Journal of Applied Clinical Medical Physics最新文献

{"title":"A method for measuring spatial resolution based on clinical chest CT sequence images.","authors":"Ying Liu, Jingying Shen, Haowei Zhang, Haikuan Liu","doi":"10.1002/acm2.70078","DOIUrl":"https://doi.org/10.1002/acm2.70078","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop and validate a method for characterizing the spatial resolution of clinical chest computed tomography (CT) sequence images.</p><p><strong>Methods: </strong>An algorithm for characterizing spatial resolution based on clinical chest CT sequence images was developed in Matlab (2021b). The algorithm was validated using CT sequence images from a custom-made chest automatic tube current modulation (ATCM) phantom and clinically reconstructed chest CT sequence images. A region of interest (ROI) was automatically established at the edges of CT image subject to calculate the edge spread function (ESF). The ESF curves from consecutive CT images within the same sequence were fitted into a curve, and the line spread function (LSF) was derived through differentiation. A Fourier transformation of the LSF curve was conducted to obtain the modulation transfer function (MTF). The method's effectiveness was verified by comparing the 50% MTF and 10% MTF values with those calculated using IndoQCT (22a) software. The method was also applied to clinical CT images to calculate MTF values for various reconstructions, confirming its sensitivity by determining spatial resolution of clinically reconstructed images.</p><p><strong>Results: </strong>Validation experiments based on the phantom CT sequence images demonstrated that the MTF values calculated using the proposed method had an average difference of within ± 5% compared to the results obtained with IndoQCT. Validation experiments with clinical CT sequence images indicated that the method effectively reflects differences and variations in spatial resolution of images under different reconstruction kernels, with the MTF values for B10f-B50f and D10f-D50f exhibiting a consistent increase.</p><p><strong>Conclusion: </strong>A method for measuring spatial resolution using clinical chest CT sequence images was developed. This method provides a direct means of spatial resolution characterization for clinical CT datasets and a more accurate representation of CT imaging quality, effectively reflects variations across different reconstruction convolution kernels, demonstrating its sensitivity.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70078"},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geometric and dosimetric evaluation of a commercial AI auto-contouring tool on multiple anatomical sites in CT scans.","authors":"Robert N Finnegan, Alexandra Quinn, Patrick Horsley, Joseph Chan, Maegan Stewart, Regina Bromley, Jeremy Booth","doi":"10.1002/acm2.70067","DOIUrl":"https://doi.org/10.1002/acm2.70067","url":null,"abstract":"<p><p>Current radiotherapy practices rely on manual contouring of CT scans, which is time-consuming, prone to variability, and requires highly trained experts. There is a need for more efficient and consistent contouring methods. This study evaluated the performance of the Varian Ethos AI auto-contouring tool to assess its potential integration into clinical workflows. This retrospective study included 223 patients with treatment sites in the pelvis, abdomen, thorax, and head and neck regions. The Ethos AI tool generated auto-contours on each patients' pre-treatment planning CT, and 45 unique structures were included across the study cohort. Multiple measures of geometric similarity were computed, including surface Dice Similarity Coefficient (sDSC) and mean distance to agreement (MDA). Dosimetric concordance was evaluated by comparing mean dose and maximum 2 cm³ dose (D_{2 cc}) between manual and AI contours. Ethos AI demonstrated high geometric accuracy for well-defined structures like the bladder, lungs, and femoral heads. Smaller structures and those with less defined boundaries, such as optic nerves and duodenum, showed lower agreement. Over 70% of auto-contours demonstrated a sDSC > 0.8, and 74% had MDA < 2.5 mm. Geometric accuracy generally correlated with dosimetric concordance, however differences in contour definitions did result in some structures exhibiting dose deviations. The Ethos AI auto-contouring tool offers promising accuracy and reliability for many anatomical structures, supporting its use in planning workflows. Auto-contouring errors, although rare, highlight the importance of ongoing QA and expert manual oversight.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70067"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commissioning evaluation of a deviceless 4DCT scanner.","authors":"Hunter Tillery, Cheyann Windsor, Christopher Aguilera","doi":"10.1002/acm2.70048","DOIUrl":"https://doi.org/10.1002/acm2.70048","url":null,"abstract":"<p><strong>Background: </strong>The utilization of four-dimensional computed tomography (4DCT) for radiation therapy has not seen major advances to the method of data binning since shortly after inception. Recently there is increased interest in the utilization of an alternative binning method rather than more established techniques. At this point routine quality assurance and commissioning of 4DCT have been well studied and established with traditional binning methods. Due to this new \"deviceless\" technique relying on algorithms instead of an external breathing signal, established dynamic phantoms and equipment typically used in the commissioning and quality assurance workflow have proven to no longer be compatible.