# Clinical Workflow of Spine Stereotactic Radiotherapy and Radiosurgery: Insights from a Single-Institution Physics Perspective

## TL;DR

This paper outlines the clinical workflow for spine stereotactic radiotherapy and radiosurgery, focusing on medical physics processes at a single institution.

## Contribution

The paper provides a detailed descriptive overview of established SSRS clinical workflows and medical physics processes in routine clinical practice.

## Key findings

- The clinical workflow includes patient selection, immobilization, imaging, treatment planning, quality assurance, and image-guided delivery.
- The workflow emphasizes integration of SSRS techniques into daily clinical care at a high-volume academic center.
- The focus is on medical physics processes rather than presenting new clinical outcome data.

## Abstract

Spine stereotactic radiotherapy and radiosurgery (SSRS) is a precise form of radiation therapy used to treat cancer involving the spine, delivering high doses to tumors while limiting exposure to nearby critical structures. This manuscript describes the clinical workflow used to deliver SSRS at our institution, with attention to the medical physics processes that support routine clinical practice. Key elements include patient selection, treatment region-specific immobilization, CT and MRI-based imaging, treatment planning, patient-specific quality assurance, and image-guided treatment delivery, providing an overview of how SSRS is implemented in day-to-day clinical care.

Spine stereotactic radiotherapy and radiosurgery (SSRS) techniques, encompassing both fractionated stereotactic treatments and single-fraction radiosurgery, are widely used for the management of spinal metastases due to their ability to deliver highly conformal radiation while limiting dose to adjacent critical structures. Clinical outcomes following SSRS, including durable local control and acceptable toxicity, have been reported previously in multiple institutional series. In this manuscript, we describe the clinical workflow used to deliver SSRS at a high-volume academic center, with emphasis on the medical physics processes that support routine clinical practice. Key elements of the workflow include patient selection, treatment region-specific immobilization, CT and MRI-based simulation, treatment planning, patient-specific quality assurance, and image-guided treatment delivery. Rather than presenting new outcome data, this work provides a descriptive overview of how established SSRS techniques are integrated into day-to-day clinical care.