Journal of Applied Clinical Medical Physics最新文献

{"title":"Comparison of in-field secondary cancer risk based on therapeutic proton dose between proton arc therapy and intensity-modulated proton therapy in lung cancer patients","authors":"Yuankang Xu, Wenguang Chen, Junxiang Wu, Hao Guo, Fanrui Zeng, Tianyu Zhang, Feng Yang, Xinhui Huang, Da Zhang, Xianliang Wang","doi":"10.1002/acm2.70793","DOIUrl":"10.1002/acm2.70793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Proton arc therapy (PAT) is an emerging delivery modality that delivers proton beams through continuous gantry rotation combined with spot scanning. Compared with intensity-modulated proton therapy (IMPT), PAT improves target conformity and spares organs at risk. However, the dynamic multi-angle irradiation pattern may alter the low-dose region distribution: the low-dose bath expands while the integral dose decreases. The net effect on secondary cancer risk, especially in radiosensitive lungs, remains unclear. Quantitative risk assessment is essential for clinical translation of PAT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To quantitatively compare secondary lung cancer risk between PAT and IMPT using organ equivalent dose (OED) and lifetime attributable risk (LAR) models, and to assess cross-population robustness across China, France, Sweden, and Germany.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from 25 lung cancer patients (60 Gy/30 fractions) were retrospectively included. For each patient, robustly optimized IMPT and PAT plans were generated with a 3 mm setup and 3% range uncertainties across 21 error scenarios. Dosimetric parameters—ipsilateral lung <span></span><math>\u0000 <semantics>\u0000 <msub>\u0000 <mi>V</mi>\u0000 <mn>5</mn>\u0000 </msub>\u0000 <annotation>${{mathrm{V}}_5}$</annotation>\u0000 </semantics></math>, <span></span><math>\u0000 <semantics>\u0000 <msub>\u0000 <mi>V</mi>\u0000 <mn>20</mn>\u0000 </msub>\u0000 <annotation>${{mathrm{V}}_{20}}$</annotation>\u0000 </semantics></math>, and mean dose; whole lungs <span></span><math>\u0000 <semantics>\u0000 <msub>\u0000 <mi>V</mi>\u0000 <mn>5</mn>\u0000 </msub>\u0000 <annotation>${{mathrm{V}}_5}$</annotation>\u0000 </semantics></math>, <span></span><math>\u0000 <semantics>\u0000 <msub>\u0000 <mi>V</mi>\u0000 <mn>20</mn>\u0000 </msub>\u0000 <annotation>${{mathrm{V}}_{20}}$</annotation>\u0000 </semantics></math>, and mean dose; and esophageal mean dose—were compared between the two techniques. The mechanistic OED model (with repopulation factor R) and its simplified linear model were used to calculate OED for the ipsilateral lung, both l","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-assisted software development for brachytherapy seed inventory management","authors":"Tonghe Wang,&nbsp;Joel Beaudry,&nbsp;Antonio L Damato,&nbsp;Marisa Kollmeier,&nbsp;David Aramburu Núñez","doi":"10.1002/acm2.70795","DOIUrl":"10.1002/acm2.70795","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Medical physics departments frequently rely on in-house software to address niche clinical needs, yet these tools are often built by physicists without formal software engineering training, resulting in legacy applications that are difficult to maintain, poorly documented, and vulnerable to obsolescence from operating system upgrades. This study investigates the use of AI-driven “vibe coding”, i.e. software development through natural language prompting, to enable a clinical physicist with no web development experience to replace an obsolete MATLAB-based radioactive seed inventory system with a modern desktop application.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>Development was performed using Claude Code (Anthropic) powered by the Claude Sonnet 4.6 large language model. A structured “Plan-Review-Execute-Verify-Feedback” (PREVF) methodology governed all development, with the physicist providing natural language prompts and the AI generating all source code. The resulting application manages five seed models across four clinical applications, with features including seed batch lifecycle tracking, calibration record management, audit logging, waste deposit tracking, etc. Evaluation metrics included development time and prompt volume, feature completeness against eight pre-defined requirements, System Usability Scale (SUS) scores comparing the legacy and new systems, and an independent maintainability test in which team members with minimal coding experience attempted modifications without developer assistance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The application was developed in approximately 