Document Type
Article
Publication Date
8-18-2026
Abstract
This review summarizes the rationale for radiation oncology cyberattack simulation exercises, recent results from multi-institutional resiliency drills, and the landscape of software tools developed to help clinics resume radiotherapy treatments rapidly and safely during a cyberattack or other major clinical software outage. Simulation exercises using record-and-verify (R&V) downtime and File Mode treatment delivery have identified failure modes not apparent in theoretical planning alone, including risks related to treatment documentation, repeated fractions, patient setup, and missed safety checks. Available software tools emphasize insulated backup of DICOM-format planning data and clinical notes, treatment-state dashboards, File Mode treatments, redundant R&V installations, and human-readable treatment records. Future work should emphasize minimization of backup latency, ensuring File Mode feasibility under a variety of outage conditions, facilitation of inter-institutional patient transfer, and postattack data reconciliation.
Recommended Citation
Vinogradskiy, Yevgeniy and Lamb, James, "Software Tools and Simulation Exercises for Radiation Oncology Cyber-Attack Resiliency" (2026). Department of Radiation Oncology Faculty Papers. Paper 240.
https://jdc.jefferson.edu/radoncfp/240
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
42612436
Language
English
Comments
This article is the author’s final published version in Seminars in Radiation Oncology, Volume 39, 2026, Article number 151056.
The published version is available at https://doi.org/10.1016/j.semradonc.2026.151056. Copyright © 2026 The Authors..