Journal of Applied Clinical Medical Physics最新文献

{"title":"Intersoftware variability in SPECT quality control: A technical note on analytical discrepancies and compliance decisions.","authors":"Feng Jiawu, Zhang Li, Wang Shaojia, Liu Fei, Chen Yuhang, Peng Huaguang, Zhou Xuan, Cheng Yongliang, Sun Jingzhi","doi":"10.1002/acm2.70595","DOIUrl":"10.1002/acm2.70595","url":null,"abstract":"<p><strong>Background: </strong>Quality control (QC) is essential for ensuring the diagnostic reliability of Single-Photon Emission Computed Tomography (SPECT) systems. However, the reliance on third-party software for analyzing QC metrics introduces a potential source of variability that is not yet standardized. Variability in QC results due to the use of different image analysis software may compromise both equipment evaluation and interinstitutional comparability.</p><p><strong>Purpose: </strong>This technical note assessed the variability in QC test results generated by different SPECT image analysis software packages to underscore the need for improved standardization.</p><p><strong>Methods: </strong>Five representative commercial SPECT QC software packages (A-E) were used to analyze identical DICOM image sets acquired from four SPECT/CT systems in accordance with the WS 523-2019 standard. Evaluated metrics included file reading success rates, key performance indicators (intrinsic uniformity, resolution, linearity), and compliance rates. Statistical analysis employed ANOVA or Welch's tests, followed by LSD post hoc testing, with effect sizes (η²) reported.</p><p><strong>Results: </strong>File reading success varied significantly (61.8%-100%), with Softwares B and D exhibiting higher failure rates. Compliance rates for identical devices varied considerably (68.8%-100%). Statistically significant intersoftware differences were found for intrinsic integral uniformity (F = 10.17, p < 0.05, η²= 0.092), intrinsic spatial resolution (Welch F = 79.7, p < 0.05, η²= 0.477), and intrinsic differential linearity (F = 2.65, p < 0.05, η²= 0.137). The effect sizes for spatial resolution and differential linearity indicated large effects (η² > 0.14). Significant differences (p < 0.05) in key indicators were also observed across analyses for UFOV/CFOV fields of view and X/Y directions. Pairwise comparisons indicated that the primary differences existed between Softwares B, D, and E compared to the other packages.</p><p><strong>Conclusion: </strong>We found significant disparities between software packages in both file reading capability and the analysis of key QC performance indicators. These differences directly impact the accuracy of equipment performance evaluations and interinstitutional comparability, potentially leading to divergent conclusions regarding the same device's compliance status.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70595"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772172","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":"Use of apertures in single-energy pristine Bragg peak FLASH radiotherapy.","authors":"Yangguang Ma, Balaji Selvaraj, Xingyi Zhao, Chingyun Cheng, Chin-Cheng Chen, Longfei Diao, Yufei Wang, Zhengda Wang, Yuntong Pei, Lele Liu, Xueqing Yan, Benjamin Durkee, Charles B Simone, Haibo Lin, Xuanqin Mou, Minglei Kang","doi":"10.1002/acm2.70593","DOIUrl":"10.1002/acm2.70593","url":null,"abstract":"<p><strong>Background: </strong>Proton single-energy Bragg peak (SEBP) FLASH delivery can achieve dosimetric distributions equivalent to conventional intensity-modulated proton therapy (IMPT). However, range-pulling and field compensator devices enlarge the proton pencil beam spot size, increasing lateral penumbra and compromising dose conformality and high-dose-rate distribution. Apertures are employed to mitigate these effects, enhancing dose metrics while preserving ultra-high dose rate performance.</p><p><strong>Purpose: </strong>To investigate the efficacy of apertures in sharpening lateral dose falloff and enhancing dose conformity in proton pencil beam scanning (PBS) Bragg peak (BP) FLASH radiotherapy (RT), addressing increased lateral dose spillage caused by universal range shifter (URS) and range compensator (RC) usage.</p><p><strong>Methods: </strong>PBS Single-energy BP (SEBP) FLASH treatment plans with and without brass apertures were optimized using an in-house planning system. Dose and dose rate characteristics were simulated using MCSquare. Penumbra reduction was assessed in a water phantom for 3 and 5 cm square fields under varying pullback (10 cm, 20 cm. 30 cm) and air gap (5 cm, 10 cm, 15 cm) conditions. Aperture effects were evaluated at the entrance, midpoint, and BP positions. The rGBM cancer plan was optimized using SEBP with various dose thresholds (0, 2, and 5 Gy) applied to analyze dose and ultra-high dose rate (V_40Gy(RBE)/s) performance.