13 hours, using approximately 115 natural language prompts. All eight functional requirements were fully implemented. The new application received a median SUS score of 95 compared to 32.5 for the legacy system. In the maintainability evaluation, three independent testers completed bug fixes and feature modifications in one to two prompts each, all in under 10 min, without guidance from the original developer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI-driven vibe coding enables clinical medical physicists to rapidly develop and maintain operational software, resolving the maintenance bottleneck characteristic of legacy in-house tools. The PREVF methodology provides a structured framework for physicist oversight of AI-generated code. This approach has potential applicability to provide clinical support tools by medical physics departments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine physics work efficacy and efficiency improvement through a shared-duty physicist-of-the-day model in a multi-hospital radiation oncology network","authors":"Guang-Pei Chen,&nbsp;Douglas E. Prah,&nbsp;Eric S. Paulson","doi":"10.1002/acm2.70792","DOIUrl":"10.1002/acm2.70792","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Large multi-hospital radiation oncology networks often rely on site-exclusive physicist coverage models that can lead to imbalanced workload distribution, inconsistent task execution, communication fragmentation, and vulnerability to delayed or missed quality checks. Increasing clinical complexity and distributed staffing models necessitate operational strategies that improve efficiency, standardization, and safety across geographically separated sites.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To describe the implementation of a shared-duty physicist-of-the-day (POD) model supported by a real-time operational dashboard and to evaluate its impact on workload distribution, task efficiency, and safety metrics across a multi-hospital radiation oncology network.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A structural transition from a site-exclusive to a shared-duty POD model was implemented in our institution—a four-site academic radiation oncology system. A custom application, RadOncStatusBoard, was developed using structured query language (SQL)-based integration with the Mosaiq Record &amp; Verify system to aggregate real-time patient appointments, treatment progress, quality checklist (QCL) items, and weekly chart check (WCC) eligibility. Microsoft Teams channels were used for daily communication and task coordination. Operational data from two matched 21-month intervals—before and after POD restructuring—were extracted using SQL. Evaluated metrics included task volumes, claim times, completion times, WCC performance, billing accuracy, and dosimetry-related Radiation Oncology Incident Learning System (RO-ILS) event reporting. Right-skewed distributions were summarized using medians and interquartile ranges (IQR). Surveys of physicists and dosimetrists were performed to assess end-user perceptions of workflow and safety.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Workload balance improved across all task categories, with substantial decreases in main-to-satellite task ratios (e.g., the ratio for chart close decreased from 1.91 to 1.27). Task claim and completion times decreased markedly at both main and satellite locations (e.g., chart-close claim time decreased from 36.8 to 6.2 min at the main campus). WCC completion improved from 97.7% to 99.9%, and WCC charge capture increased from 96.1% to 99.4%. The proportion of dosimetry-related RO-ILS events decreased numerically from 31.0% to 26.7% (&lt;i&gt;p&lt;/i&gt; = 0.339). Survey responses from physicists and dosimetrists indicated improved workflow clarity, com","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing the dose delivered to major intracranial blood vessels in brain radiotherapy using spot-scanning proton arc therapy","authors":"Peilin Liu,&nbsp;Sebastian Tattenberg,&nbsp;Xiaoda Cong,&nbsp;Peter Y. Chen,&nbsp;Xuanfeng Ding,&nbsp;Abdelkhalek Hammi","doi":"10.1002/acm2.70780","DOIUrl":"10.1002/acm2.70780","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Glioblastoma (GBM) patients have poor clinical prognoses, which may partially be explainable by correlations between radiation-induced killing of circulating blood cells (CBCs) and worse clinical outcomes. Proton radiotherapy is currently delivered via intensity-modulated proton therapy (IMPT), for which the target is irradiated from a few different angles. Spot-scanning proton arc therapy (SPArc), for which the target is irradiated from arc trajectories, is associated with dosimetric benefits, and the first SPArc treatments of head-and-neck cancer patients have now been reported. However, since SPArc increases the low-dose bath, concerns have been raised about potentially higher killing of CBC.