Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit?

Samuel Ingram; Lorenzo Brualla; Alexia Delbaere; Masoud Zarepisheh; Hendrik Piersma; Aditya Apte; Roman Ludwig; Erik Roelofs; Marcel Nachbar; Ali Zaila; Krzysztof Domanski; Josh Kirby; Giorgio Cartechini; Tobias Becher; Samuele Cavinato; Goran Stanic; Stine Korreman; Niklas Wahl; Josh Mason; Ana M. Barragan-Montero

doi:10.1016/j.radonc.2026.111587

Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit?

Samuel Ingram^*
, Lorenzo Brualla
, Alexia Delbaere
, Masoud Zarepisheh
, Hendrik Piersma
, Aditya Apte
, Roman Ludwig
, Erik Roelofs
, Marcel Nachbar
, Ali Zaila
, Krzysztof Domanski
, Josh Kirby
, Giorgio Cartechini
, Tobias Becher
, Samuele Cavinato
, Goran Stanic
, Stine Korreman
, Niklas Wahl
, Josh Mason
, Ana M. Barragan-Montero

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

Modern radiotherapy workflows depend heavily on software, yet proprietary solutions limit adaptability and transparency. Many institutions create in-house tools, resulting in duplicated efforts and sustainability challenges. Free and open-source software (FOSS) offers transparency, customization, and collaborative development opportunities, but faces barriers including fragmented efforts, regulatory complexity, and clinical adoption hurdles. This vision paper, inspired by the 2024 ESTRO Physics Workshop on "Resource sharing: open-source software & development in radiotherapy" explores these challenges and proposes strategies to promote sustainable and discoverable open-source ecosystems in radiation oncology. Key recommendations include improving interoperability, clear licensing, risk management, validation frameworks, and creating a centralised registry for resource visibility. Embracing open-source practices can accelerate innovation, reduce redundancy, and enhance patient care.

Original language	English
Article number	111587
Number of pages	9
Journal	Radiotherapy and Oncology
Volume	220
Early online date	1 May 2026
DOIs	https://doi.org/10.1016/j.radonc.2026.111587
Publication status	Published - 1 Jul 2026

Keywords

DELINEATION
TOOLKIT
HEAD
RISK

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10.1016/j.radonc.2026.111587Licence: CC BY

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Ingram, S., Brualla, L., Delbaere, A., Zarepisheh, M., Piersma, H., Apte, A., Ludwig, R., Roelofs, E., Nachbar, M., Zaila, A., Domanski, K., Kirby, J., Cartechini, G., Becher, T., Cavinato, S., Stanic, G., Korreman, S., Wahl, N., Mason, J., & Barragan-Montero, A. M. (2026). Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit? Radiotherapy and Oncology, 220, Article 111587. https://doi.org/10.1016/j.radonc.2026.111587

@article{93b305876ffe458ea841e7ea712daacb,

title = "Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit?",

abstract = "Modern radiotherapy workflows depend heavily on software, yet proprietary solutions limit adaptability and transparency. Many institutions create in-house tools, resulting in duplicated efforts and sustainability challenges. Free and open-source software (FOSS) offers transparency, customization, and collaborative development opportunities, but faces barriers including fragmented efforts, regulatory complexity, and clinical adoption hurdles. This vision paper, inspired by the 2024 ESTRO Physics Workshop on {"}Resource sharing: open-source software \& development in radiotherapy{"} explores these challenges and proposes strategies to promote sustainable and discoverable open-source ecosystems in radiation oncology. Key recommendations include improving interoperability, clear licensing, risk management, validation frameworks, and creating a centralised registry for resource visibility. Embracing open-source practices can accelerate innovation, reduce redundancy, and enhance patient care.",

keywords = "DELINEATION, TOOLKIT, HEAD, RISK",

author = "Samuel Ingram and Lorenzo Brualla and Alexia Delbaere and Masoud Zarepisheh and Hendrik Piersma and Aditya Apte and Roman Ludwig and Erik Roelofs and Marcel Nachbar and Ali Zaila and Krzysztof Domanski and Josh Kirby and Giorgio Cartechini and Tobias Becher and Samuele Cavinato and Goran Stanic and Stine Korreman and Niklas Wahl and Josh Mason and Barragan-Montero, \{Ana M.\}",

year = "2026",

month = jul,

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doi = "10.1016/j.radonc.2026.111587",

language = "English",

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journal = "Radiotherapy and Oncology",