</p><p><strong>Results: </strong>Use of aperture significantly reduced lateral penumbra across all spatial positions. The degree of penumbra reduction increased significantly with the increased pullback, and the reduction effect at the BP was generally comparable to that at the entrance. The 5 cm field generally showed greater penumbra reduction than the 3 cm field. In the rGBM case, apertures improved gross tumor volume (GTV) dose conformity and reduced organ-at-risk (OAR) exposure but decreased ultra-high dose rate coverage for both GTV and OARs. The ultra-high dose rate coverage of GTV was not affected by the dose threshold, while the ultra-high dose rate coverage of the brain increased with the increasing dose threshold.</p><p><strong>Conclusion: </strong>Apertures effectively reduce lateral penumbra and dose spalliage to OARs, improving target dose conformity in range shifter-based SEBP FLASH-RT. They also can reduce ultra-high dose-rate exposure to critical OARs in the low-dose region while maintaining the FLASH ratio in the high-dose region.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70593"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772249","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":"Impact of software tools and kinetic model selection on myocardial blood flow and flow reserve quantitation in ¹³N-ammonia PET.","authors":"Naochika Akiya, Kenta Miwa, Akira Ando, Noriaki Miyaji, Tensho Yamao, Kaito Wachi, Masaki Masubuchi, Shu Kimura, Reiji Ito, Arata Komatsu, Takuma Horikawa, Kenji Fukushima, Atsutaka Okizaki, Shiro Miura","doi":"10.1002/acm2.70605","DOIUrl":"https://doi.org/10.1002/acm2.70605","url":null,"abstract":"<p><strong>Background: </strong>Quantitative assessment of myocardial perfusion using ¹³N-ammonia PET with compartmental modeling enables evaluation of myocardial flow reserve (MFR) and prediction of patient prognosis. However, the reliability of these assessments can depend on the analytical methods used for quantitation.</p><p><strong>Purpose: </strong>The present study aimed to evaluate the variability and agreement of values obtained using three quantitative software tools and to assess the impact of kinetic model selection on myocardial blood flow (MBF) and MFR estimates in a clinical setting.</p><p><strong>Methods: </strong>We analyzed 100 patients who underwent ¹³N-ammonia PET/CT, including 60 with normal perfusion and 20, 10, and 10 with single-, two-, and three-vessel disease, respectively. We derived MBF and MFR at global (entire left ventricle) and regional (coronary territories) levels and evaluated five analytical pipelines: SyngoMBF, QPET, and three implementations of PMOD tools (1-tissue compartment, Hutchins, and UCLA models).</p><p><strong>Results: </strong>MBF and MFR showed high correlations among the software tools, although stress MBF statistically differed between PMOD and QPET. Correlation coefficients between software tools ranged from 0.81 to 0.91 at the global level, and Bland-Altman analysis demonstrated overall agreement with residual variability. In contrast, MBF and MFR values varied depending on the compartment model. The UCLA model yielded the highest stress MBF and MFR, and correlation coefficients between models ranged from 0.43 to 0.99 at the global level. Although Bland-Altman analysis showed overall agreement, noticeable scatter persisted and the UCLA model exhibited a positive bias.</p><p><strong>Conclusion: </strong>Quantitative MBF and MFR estimates from ¹³N-ammonia PET show good overall agreement across commonly used software tools but remain strongly dependent on kinetic model selection. These findings indicate that quantitative results are not directly interchangeable across different software and modeling approaches, underscoring the importance of methodological consistency when interpreting myocardial perfusion PET in clinical practice.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70605"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815424","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":"Deriving target exposure indices for common radiography exams based on automatic exposures of flat-field phantoms.","authors":"Matthew Hoerner, Emily L Marshall, Katie Hulme, Ashley Tao, Suha Alshehri, Shady AlKhazzam, Zaiyang Long, Erin Macdonald, Kathleen Scilla, Ioannis Tsalafoutas","doi":"10.1002/acm2.70562","DOIUrl":"10.1002/acm2.70562","url":null,"abstract":"<p><strong>Background: </strong>The IEC exposure index (EI), deviation index (DI), and target exposure index (EI_T), represent critical standardized metrics for the evaluation of exposure and quality in radiographic imaging.