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aims to evaluate and compare blood vessel dose and dose-averaged linear energy transfer (LET&lt;sub&gt;d&lt;/sub&gt;) distributions between IMPT and SPArc, with and without blood vessel sparing, in patients with GBM.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;For 10 GBM patients, patient-specific cerebrovasculature models were developed, and IMPT and SPArc treatment plans were created according to current clinical standards (IMPT&lt;sub&gt;Conv&lt;/sub&gt; and SPArc&lt;sub&gt;Conv&lt;/sub&gt;) and with sparing of delineated blood vessels (IMPT&lt;sub&gt;Sparing&lt;/sub&gt; and SPArc&lt;sub&gt;Sparing&lt;/sub&gt;) for every patient. Dose and LET&lt;sub&gt;d&lt;/sub&gt; distributions were then compared across all treatment plans.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;While treatment plans maintained comparable target coverage, blood vessel sparing significantly reduced the mean dose to delineated blood vessels, with values of 6.5 ± 2.9 Gy(RBE) for IMPT&lt;sub&gt;Conv&lt;/sub&gt;, 5.3 ± 2.3 Gy(RBE) for IMPT&lt;sub&gt;Sparing&lt;/sub&gt;, 5.6 ± 2.2 Gy(RBE) for SPArc&lt;sub&gt;Conv&lt;/sub&gt;, and 3.8 ± 1.6 Gy(RBE) for SPArc&lt;sub&gt;Sparing&lt;/sub&gt;. The dose within the 10% of blood vessel volume receiving the highest dose (D&lt;sub&gt;10%&lt;/sub&gt;) was 29.5 ± 13.4 Gy(RBE) for IMPT&lt;sub&gt;Conv&lt;/sub&gt;, 23.2 ± 11.0 Gy(RBE) for IMPT&lt;sub&gt;Sparing&lt;/sub&gt;, 24.5 ± 12.6 Gy(RBE) for SPArc&lt;sub&gt;Conv&lt;/sub&gt;, and 13.4 ± 8.7 Gy(RBE) for SPArc&lt;sub&gt;Sparing&lt;/sub&gt;.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Implementation of blood vessel sparing resulted in successful reductions in blood vessel dose metrics while preserving target coverage, and SPArc further reduced blood vessel dose metrics compared with IMPT, with the potential to reduce radiation-induced lymphopenia and improve clinical outc","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Cherenkov-excited fluorescence emission dosimetry for HDR Co-60 brachytherapy: Calibration and planar validation against TPS","authors":"Yagiz Yedekci,&nbsp;Mehmet Fazıl Enkavi,&nbsp;Ferah Yildiz","doi":"10.1002/acm2.70785","DOIUrl":"10.1002/acm2.70785","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Accurate dose verification in High-Dose-Rate (HDR) brachytherapy presents a significant challenge due to steep dose gradients and the absence of beam collimation. Conventional quality assurance (QA) methods typically rely on point detectors or film-based techniques, which lack the capability to provide real-time, full-field visualization of dose distributions in a water-equivalent medium. While Cherenkov emission (CE) imaging has been investigated for Iridium-192 (&lt;sup&gt;192&lt;/sup&gt;Ir) systems, the low mean photon energy of &lt;sup&gt;192&lt;/sup&gt;Ir (∼380 keV) constrains the optical yield and limits the signal-to-noise ratio. Because Cobalt-60 (&lt;sup&gt;60&lt;/sup&gt;Co) emits higher primary photon energies, it generates distinct Cherenkov intensities and spatial characteristics, requiring dedicated evaluation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aims to characterize the relationship between Cherenkov emission intensity and absorbed dose generated by an HDR &lt;sup&gt;60&lt;/sup&gt;Co source. Furthermore, it seeks to generate high-resolution two-dimensional dose maps using Cherenkov-excited fluorescence imaging and validate their dosimetric accuracy against Treatment Planning System (TPS) calculations to evaluate the system for clinical QA implementation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A custom 3D-printed polylactic acid (PLA) phantom was fabricated with an internal cavity filled with an aqueous quinine hemisulfate solution (1 g/L). This solution was used to convert ultraviolet Cherenkov photons into isotropic visible fluorescence, thereby enhancing optical signal detection. Optical emissions were captured using a standard monochrome CMOS camera positioned at a 24 cm working distance. To eliminate radiation-induced artifacts on the sensor without relying on complex time-gated hardware, an image processing pipeline comprising dark frame subtraction, median filtering, and morphological operations was applied. A calibration function was established by delivering doses between 10 and 1500 cGy using a &lt;sup&gt;60&lt;/sup&gt;Co HDR afterloader. Dosimetric accuracy was then evaluated across ten independent verification plans using two-dimensional gamma index analysis with 3% dose difference and 3 mm distance-to-agreement (3%/3 mm) criteria.