible and supported by policy.
Confirm deliverability against machine constraints, not only dosimetric quality.
Treat export to record-and-verify as a high-risk step that deserves a checklist.
Verify the correct plan version is approved and transferred; avoid “near-duplicate” plans.
Lock or control plan status to prevent unintended edits after approval.
Maintain

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