Zeitschrift fur medizinische Physik最新文献

{"title":"Refining visceral adipose tissue quantification: Influence of sex, age, and BMI on single slice estimation in 3D MRI of the German National Cohort.","authors":"Tobias Haueise, Fritz Schick, Norbert Stefan, Elena Grune, Marc-Nicolas von Itter, Hans-Ulrich Kauczor, Johanna Nattenmüller, Tobias Norajitra, Tobias Nonnenmacher, Susanne Rospleszcz, Klaus H Maier-Hein, Christopher L Schlett, Jakob B Weiss, Beate Fischer, Karl-Heinz Jöckel, Lilian Krist, Thoralf Niendorf, Annette Peters, Anja M Sedlmeier, Stefan N Willich, Fabian Bamberg, Jürgen Machann","doi":"10.1016/j.zemedi.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.02.005","url":null,"abstract":"<p><strong>Objectives: </strong>High prevalence of visceral obesity and its associated complications underscore the importance of accurately quantifying visceral adipose tissue (VAT) depots. While whole-body MRI offers comprehensive insights into adipose tissue distribution, it is resource-intensive. Alternatively, evaluation of defined single slices provides an efficient approach for estimation of total VAT volume. This study investigates the influence of sex-, age-, and BMI on VAT distribution along the craniocaudal axis and total VAT volume obtained from single slice versus volumetric assessment in 3D MRI and aims to identify age-independent locations for accurate estimation of VAT volume from single slice assessment.</p><p><strong>Materials and methods: </strong>This secondary analysis of the prospective population-based German National Cohort (NAKO) included 3D VIBE Dixon MRI from 11,191 participants (screened between May 2014 and December 2016). VAT and spine segmentations were automatically generated using fat-selective images. Standardized craniocaudal VAT profiles were generated. Axial percentage of total VAT was used for identification of reference locations for volume estimation of VAT from a single slice.</p><p><strong>Results: </strong>Data from 11,036 participants (mean age, 52 ± 11 years, 5681 men) were analyzed. Craniocaudal VAT distribution differed qualitatively between men/women and with respect to age/BMI. Age-independent single slice VAT estimates demonstrated strong correlations with reference VAT volumes. Anatomical locations for accurate VAT estimation varied with sex/BMI.</p><p><strong>Conclusions: </strong>The selection of reference locations should be different depending on BMI groups, with a preference for caudal shifts in location with increasing BMI. For women with obesity (BMI >30 kg/m²), the L1 level emerges as the optimal reference location.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DeepSMCP - Deep-learning powered denoising of Monte Carlo dose distributions within the Swiss Monte Carlo Plan.","authors":"Hannes A Loebner, Raphael Joost, Jenny Bertholet, Stavroula Mougiakakou, Michael K Fix, Peter Manser","doi":"10.1016/j.zemedi.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.02.004","url":null,"abstract":"<p><p>This work demonstrated the development of a fast, deep-learning framework (DeepSMCP) to mitigate noise in Monte Carlo dose distributions (MC-DDs) of photon treatment plans with high statistical uncertainty (SU) and its integration into the Swiss Monte Carlo Plan (SMCP). To this end, a two-channel input (MC-DD and computed tomography (CT) scan) 3D U-net was trained, validated and tested (80%/10%/10%) on high/low-SU MC-DD-pairs of 106 clinically-motivated VMAT arcs for 29 available CTs, augmented to 3074 pairs. The model was integrated into SMCP to enable a \"one-click\" workflow of calculating and denoising MC-DDs of high SU to obtain MC-DDs of low SU. The model accuracy was evaluated on the test set using Gamma passing rate (2% global, 2 mm, 10% threshold) comparing denoised and low-SU MC-DD. Calculation time for the whole workflow was recorded. Denoised MC-DDs match low-SU MC-DDs with average (standard deviation) Gamma passing rate of 82.9% (4.7%). Additional application of DeepSMCP to 12 unseen clinically-motivated cases of different treatment sites, including treatment sites not present during training, resulted in an average Gamma passing rate of 91.0%. Denoised DDs were obtained on average in 35.1 s, a 340-fold efficiency gain compared to low-SU MC-DD calculation. DeepSMCP presented a first seamlessly integrated promising denoising framework for MC-DDs.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing clinical safety in radiation oncology: A data-driven approach to risk management.","authors":"Lukas Sölkner, Dietmar Georg, Uwe Wolff, Andreas Renner, Joachim Widder, Gerd Heilemann","doi":"10.1016/j.zemedi.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.02.003","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate a data-driven risk management (RM) strategy in radiation oncology using an in-house developed web-based incident reporting system. The system leverages real-time analytics to enhance clinical risk prioritization and management, improving patient safety and treatment efficiency.