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The dosimetric calibration demonstrated a highly predictable and linear dose-response relationship, yielding a coefficient of determination (&lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;) of 0.9999 and a root mean square error (RMSE) of 3.46 cGy. For the clinical veri","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13556302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of inter-fractional anatomical variations due to compression belt placement reproducibility using MR-guided radiotherapy treatment fraction images","authors":"Olivia Shay,&nbsp;David Solis,&nbsp;Morgan Aire,&nbsp;Christopher Schneider,&nbsp;Krystal Kirby","doi":"10.1002/acm2.70783","DOIUrl":"10.1002/acm2.70783","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Abdominal compression (AC) using a belt-based system is widely employed in radiation therapy to limit respiration-induced target motion for abdominal and hepatic malignancies. While AC has demonstrated efficacy in reducing intrafraction motion amplitude, the interfractional anatomical consequences of daily compression belt (CB) placement variability remain poorly characterized. A clearer understanding of this variability is necessary to determine whether online adaptive radiotherapy (oART) is required to maintain dosimetric robustness throughout the treatment course.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aims to quantify interfractional anatomical variability associated with CB use in a clinical MR-guided radiotherapy cohort and to compare these findings against a matched cohort of non-compressed abdominal patients to determine the clinical significance of CB-induced setup variability.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Daily treatment MR images were retrospectively collected from 17 CB patients and 17 matched non-CB controls treated on an MR-Linac. External contours were delineated at the center of the planning target volume (PTV) and at the region of maximum compression for CB patients. Interfractional variability was assessed using cross-sectional area (CSA), Dice Similarity Coefficient (DSC), Mean Distance to Agreement (MDA), and Hausdorff Distance (HD). Interfractional organ displacement of the liver and kidneys was quantified via rigid registration. Linear mixed-effects models (LMEMs) evaluated the association between patient demographics—including age, BMI, sex, subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT)—and interfractional variability metrics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Interfractional DSC over the PTV region was significantly lower in the CB cohort compared with non-CB controls (&lt;i&gt;p&lt;/i&gt; = 0.01 and &lt;i&gt;p&lt;/i&gt; = 0.03 for comparisons to fraction one and sequential fraction comparisons, respectively), and MDA was significantly elevated in the CB cohort (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). No significant difference in CSA variability was observed between cohorts. In the maximum compression region, median HD was 1.6 cm relative to fraction one, with no significant correlation between compression-region and PTV-region CSA variability (&lt;i&gt;p&lt;/i&gt; = 0.99). Older age, male sex, and higher BMI were associated with improved belt-contact shape reproducibility (all &lt;i&gt;p&lt;/i&gt; &lt; 0.05), though these demographic effects did not translate to PTV-region stability. ","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A combined radiomics-clinical nomogram for assessing MRI-defined femoral Head collapse status in osteonecrosis of the femoral Head","authors":"Lijun Peng,&nbsp;Yi Zhou,&nbsp;Lihua Zhou","doi":"10.1002/acm2.70779","DOIUrl":"10.1002/acm2.70779","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Osteonecrosis of the femoral head (ONFH) frequently progresses to femoral head collapse, resulting in irreversible joint dysfunction and the need for total hip arthroplasty. Reliable assessment of magnetic resonance imaging (MRI)-defined collapse status remains limited with conventional assessment methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To develop and validate a multi-modal nomogram integrating MRI-based radiomics signatures and clinical risk factors for the assessment of MRI-defined collapse status in patients with osteonecrosis of the femoral head (ONFH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 149 ONFH patients (99 non-collapsed, 50 collapsed), partitioned into training (<i>n</i> = 104) and testing (<i>n</i> = 45) sets. Radiomics features were extracted from MRI-based necrotic lesion segmentations. A Radscore, derived via least absolute shrinkage and selection operator (LASSO) regression, was integrated with selected clinical variables to construct a combined nomogram.