Techniques for adjusting radiotherapy treatment for a patient in real time are provided. The techniques include operations comprising: obtaining, during delivery of a radiotherapy treatment fraction to a patient, one or more images of the patient at a first rate; generating patient motion information at a second rate based on the one or more images obtained at the first rate; receiving, during delivery of the radiotherapy treatment fraction, radiotherapy treatment device settings at a third rate; computing, during delivery of the radiotherapy treatment fraction, dose delivered to the patient with a first level of accuracy based on the generated patient motion information and the radiotherapy treatment device settings; and determining, during delivery of the radiotherapy treatment fraction, a real-time measure of accumulated dose delivered to the patient with a second greater level of accuracy than the first level of accuracy using one or more prior dose computations.
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