</p><p><strong>Purpose: </strong>This work develops and validates a systematic procedure to estimate the EI_T for eight of the most common radiography imaging protocols utilizing automatic exposure control (AEC) from measurements acquired under reference conditions.</p><p><strong>Methods: </strong>A model was developed to define the relationship between a systems AEC logic, and an estimation of the EI under flat-field conditions (EIFFC). Separately, clinical data and acquisition protocol information for resultant EI during patient studies were also collected for the eight protocols studied: Chest posteroanterior (PA), Chest lateral, Abdomen anteroposterior (AP), Pelvis AP, L-Spine AP, C-Spine AP, T-Spine AP, and Ribs AP. Data were collected from 41 x-ray units spanning seven institutions. For each protocol on each unit the EIFFC was computed based on the acquisition protocol, as well as median EI from clinical exams to produce a scaling factor (SF). Kruskal-Wallis statistical tests were used to compare SF's between vendors and AEC cell configurations.</p><p><strong>Results: </strong>SFs for eight radiographic imaging protocols have been produced per vendor and per AEC cell selection. A workflow has been established for end-users to follow to apply these SFs to flat-field measurements taken at their own locations to establish local EI_T.</p><p><strong>Conclusions: </strong>The study results show that in seven of the eight imaging protocols, the SFs for most units included in the study report SFs within 1 DI (± 25%) of their respective final vendor reported SF (218/228). The ribs protocol is the exception to this finding (n = 26). SFs have high utility for establishing EI_T values on individual x-ray units and normalizing EI value distributions for quality assurance purposes.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70562"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772211","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":"Impact of variation in the α/β of cervical cancer on predicted clinical outcomes.","authors":"Cameron Thayer-Freeman, Brien Washington, Dennis Cheek, Wei Luo","doi":"10.1002/acm2.70608","DOIUrl":"10.1002/acm2.70608","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To improve the effectiveness and efficiency in radiation therapy, various treatment modalities and fractionation schemes have been introduced and combined for cancer treatment. Biological effective dose (BED) and equivalent dose in 2 Gy fraction (EQD&lt;sub&gt;2&lt;/sub&gt;) are used to evaluate and compare different modalities and fractionations and also used to determine dose prescriptions for new radiation schemes. BED and EQD&lt;sub&gt;2&lt;/sub&gt; are functions of α/β and the accuracy of α/β value is essential. A single α/β value of 10 Gy has been used for cervical cancer in clinical practice. However, our previous study first found that cervical cancer has a broad range of α/β values across in vitro studies that follow a right-skewed log-normal distribution. If patient populations follow such a distribution, it may have potential impact on radiation therapy for cervical cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To investigate the impact of variation in the α/β of cervical cancer on the expected EQD&lt;sub&gt;2&lt;/sub&gt; associated with clinical outcome for cervix cancer patients treated with radiation therapy and how that variance could influence the determination of alternate fractionation schemes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A right-skewed log-normal distribution of experimentally derived α/β values was applied to a reference tumor control probability (TCP) curve generated from cervical cancer patients treated with radiation, and a population of patients following that distribution were simulated using Monte Carlo sampling. An alternate equation for equivalent dose in 2 Gy fractions (EQD&lt;sub&gt;2&lt;/sub&gt;) was derived that considered variance in α/β and was used to generate new values and associated TCP curves that could be plotted on a common EQD&lt;sub&gt;2&lt;/sub&gt; axis. Convolution curves of TCP and normal tissue complication probability (NTCP) were generated to determine the potential shift in optimal dose and probability of risk-free local control (RFLC). Theoretical treatment failure rates were generated to evaluate changes in rates of treatment outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Variation in α/β obtained from published experimental results produced potential losses in TCP of up to 24% in the range of clinical interest. RFLC curves predicted an optimal treatment dose of 95 Gy EQD&lt;sub&gt;2&lt;/sub&gt; when applying our most probable α/β of 4.25 Gy, 10 Gy higher than that predicted by the reference curve. The α/β distribution saw a decrease in RFLC of 17%. To achieve a TCP of 90%, possible HDR fractionation schemes ranged from 56 Gy in 14 fractions to 32 Gy in 2 fractions, with the associated increase in normal tissue dose ranging from 11 to 16 Gy EQD&lt;sub&gt;2&lt;/sub&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The distribution of cervical cancer α/β values derived from experimental results produced significant changes in tumor control when applied to a reference TCP curve. TCP decreased with both the average and most probable α/β values. It is suggested that va","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70608"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838152","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":"COMP Report: Patient-specific quality assurance practices in Canadian radiotherapy-results from a national survey.","authors":"Muoi N Tran, Renée-Xavière Larouche, Brennen Dobberthien, Nicolas Varfalvy, Gerard Lagmago Kamta, Philip Wright, Richard Lee, Gordon H Chan","doi":"10.1002/acm2.70591","DOIUrl":"https://doi.org/10.1002/acm2.70591","url":null,"abstract":"<p><p>Patient-specific quality assurance (PSQA) is an essential component of modern radiotherapy, ensuring safe and accurate delivery of increasingly complex treatments. Given its resource-intensive nature and the availability of evolving approaches, examining how PSQA is implemented and optimized across Canada is important to inform best practices. This study aimed to characterize the current landscape of PSQA practice across Canadian radiotherapy centers, identify patterns and regional variations, and explore opportunities for future national guidance. A 30-question web-based survey was developed and distributed in March 2024 to all Canadian radiotherapy centers, including satellites. The survey addressed staffing, treatment machines, PSQA tools and methodologies, policies, data analysis, frequency of PSQA, and failure management. Responses were collected in both English and French, de-identified, and analyzed by center size and region (British Columbia, Prairies, Ontario, Quebec, and Atlantic). The survey achieved a 90% response rate (45 of 50 centers). Most centers reported using 3D array detectors, followed by EPID and point detectors. Gamma index analysis was the predominant evaluation method. More than half of participating centers, including 65% of large centers, reported reducing PSQA measurement frequency, citing accumulated local experience rather than external guidance. However, all centers in the Prairies and Atlantic regions reported maintaining full measurement frequency. A vast majority of centers that used delivery log calculations also reported a reduction in measurement frequency, while most centers using EPID did not. Across all regions, selective adoption of recommendations from both Canadian and American guidelines was observed. PSQA practices in Canada are heterogeneous, reflecting local resources, institutional experience, and evolving international recommendations. Given the resource-intensive nature of PSQA and observed variability in practice, these findings highlight the value of developing national guidance tailored to Canadian clinical realities.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70591"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13099579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772126","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":"Refining imaging parameters for dual-energy cone-beam computed tomography in image-guided radiation therapy.","authors":"Hyejoo Kang, Andrew Keeler, Matthew Georgesen, Jason Luce, Ha Nguyen, Mathias Lehmann, Sebastien Gros, John C Roeske","doi":"10.1002/acm2.70516","DOIUrl":"https://doi.org/10.1002/acm2.70516","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a dose estimation method for virtual monoenergetic images (VMIs) derived from sequential dual-energy (DE) cone-beam computed tomography (CBCT), enhancing image quality while reducing imaging dose. The goal is to generate VMIs with lower imaging dose than standard CBCT for future clinical applications.