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The combined clinical-radiomics model demonstrated favorable discriminative performance, achieving an AUC of 0.940 (95% CI: 0.858–0.994) in the testing set, which outperformed the clinical-only model (AUC = 0.589) and the radiomics-only model (AUC = 0.818). Using the cutoff determined by the Youden index in the training cohort, the combined model exhibited a sensitivity of 80.0%, specificity of 90.0%, and overall accuracy of 86.7% in the testing cohort. Calibration curves showed acceptable agreement between model-predicted probabilities and observed MRI-defined collapse status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The integrated clinical-radiomics nomogram showed promising performance for non-invasive assessment of femoral head collapse status in patients with ONFH. This quantitative approach may assist individualized collapse-status stratification, but external validation and prospective clinical workflow studies are required before routine clinical implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empirical noise mapping guides optimal region-of-interest selection for accurate noise estimation in prostate DWI","authors":"Milica Medved,&nbsp;Aritrick Chatterjee,&nbsp;Ambereen Yousuf,&nbsp;Batuhan Gundogdu,&nbsp;Aytekin Oto,&nbsp;Gregory S. Karczmar","doi":"10.1002/acm2.70738","DOIUrl":"10.1002/acm2.70738","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Signal-to-noise ratio (SNR) measurements are important for quality assurance, especially when quantitative MRI markers or new hardware are being developed or evaluated. Regions of low signal or assumed uniform signal are used for SNR estimation in a variety of MR image types, but this is unreliable due to spatial heterogeneity of noise arising from the organization of multiple-detector arrays and sensitivity encoding (SENSE) reconstruction.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We present a universally applicable method for empirical noise mapping by propagating simulated noise through the image-generating reconstruction pipeline, to identify optimal regions of interest (ROIs) for determining noise levels in prostate diffusion-weighted imaging (DWI).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Thirty-six men were imaged at 3T with DWI. K-space data were propagated through an off-line reconstruction pipeline including sensitivity encoding (SENSE), to generate DW images. Simulated complex Gaussian noise generated from prescan per-channel measurements was similarly processed to produce pure noise maps. Per-voxel standard deviations (SD) of spatial distributions of noise, averaged over prostate, internal obturator muscle (IOM), low signal (anterior and posterior), rectum, and bladder ROIs were calculated and compared to evaluate suitability for SNR estimation in prostate DWI.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;IOM ROI noise levels, averaged bilaterally, were not significantly different from those in the prostate. Bladder ROI noise levels were comparable. Noise levels measured in low signal areas were highly dependent on SENSE algorithm regularization strength.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The proposed method can be used—on any scanner—to accurately calculate noise levels in MR images, without repeated acquisition or interference from SENSE use.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Bladder and averaged IOM ROIs are appropriate for estimating DWI noise levels in the prostate. Low signal ROIs should not be used, due to the strong dependence on the SENSE regularization strength, and by extension, on the SENSE reconstruction algorithm. The presented method can be used instead to obtain accurate spatial maps of noise levels.