</p><p><strong>Methods: </strong>We developed and implemented a web-based incident reporting system that allows any staff member to report incidents in real time, supporting anonymous submissions and capturing detailed incident data. The collected data are followed up in monthly meetings of a dedicated multidisciplinary RM team that decides on respective interventions. Over five years, incident data were analyzed to assess the effectiveness of safety barriers-pre-planning, physics, and pre-treatment checks-in capturing incidents before they impact patient care and safety. The analysis focused on incident frequencies and the workflow steps where errors originated versus where they were detected, highlighting deficiencies and guiding improvements. When specific issues increased, a Failure Mode and Effects Analysis (FMEA) was initiated to identify and prioritize failure modes and implement corrective actions, such as new safety barriers or refining existing safety measures.</p><p><strong>Results: </strong>The web-based incident reporting system enhances responsive incident reporting and tailors RM strategies effectively. Data analysis reveals incident frequencies and detection points, identifying errors that bypass safety barriers and enabling targeted countermeasures. Despite safety barriers intercepting many incidents, critical gaps were identified. Since implementing data-driven RM in 2019, the average number of process steps between incident cause and detection could be halved. Resource analysis indicates increased allocation is needed; development required approximately 150 h, and RM averages 20% of a full-time equivalent position.</p><p><strong>Conclusion: </strong>Implementing the web-based incident reporting system has advanced RM in radiation oncology, ensuring legal compliance and enhancing safety through real-time analytics. The system effectively identifies and mitigates risks, strengthening QA barriers as evidenced by decreased time between error origin and detection. Adequate resource allocation is essential to sustain these improvements. Increasing full-time equivalent allocations for RM activities is recommended.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantum physics at a historic milestone: How has it shaped medical physics?","authors":"Michael Bock, Jürgen R Reichenbach","doi":"10.1016/j.zemedi.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.02.002","url":null,"abstract":"","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of perceived cochlear implant sound quality through individualized psychoacoustic-based frequency fitting.","authors":"Tobias Rader, Lisa Lippl, Joachim Müller","doi":"10.1016/j.zemedi.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.02.001","url":null,"abstract":"<p><strong>Objective: </strong>In recent years, there has been a trend toward more individualization in the fitting of cochlear implants (CI). Here, a new individualized approach to frequency band allocation was used. This approach is based on binaural perceptual pitch matching.</p><p><strong>Patient: </strong>The patient had congenital bilateral progressive sensorineural hearing loss due to Usher Syndrome. He had used hearing aids in both ears since the age of 4 years. In his mid-40s, he received a CI on his right ear and, ten months later, a second CI on the left ear.</p><p><strong>Intervention: </strong>Adjustments to the frequency band allocations were made, guided by the binaural perceptual pitch matching of piano notes. For the first CI, pitch matching was performed using the contralateral ear as the reference, which had preserved low-frequency residual hearing (bimodal pitch matching). For the second CI, pitch matching was performed using the first implanted side as the reference (bilateral electrical pitch matching).</p><p><strong>Results: </strong>The final frequency band allocation adjustments were always shifted toward lower frequencies relative to the default band allocations. The adjustments were larger in magnitude for the second CI compared to the first CI. Speech perception scores generally increased over the course of rehabilitation and were higher with the individualized fitting compared to the default fitting. The subjective sound quality was reportedly greatly improved with the individualized fitting.</p><p><strong>Conclusions: </strong>Individualized psychoacoustic frequency-based fitting can yield improvements in the perceived sound quality with a CI. However, this method requires significant residual hearing in at least one ear, and the patient must have relatively fine pitch discrimination abilities.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an MR-only radiotherapy treatment planning workflow using a commercial synthetic CT generator for brain and head & neck tumor patients.","authors":"Martin Buschmann, Harald Herrmann, Manuela Gober, Aleksandra Winkler, Nicole Eder-Nesvacil, Franziska Eckert, Joachim Widder, Dietmar Georg, Petra Trnková","doi":"10.1016/j.zemedi.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>In magnetic resonance (MR)-only radiotherapy (RT) workflows, synthetic computed tomography images (sCT) are needed as a surrogate for a dose calculation. Commercial and certified sCT algorithms became recently available, but many have not been evaluated in a clinical setting, especially in the head and neck tumor (HN) region. In this study, an MRI-only workflow using a commercial sCT generator for photon beam therapy in brain and HN body sites was evaluated in terms of dose calculation accuracy, modelling of immobilization devices, as well as usability for autosegmentation.