</p><p><strong>Materials and methods: </strong>Normalized air kerma (K_air) was measured using an ion chamber for eight CBCT datasets with varying exposures and framerates at 80 and 140 kVp. Correlations between K_air and measured cone-beam dose indices (CBDI) were established to estimate K_air-based imaging dose for DE-CBCT, and then the estimates were subsequently validated. Separately, VMIs were reconstructed from eight new DE-CBCT protocols of a Catphan 604 phantom using the Feldkamp-Davis-Kress (FDK) algorithm within the open-source TIGRE. Image quality of these VMIs at 60 keV, optimal for soft tissue contrast, was evaluated using the contrast-noise-ratio (rCNR) relative to the clinical Pelvis Large Protocol (PLP), the mean Hounsfield units (HU) accuracy over all material inserts, and HU uniformity.</p><p><strong>Results: </strong>The average difference between estimated and measured K_air was 0.7 ± 2.1% for 80 kVp and 1.3 ± 1.9% for 140 kVp. All VMIs exhibited rCNR values greater than 1 (range: 1.11-1.70), indicating enhanced soft tissue contrast compared to the PLP. The estimated relative K_air for these VMIs ranged from 60% to 100% of a single PLP. VMIs also exhibited improved HU accuracy, reduced HU variance, and substantially improved HU uniformity including those with 60% of the PLP imaging dose.</p><p><strong>Conclusion: </strong>This pilot study demonstrates that VMIs can improve CNR and HU uniformity while reducing imaging dose by up to 40%, relative to the PLP, without compromising HU accuracy. Our approach offers potential for optimizing VMIs by balancing image quality enhancement and dose reduction. Future work will focus on the application of advanced reconstruction algorithms to further improve VMIs quality.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70516"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772162","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":"Stereotactic body radiotherapy to the left lung in right lateral decubitus: A challenging case report.","authors":"Jochen Cammin, Elizabeth Manuel, Shifeng Chen, Zaker Rana, Matthew J Ferris","doi":"10.1002/acm2.70564","DOIUrl":"https://doi.org/10.1002/acm2.70564","url":null,"abstract":"<p><p>This case report describes a lung stereotactic body radiotherapy (SBRT) treatment complicated by the patient's inability to tolerate standard supine positioning, requiring simulation and delivery in the right lateral decubitus position. Five major workflow challenges were encountered involving patient positioning, 4DCT acquisition, treatment planning involving gantry‑clearance limitations, patient‑specific QA, and CBCT‑based image guidance. Customized solutions, including non-standard respiratory-surrogate placement for 4DCT, off‑center isocentering, customized limited‑arc CBCT, and measurement‑based patient-specific QA, enabled safe and effective treatment. This case highlights the need for adaptable SBRT workflows for patients unable to tolerate conventional positioning.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70564"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13106943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147772181","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":"Development and clinical deployment of an automated planning tool for prostate only and male whole pelvis plans based on multi-criteria optimization.","authors":"Kai Huang, Kai Wang, Adam Schrum, Eric Kusmaul, Erica Fisler, Mariana Guerrero","doi":"10.1002/acm2.70598","DOIUrl":"10.1002/acm2.70598","url":null,"abstract":"<p><strong>Background: </strong>Multi-criteria optimization (MCO) is an advanced optimization technique that can be applied to any problem with multiple objectives that may be conflicting. MCO has been available in commercial treatment planning systems (TPS) for several years now and has been applied to treatment planning of many anatomical locations in a variety of ways. The MCO optimization method is based on the Pareto plans generation and is very powerful, but there are significant hurdles in terms of clinical implementation due to long computing times, lack of dosimetrists training and plan degradation after the optimized fluence is converted to deliverable. While some authors have studied the use of MCO in automation, no clinical implementation of an MCO-based auto-planning technique has been reported.</p><p><strong>Purpose: </strong>This study aims to develop and clinically deploy an automated planning tool based on MCO for prostate and whole-pelvis radiotherapy.