</p><p><strong>Methods: </strong>A commercially available phantom was modified to include components that the deviceless 4D algorithm uses for binning. Typical 4DCT commissioning datasets were acquired and reconstructed using both deviceless and device-based binning techniques. Both regular and irregular breathing curves were evaluated for performance, similar to what would be seen with typical radiation therapy patients.</p><p><strong>Results: </strong>Deviceless and device-based binning methods performed similarly and well for regular breathing curves. As datasets became more irregular, the deviceless algorithm was better able to reconstruct 4DCTs.</p><p><strong>Conclusion: </strong>Commissioning datasets for both device-based and deviceless 4DCTs were evaluated to test if modifications to a commercially available phantom would allow for an accurate comparison between binning systems. It was shown that not only did these modifications work but also highlighted a difference in the way that these systems binned data, which could be applied to patients with breathing irregularities.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70048"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitating 1.5T MR-Linac adoption: Workflow strategies and practical tips.","authors":"Madeline Michel, Zelda Paquier, Christelle Bouchart, Akos Gulyban, Nicolas Jullian, Dirk Van Gestel, Sara Poeta, Nick Reynaert, Philippe Martinive, Robbe Van Den Begin","doi":"10.1002/acm2.70073","DOIUrl":"https://doi.org/10.1002/acm2.70073","url":null,"abstract":"<p><strong>Background: </strong>MR-guided radiotherapy (MRgRT) offers new opportunities but also introduces workflow complexities requiring dedicated optimization. Implementing magnetic resonance linear accelerator (MR-Linac) technology comes with challenges such as prolonged treatment times and workflow integration issues.</p><p><strong>Purpose: </strong>We present here our experience and share practical tips and tricks to streamline MR-Linac implementation, optimize workflow efficiency, and improve coordination.</p><p><strong>Methods: </strong>The first 150 patients treated with a 1.5T MR-Linac Unity^® at our institution were analyzed. Treatments were assessed based on session recordings, difficulties encountered were identified, and solutions documented.</p><p><strong>Results: </strong>A total of 726 fractions were delivered, with a mean treatment time of 48 minutes. Key optimizations included standardized operating procedures (SOPs) and structured briefing sheets, leading to reduced delays and improved treatment consistency.</p><p><strong>Conclusion: </strong>Strategic workflow standardization and optimized communication tools significantly improved the ability to deliver high-quality, patient-centered care by streamlining processes and enhancing coordination among team members. These insights provide practical guidance for centers integrating MR-Linac technology.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70073"},"PeriodicalIF":2.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic image-based treatment planning for online adaptive ultra-hypofractionated prostate cancer radiotherapy with MR-Linac.","authors":"Yuan Xu, Ningning Lu, Qiao Li, Kuo Men, Xinming Zhao, Jianrong Dai","doi":"10.1002/acm2.70075","DOIUrl":"https://doi.org/10.1002/acm2.70075","url":null,"abstract":"<p><strong>Purpose: </strong>A new workflow was investigated for Elekta Unity MR-Linac by removing the computed tomography (CT)-simulation step and using diagnostic CT (DCT) for reference plan generation.</p><p><strong>Materials and methods: </strong>Ten patients with ultra-hypofractionated prostate cancer treated with magnetic resonance imaging (MRI)-guided adaptive radiotherapy were retrospectively enrolled. Targets and organs at risk (OARs) were recontoured on DCT, and Hounsfield unit conversions to relative electron density were calibrated for DCT. Reference plans were reoptimized and recalculated using DCT for Unity. Subsequent adaptive plans were designed through an adapt-to-shape workflow to edit targets and OARs via daily MRI to generate a new treatment plan. Bulk electron density information for Unity adaptive plan was compared between planning CT (PCT) and DCT for volumes of interest. Dosimetric parameters were evaluated between PCT- and DCT-based reference and adaptive plans for target coverage and OAR dose constraints.</p><p><strong>Results: </strong>Bulk relative electron density differences between PCT and DCT were within ±1% for targets and OARs, excepting the rectum. PCT and DCT-based reference plans did not significantly differ in mean target coverages or for OARs in dosimetric difference except for V_36 Gy of the rectum. PCT- and DCT-based adaptive plans did not significantly differ for most dosimetric parameters of targets and OARs except for V_29 Gy and V_36 Gy of the rectum, V_18.1 Gy of the bladder, and D_50% of the urethra.