KaSARi: a national framework for standardized, automated, and predictive radiotherapy in Finland

Background and purpose: National radiotherapy (RT) data infrastructures are emerging to support treatment quality assurance and outcome research. However, prospective nationwide integration of full DICOM-RT data with toxicity and patient-reported outcome measures (PROMs) remains uncommon. KaSARi (Key advances in Standardizing, Automating, and predicting Risks in RT) was established to create national research infrastructure for prospective RT data collection and integration in Finland. Materials and methods: KaSARi is a prospective, consent-based multicenter cohort infrastructure involving Finnish university and central hospitals. All adult patients receiving RT are eligible. DICOM-RT datasets from treatment planning and oncology information systems are linked to clinician-graded toxicity, PROMs and relevant clinical variables. The infrastructure builds on previously validated multi-institutional DICOM workflows and follows FAIR (Findable, Accessible, Interoperable, Reusable) data principles. Predefined work packages support data harmonization, scalable data processing and enable downstream applications such as AI-based segmentation, dose prediction, and outcome modeling. Results: Patient recruitment started in May 2025. By February 2026, 221 patients had been enrolled at the coordinating center, initially including breast cancer patients and subsequently expanding to all RT indications. Recruitment at a second center began in November 2025, with 37 patients enrolled. The infrastructure is projected to include approximately 29,000 patients over 15 years. Integration of dosimetric, clinical and PROM data is progressing through a phased national implementation as additional centers join the network. Interpretation: KaSARi represents a national infrastructure prospectively integrating full DICOM-RT datasets with clinician-graded toxicity and PROMs across all RT indications within a unified research protocol. The study provides a foundation for nationwide outcome modeling, harmonization of RT practices and development and validation of data-driven AI-based methods.