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure modes and effects analysis for clinical implementation of online adaptive radiotherapy: A systematic review.","authors":"Deepikaa Balaji, Sonja Wegener, Sebastian Klüter, Sara L Hackett","doi":"10.1002/acm2.70749","DOIUrl":"10.1002/acm2.70749","url":null,"abstract":"<p><strong>Background: </strong>The accuracy of radiotherapy is limited by anatomical variations occurring over time scales ranging from sub-seconds to days. Online Adaptive Radiotherapy (OART) addresses this by enabling daily plan adaptation based on real-time imaging. While OART offers improved dose conformity, its dynamic, time-constrained workflow introduces novel failure modes that challenge traditional quality assurance protocols.</p><p><strong>Purpose: </strong>This study aims to synthesize the existing literature on Failure Modes and Effects Analysis (FMEA) for OART to systematically catalog risks and identify mitigation strategies.</p><p><strong>Methods: </strong>A systematic literature search was conducted to identify studies applying FMEA to OART workflows. Eleven studies were included, covering MR-guided (ViewRay MRIdian, Elekta Unity), CBCT-guided (Varian Ethos), and MR-enhanced C-arm linac systems. To address heterogeneity in risk scoring methodologies (e.g., TG-100 10-point scales vs. 5-point rankings), extracted failure modes were harmonized into a standardized three-tier risk classification system (Class I: Low, Class II: Intermediate, Class III: High).</p><p><strong>Results: </strong>A total of 300 unique failure modes were identified, with 49.6 percent classified as high-risk (Class III). Analysis revealed that the majority of high-risk failures were concentrated in the online treatment delivery phase, specifically within human-computer interactions and anatomical contouring steps.</p><p><strong>Conclusions: </strong>This study supports the development of tailored, robust QA frameworks that prioritize human factors and process consistency to guide safe implementation in diverse clinical settings.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":"e70749"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying variation in DLP- to- effective-dose conversion factors in CT using a Monte Carlo-based dose-estimation software","authors":"Jelena M. Mihailovic,&nbsp;Renxin Chu,&nbsp;Da Zhang,&nbsp;Andrew M. Hernandez,&nbsp;Kai Yang,&nbsp;Lifeng Yu","doi":"10.1002/acm2.70724","DOIUrl":"10.1002/acm2.70724","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A common method to estimate the effective dose in CT is to multiply the dose length product in a CT scan by a conversion factor (k). The k-factors are determined by dividing the effective dose (calculated using a weighted summation of organ doses) by the dose length product (DLP) for specific digital phantoms. The k-factors determined in this way may vary substantially depending on the effective dose calculation methods and phantom models used.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The purpose of this study was to estimate variation associated with different acquisition and patient characteristics in the quantification of k-factors.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;K-factors were calculated using VirtualDoseCT for a diverse set of computational phantoms representing different patient models, scanner models, and seven CT exams. The tube potential varied from 80 to 120 kV. The scan length was varied by ± 5 cm relative to the default setting. The CTDIvol was set to 10 mGy when tube current modulation was not used; otherwise, the software default was used. A multivariable regression method was employed to derive an empirical formula for k-factors, along with model-uncertainty analysis and Sobol's sensitivity analysis to identify the influence of each variable.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;K-factors for all exams increased with kV. Negative dependence of k-factors on BMI was observed, with lower values in males than in females. Moderate to high variation was observed in the quantification of k-factors without TCM, which remained unchanged with TCM. Based on Sobol's indices (0.8–1), k-factors were influenced most by scan length and patient size for adults, and scan length and age for pediatric phantoms.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The study showed that a large spread in k-factors was predominantly influenced by scan length, patient size and age. The heterogeneity in k-factors may lead to large heterogeneity in the effective dose estimate if the DLP×k method is used. These results indicate that age and size specific k-factors to estimate effective dose from DLP may be warranted.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A set of k-factors should be established to account for these factors and improve effective dose estimations.&lt;/p&gt;\u0000 &lt;/s","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}