</p><p><strong>Conclusions: </strong>By removing the CT simulation step, it is feasible to use DCT for designing reference and adaptive plans in the Unity ATS workflow. The workflow increased adaptive radiotherapy efficiency and decreased patient waiting time and additional radiation dose.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70075"},"PeriodicalIF":2.0,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced dose prediction for head and neck cancer artificial intelligence-driven radiotherapy based on transfer learning with limited training data.","authors":"Hui-Ju Wang, Austen Maniscalco, David Sher, Mu-Han Lin, Steve Jiang, Dan Nguyen","doi":"10.1002/acm2.70012","DOIUrl":"https://doi.org/10.1002/acm2.70012","url":null,"abstract":"<p><strong>Purpose: </strong>Training deep learning dose prediction models for the latest cutting-edge radiotherapy techniques, such as AI-based nodal radiotherapy (AINRT) and Daily Adaptive AI-based nodal radiotherapy (DA-AINRT), is challenging due to limited data. This study aims to investigate the impact of transfer learning on the predictive performance of an existing clinical dose prediction model and its potential to enhance emerging radiotherapy approaches for head and neck cancer patients.</p><p><strong>Method: </strong>We evaluated the impact and benefits of transfer learning by fine-tuning a Hierarchically Densely Connected U-net on both AINRT and DA-AINRT patient datasets, creating Model_AINRT (Study 1) and Model_DA-AINRT (Study 2). These models were compared against pretrained and baseline models trained from scratch. In Study 3, both fine-tuned models were tested using DA-AINRT patients' final adaptive sessions to assess Model_AINRT 's effectiveness on DA-AINRT patients, given that the primary difference is planning target volume (PTV) sizes between AINRT and DA-AINRT.</p><p><strong>Result: </strong>Studies 1 and 2 revealed that the transfer learning model accurately predicted the mean dose within 0.71% and 0.86% of the prescription dose on the test data. This outperformed the pretrained and baseline models, which showed PTV mean dose prediction errors of 2.29% and 1.1% in Study 1, and 2.38% and 2.86% in Study 2 (P < 0.05). Additionally, Study 3 demonstrated significant improvements in PTV dose prediction error with Model_DA-AINRT, with a mean dose difference of 0.86% ± 0.73% versus 2.26% ± 1.65% (P < 0.05). This emphasizes the importance of training models for specific patient cohorts to achieve optimal outcomes.</p><p><strong>Conclusion: </strong>Applying transfer learning to dose prediction models significantly improves prediction accuracy for PTV while maintaining similar dose performance in predicting organ-at-risk (OAR) dose compared to pretrained and baseline models. This approach enhances dose prediction models for novel radiotherapy methods with limited training data.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70012"},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of multi-leaf collimator leaf width on VMAT treatment plan quality.","authors":"Gregory Sadharanu Peiris, Brendan Whelan, Nicholas Hardcastle, Suzie Lynn Sheehy","doi":"10.1002/acm2.70018","DOIUrl":"https://doi.org/10.1002/acm2.70018","url":null,"abstract":"<p><strong>Background: </strong>The advent of volumetric modulated arc therapy (VMAT) in radiotherapy has made it one of the most commonly used techniques in clinical practice. VMAT is the delivery of intensity modulated radiation therapy (IMRT) while the gantry is in motion, and existing literature has shown it has decreased treatment delivery times and the number of monitor units without sacrificing coverage. It has previously been shown that for IMRT, multi-leaf collimators (MLC) with narrower leaf widths produce demonstrably higher treatment plan quality. However, as VMAT is rapidly becoming the global standard, this needs to be re-evaluated, especially in a global context. This study assesses the impact of MLC leaf width on VMAT treatment plans and asks whether reducing the number of leaves- and thus increasing leaf width- provides clinically acceptable treatment plans using VMAT delivery.</p><p><strong>Material & methods: </strong>Using Varian Eclipse, 51 anonymised patients with prostate, lung, liver, colorectal, or cervical cancer had VMAT treatment plans generated. Treatment plans were generated for MLC leaf widths of 2.5, 5 and 10 mm. Plans were compared using D₂[%], D₅₀[%], and D₉₈[%], homogeneity index (HI), conformity index (CI), average leaf pair opening (ALPO), modulation factor (MF) and Estimated Treatment Delivery Time.</p><p><strong>Results: </strong>The dose to the target structures showed little difference between 2.5 and 5 mm MLC leaves, however 10 mm MLC provided 5% more median dose than the narrower leaf widths for D₂[%] (p < 0.05) and D₅₀[%] (p < 0.05). The average HI per leaf width was 0.0777 for 2.5 mm, 0.0752 for 5 mm, and 0.0890 for 10 mm. Organs At Risk (OAR) sparing was consistent between all leaf widths except at low dose percentages, where 10 mm MLC delivered an extra dose to the bladder (p < 0.05) and the heart (p < 0.05). The average ALPO was 38.0 mm for 2.5 mm, 34.1 mm for 5 mm, and 32.7 mm for 10 mm leaf width. 