</p><p><strong>Methods: </strong>For 13 brain and 10 HN cancer patients, MR scans using T1W mDIXON sequences were retrospectively collected. Four brain and all HN patients were scanned in RT treatment position with immobilization devices. All MRIs were converted to a sCT using the MRCAT algorithm (Philips, Eindhoven, The Netherlands). All patients underwent standard planning CT (pCT) for clinical segmentation and VMAT treatment planning. The sCT was rigidly registered to the pCT and clinical contours were transferred to the sCT. For dosimetric evaluation of sCT based dose calculation, all VMAT plans were recalculated on the sCT. D_1% and D_mean were compared for all structures between pCT and sCT, but D_95%, D_98% for targets only. For MR-invisible RT immobilization device modelling, MR-visible markers were placed into sCT and a geometric robustness analysis was performed based on the same target dose-volume parameters. For organs-at-risk (OARs) autosegmentation, both pCT and sCT were autosegmented with a clinically established CT-based autocontouring software. The agreement of contours on pCT and sCT was analyzed by similar dose-volume parameters and dice similarity (DSC) and Hausforff distance (HD).</p><p><strong>Results: </strong>The overall median deviation (± interquartile range) of dosimetric parameters between sCT and pCT including the immobilization model was 1.1 ± 0.4% for brain target volumes, 1.3 ± 1.2% for brain OAR, 0.4 ± 0.7% for HN target volumes and 0.4 ± 0.9% for HN OAR. The median geometric agreement over all sCT autocontours compared to pCT autocontours resulted in DSC = 0.82 for brain OAR and DSC = 0.79 for HN OAR.</p><p><strong>Conclusion: </strong>MR-only RT planning using MRCAT software package was feasible for brain and HN tumors, with acceptable clinical accuracy. The MR-invisible immobilization devices could be modelled in the planning system and the autosegmentation on sCTs using a CT-based autosegmentation tool was feasible.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the corneal epithelium on the corneal power using 3D raytracing with OCT data.","authors":"Achim Langenbucher, Nóra Szentmáry, Alan Cayless, Peter Hoffmann, Jascha Wendelstein","doi":"10.1016/j.zemedi.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.zemedi.2025.01.002","url":null,"abstract":"<p><strong>Purpose: </strong>To study the effects of corneal imaging and focusing using a raytracing simulation with 2 and 3 surface corneal models based on customized surface representations of corneal tomography data .</p><p><strong>Methods: </strong>Raytracing simulation using surface data for the epithelium (S1), stroma (S2) and endothelium (S3) extracted from MS-39 anterior segment tomographer CSV export files. Customized surface representations were derived using Gaussian Process Predictors, and rays traced through the cornea and a 3.5 mm aperture stop located 3.66 mm behind the corneal apex. 4 clinical examples were evaluated: A) after hyperopic LASIK, B) after myopic LASIK, C) keratoconus, and D) after PRK with postoperatively developed Salzmann nodules.</p><p><strong>Results: </strong>The raytracing based bundle focus and wavefront focus distances of the 2 surface (S1 and S3) and 3 surface cornea models (S1, S2 and S3) were comparable, whereas the paraxial focus derived from a 1 surface cornea (S1), 2 (S1 and S3) or 3 surface cornea (S1, S2 and S3) using floating best fit sphere representations for S1, S1 and S3 showed systematically lower / higher focal distance with B) / C) indicating an overestimation / underestimation of corneal power with paraxial calculations.</p><p><strong>Conclusions: </strong>The clinical examples in this study exhibited only minor differences between the mono- and dual layer cornea models. We recommend verification in a larger clinical study. Three surface corneal raytracing models could be of clinical relevance in intraocular lens calculations and LASIK ablation nomograms, offering potential improvements over paraxial calculations especially in cases with surface irregularities.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging dose and image quality of kilovoltage imaging implemented on a helical tomotherapy unit.","authors":"Eric D Ehler, Parham Alaei","doi":"10.1016/j.zemedi.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.zemedi.2024.12.003","url":null,"abstract":"<p><p>The purpose of this work was to evaluate the imaging dose for the Accuray Radixact ClearRT system. Low-contrast resolution and CT number consistency was evaluated as well. CTDI measurements were compared to vendor supplied values, and similar measurements were done on a Varian TrueBeam kV cone-beam CT (CBCT) and a Philips Big Bore CT scanner. In-field imaging doses were measured using various protocols in an anthropomorphic phantom, while out-of-field doses were measured 10 cm from the imaging field edge. Comparison of the CTDI and the in-field doses showed considerable disagreement when the patient anatomy size was not congruent with the size of the CTDI phantom. While that is an expected outcome, this work provides an estimate of the differences for a variety of ClearRT protocols when this situation arises. The CNR was measured for all combinations of ClearRT settings for comparisons within the system, as well as for a comparison with a CBCT and fan-beam CT system. The CNR and dose information provided in this work can be used to aid in selecting a ClearRT imaging protocol. The CT number stability was tracked over 27 months; two instances where the CT number constancy exceeded tolerance were observed after service.