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Ingram, S, Brualla, L, Delbaere, A, Zarepisheh, M, Piersma, H, Apte, A, Ludwig, R, Roelofs, E, Nachbar, M, Zaila, A, Domanski, K, Kirby, J, Cartechini, G, Becher, T, Cavinato, S, Stanic, G, Korreman, S, Wahl, N, Mason, J & Barragan-Montero, AM 2026, 'Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit?', Radiotherapy and Oncology, vol. 220, 111587. https://doi.org/10.1016/j.radonc.2026.111587

TY - JOUR

T1 - Resource sharing and open-source software in radiation oncology

T2 - From challenges to opportunities for community-wide benefit?

AU - Ingram, Samuel

AU - Brualla, Lorenzo

AU - Delbaere, Alexia

AU - Zarepisheh, Masoud

AU - Piersma, Hendrik

AU - Apte, Aditya

AU - Ludwig, Roman

AU - Roelofs, Erik

AU - Nachbar, Marcel

AU - Zaila, Ali

AU - Domanski, Krzysztof

AU - Kirby, Josh

AU - Cartechini, Giorgio

AU - Becher, Tobias

AU - Cavinato, Samuele

AU - Stanic, Goran

AU - Korreman, Stine

AU - Wahl, Niklas

AU - Mason, Josh

AU - Barragan-Montero, Ana M.

PY - 2026/7/1

Y1 - 2026/7/1

N2 - Modern radiotherapy workflows depend heavily on software, yet proprietary solutions limit adaptability and transparency. Many institutions create in-house tools, resulting in duplicated efforts and sustainability challenges. Free and open-source software (FOSS) offers transparency, customization, and collaborative development opportunities, but faces barriers including fragmented efforts, regulatory complexity, and clinical adoption hurdles. This vision paper, inspired by the 2024 ESTRO Physics Workshop on "Resource sharing: open-source software & development in radiotherapy" explores these challenges and proposes strategies to promote sustainable and discoverable open-source ecosystems in radiation oncology. Key recommendations include improving interoperability, clear licensing, risk management, validation frameworks, and creating a centralised registry for resource visibility. Embracing open-source practices can accelerate innovation, reduce redundancy, and enhance patient care.

AB - Modern radiotherapy workflows depend heavily on software, yet proprietary solutions limit adaptability and transparency. Many institutions create in-house tools, resulting in duplicated efforts and sustainability challenges. Free and open-source software (FOSS) offers transparency, customization, and collaborative development opportunities, but faces barriers including fragmented efforts, regulatory complexity, and clinical adoption hurdles. This vision paper, inspired by the 2024 ESTRO Physics Workshop on "Resource sharing: open-source software & development in radiotherapy" explores these challenges and proposes strategies to promote sustainable and discoverable open-source ecosystems in radiation oncology. Key recommendations include improving interoperability, clear licensing, risk management, validation frameworks, and creating a centralised registry for resource visibility. Embracing open-source practices can accelerate innovation, reduce redundancy, and enhance patient care.

KW - DELINEATION

KW - TOOLKIT

KW - HEAD

KW - RISK

U2 - 10.1016/j.radonc.2026.111587

DO - 10.1016/j.radonc.2026.111587

M3 - (Systematic) Review article

SN - 0167-8140

VL - 220

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

M1 - 111587

ER -

Resource sharing and open-source software in radiation oncology: From challenges to opportunities for community-wide benefit?

Abstract

Keywords

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