</p><p><strong>Materials and methods: </strong>A Python script based on a commercial treatment planning system was developed to automate MCO, including Pareto plan generation, fluence plan selection, dose conversion, and post-processing. The tool underwent retrospective validation on 10 prostate patients with the input of four dosimetrists and a 10-month prospective pilot involving another three senior dosimetrists across different community sites. Dosimetrists evaluated plan quality and provided quantitative and qualitative feedback for iterative improvements of the tool. The study reports on the plan comparisons between the clinical and the MCO generated plans for retrospective patients. The study also reports the prospective use cases and the qualitative and quantitative evaluations from dosimetrists.</p><p><strong>Results: </strong>Retrospective evaluations showed 82.5% of MCO prostate plans were clinically acceptable. The tool generated prostate plans in approximately 10.1 min and whole pelvis plans in 27.2 min. Dosimetric analysis revealed comparable plan quality to clinical plans, with MCO plans achieving lower organ-at-risk doses. In the pilot phase, the MCO tool was used for 41 prospective patients, producing plans that dosimetrists could refine to achieve clinical acceptability within a median of 10 min.</p><p><strong>Conclusions: </strong>This study demonstrates the successful development and clinical implementation of an MCO-based automated planning tool for generating acceptable VMAT plans for prostate and whole pelvis radiotherapy. The extensive pilot phase showcases an effective strategy for integrating automated planning solutions into routine clinical practice.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 5","pages":"e70598"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815366","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":"Using deformable registration to assess dosimetric impact of variability in deep inspiration breath hold (DIBH) levels for left breast treatment","authors":"Venketesh Thrithamara Ranganathan,&nbsp;Amy Gouthro,&nbsp;Tynan Stevens","doi":"10.1002/acm2.70541","DOIUrl":"10.1002/acm2.70541","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In deep inspiration breath hold (DIBH) left breast radiation treatment, dosimetric impact of variation within breath hold (BH) tolerances has not been precisely quantified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Estimate target and organs at risk (OAR) dose variations due to patient movements within BH target tolerances, and assess impacts on 3DCRT, VMAT and pseudo skin flash planning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty patients who underwent left breast DIBH treatment with 4000 cGy in 15 fractions using 3DCRT or VMAT were retrospectively selected. A combination of deformable registration and breathing traces from CT simulation were used to generate CT volumes corresponding to ± 5 mm about the BH target. 3DCRT clinical treatment plans were applied directly to the generated CT volumes. For VMAT, new optimizations were performed on the target BH CT scan to achieve target dose within ± 0.5 % of the treated plan. The re-optimized plan was applied to the generated CT volumes to estimate the organ doses. Pseudo skin flash treatment plans were created for the VMAT patients using the same optimization parameters, and applied to the generated CT volumes. Target coverage (D₉₅), heart, lung, and breast mean doses, and heart hotspot (D1cc) were evaluated at each deviation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Deformable registration demonstrated relative motion of the target and OARs not previously observed with simple rigid registration methods. Target coverage in 3DCRT plans were more robust against BH target variation compared to VMAT and pseudo skin flash. However, pseudo skin flash show comparable target coverage to 3DCRT for BH target overshoot. With 3DCRT, the heart hot spot shows significant individual variations in the undershoot regime.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Deformable registration-based dose estimation reveals complex organ motion with significant individual variability in plan robustness. 3DCRT is less sensitive to BH variability than VMAT. Our protocol potentially enables individualized approach to selecting technique and tolerances based on patients’ DIBH movements.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 4","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13067201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645152","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}