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Black-blood MRI at 7T using 2D RARE MRI: In vitro testing and in vivo demonstration.","authors":"Eva Peschke, Mariya S Pravdivtseva, Olav Jansen, Naomi Larsen, Jan-Bernd Hövener","doi":"10.1016/j.zemedi.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.zemedi.2024.11.002","url":null,"abstract":"<p><p>Vessel walls play a crucial role in many inflammatory vascular diseases. Vessel wall imaging (VWI) using mangnetic resonance imaging (MRI) is one of the few methods by which vessel walls and inflammation can be visualized noninvasively, in vivo, and without ionizing radiation. VWI is based on black-blood (BB) MRI, where the signal from flowing blood is suppressed and contrast agent accumulation in the (inflamed) vessel wall is highlighted. Here, high resolution, T1 weighting, suppression of fat and flowing spins is essential. Whereas VWI is often applied in humans, only very few reports describe its use in small animals. Here, we investigated whether BB MRI for rodents can be implemented using a state-of-the-art, but commercially available, preclinical MRI system and imaging sequence. We identified 2D spin-echo (RARE)-based BB-MRI as a promising sequence that is widely available and not vendor dependent. First, we investigated the properties of the sequence in vitro with respect to image contrast, resolution, the suppression of signal of flowing spins and fat using a newly developed, 3D-printed model setup (cylindrical model with exchangeable nuclear magnetic resonance tubes and flow tube in agarose, printed with stereolithography). For example, good signal-to-noise ratio, BB and T1 contrast were obtained for TE = 5 ms for slice thickness equal or below 0.352 mm or slice thickness = 0.8 mm with TE at least 25 ms. In vivo, we obtained a pronounced BB effect for both intracranial and abdominal vessels of healthy rats down to a 0.25 mm diameter in no more than 1:36 min with TE = 12 ms, TR = 750 ms, voxel 156 × 156 × 800 µm³, and 11 slices. Compared to in vitro, we were able to reduce TE without apparent artifacts likely because the flow was faster in vivo than in vitro. Additionally, we needed to increase the resolution to image small vessels. Thus, we found that BB-MRI with 2D spin-echo sequences is feasible on rodents with state-of-the-art, commercially available preclinical MRI systems. We believe that these results will facilitate the development and application of rodent VWI in longitudinal studies, which, in comparison to histology, may reduce the number of needed animals and intersubject variability at the same time.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematizing the risk management process in clinical radiotherapy practice: Recommendations of the working group on risk management of the DGMP.","authors":"Dominik Kornek, Cordelia Hoinkis, Natasa Milickovic, Ailine Lange, Alena Knak, Manuel März, Mieke L Möller, Markus Buchgeister","doi":"10.1016/j.zemedi.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.zemedi.2024.11.001","url":null,"abstract":"<p><strong>Purpose: </strong>The Deutsche Gesellschaft für Medizinische Physik [German Society of Medical Physics] has recently published two coherent reports, No. 25 and No. 28, detailing the design and implementation of a risk management (RM) process for German radiotherapy (RT) departments. This study offers an overview and background of the efforts behind these reports.</p><p><strong>Methods and materials: </strong>For three years, up to nine medical physicists (MPs) with practical RM experience held weekly meetings to develop recommendations for a clinical RM process. Care was taken to ensure that the recommendations were equally applicable to RT departments of various sizes. A process-based method derived from the failure mode and effects analysis (FMEA) was created to identify and address risks from unintentional radiation exposure. This method was applied to exemplarily analyze the hazardous scenarios in breast RT using surface guidance and deep inspiration breath hold (DIBH) techniques. Three common criticality methods-risk matrix, risk priority number, and action priority-were applied, and each step was schematically explained for first-time users. Each report was peer-reviewed by two radiation oncologists and 11 MPs.</p><p><strong>Results: </strong>In report No. 25, basic requirements were outlined for running the RM process, conducting risk assessments, and monitoring clinical procedures. A three-year plan-do-check-act cycle was proposed for continuous improvement. In report No. 28, general process lists for external beam radiotherapy (EBRT), brachytherapy, and radionuclide therapy were designed. Based on the EBRT process list, 45 hazardous scenarios in the surface-guided breast RT in DIBH were identified. Two scenarios were used to illustrate handling instructions for the three criticality methods.</p><p><strong>Conclusions: </strong>The recommendations provide clinical MPs and other health professionals with a pragmatic approach to RM, balancing both the needs of smaller practices and larger clinics in Germany. The risk of unintended exposures of patients is viewed acceptable once it has been lowered to a state that is as low as reasonably achievable.</p>","PeriodicalId":101315,"journal":{"name":"Zeitschrift fur medizinische Physik","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}