10 mm MLC leaves traveled a shorter distance from the center (p < 0.05). The median MF was 336 MU/Gy for 2.5 mm, 344 MU/Gy for 5 mm, and 384 MU/Gy for 10 mm. There were no differences in estimated treatment delivery time between MLC leaf width.</p><p><strong>Conclusion: </strong>There is little difference in treatment quality between any of the investigated MLC leaf widths. This work demonstrates that for VMAT treatments, wider MLC leaf widths can still deliver acceptable treatment plans. This finding has potential implications for radiotherapy in low- and middle-income countries and low socio-economic or rural areas where a focus on MLC robustness and LINAC up-time is paramount.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70018"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High spatial resolution dosimetry for radiation oncology with \"MagicPlates,\" a new 976-pixel monolithic silicon detector.","authors":"Ilia Filipev, Saree Alnaghy, Martin Carolan, Jason Paino, Marco Petasecca, Dean Cutajar, Joel Poder, Justin B Davies, Bradley M Oborn, Nicholas Hardcastle, Susanna Guatelli, Michael Lerch, Tomas Kron, Anatoly Rosenfeld","doi":"10.1002/acm2.70015","DOIUrl":"https://doi.org/10.1002/acm2.70015","url":null,"abstract":"<p><strong>Purpose: </strong>We introduce the next generation of \"MagicPlate\" 2D monolithic pixelated semiconductor detectors - MagicPlate-976 (MP976). It features a larger array area, higher spatial resolution, and does not require external triggering. We perform a comprehensive characterization for small-field steep-dose-gradient dosimetry applications in radiation therapy focusing on x-ray beams used in stereotactic treatments.</p><p><strong>Methods: </strong>The MP976, developed by the Centre for Medical Radiation Physics, consists of 976 ion-implanted diodes on a thin n-type epitaxial silicon substrate with a total array area of 58 × 58 mm². The central region has \"small\" diodes with an area of 0.2 × 0.2 mm² and 1 mm pitch and the peripheral region has \"large\" diodes with an area of 0.6 × 0.6 mm² and 2 mm pitch. The detector was primed with 10 kGy (Co-60) and tested using a Varian TrueBeam linear accelerator for sensitivity change and dose linearity, and variations in response due to dose-per-pulse and beam incidence angle. Output factors, depth dose, and beam profiles were measured and compared with reference data.</p><p><strong>Results: </strong>After the 10 kGy, the sensitivity declined by (74 ± 5)% for \"large\" diodes and by (78 ± 7)% for the \"small\" ones, the dose-per-pulse (DPP) dependence was in the range of commercially available diodes, however, a difference in the DPP dependence between the \"large\" and \"small\" diodes of (8.4 ± 0.2)% was found in the studied DPP range from 0.131-1.111 mGy/pulse. The minimum angular response was at 90° for 6 MV and 100° for 10 MV flattened beams (76% and 82%, respectively). The output factors and depth dose response showed agreement with the reference within 3.1% and 1%, respectively. Deviation in small field 80%/20% penumbra measurements was within 0.5 mm for 6 MV FF and 0.3 mm for 10 MV FFF. Full width at half maximum (FWHM) for the beam profiles agreed within 0.5 mm for both beam qualities.</p><p><strong>Conclusion: </strong>The new MagicPlate-976 detector system is shown to be suitable for dosimetry in small fields and steep dose gradients. It provides 1 mm spatial resolution in the central region and 2 mm on the periphery and has no dependence on the field size. The system's high spatial and temporal resolution opens new opportunities for trigger-less, film-less, and time-resolved verification and error identification for complex stereotactic treatment plans.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70015"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric effect of silicone-based gel on skin surface during volumetric modulated arc therapy for breast cancer.","authors":"Tenyoh Suzuki, Shingo Ohira, Mami Ogita, Takeshi Ohta, Yuki Nozawa, Masanari Minamitani, Takuya Hayashi, Shigeki Saegusa, Toshikazu Imae, Tsuyoshi Ueyama, Atsuto Katano, Hideomi Yamashita, Weishan Chang, Keiichi Nakagawa","doi":"10.1002/acm2.70070","DOIUrl":"https://doi.org/10.1002/acm2.70070","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to quantify and compare the dosimetric effects of varying thicknesses of StrataXRT, a silicone-based gel, and other topical agents on the skin surface during volumetric modulated arc therapy (VMAT) for breast cancer.</p><p><strong>Methods: </strong>A VMAT plan was created for breast cancer treatment using a female RANDO phantom with a prescription dose of 50 Gy in 25 fractions. The planning target volume (PTV) encompassed the left breast and the regional lymph nodes. Irradiation was performed using a 6 MV photon beam. Three topical agents (StrataXRT, Hirudoid Soft Ointment, and RINDERON-Vs Ointment) having eight thicknesses (0.0-1.5 mm) were evaluated. Dosimetry was conducted using Gafchromic EBT4 films at three anatomical locations-subclavicular, medial, and lateral aspects of the left breast.</p><p><strong>Results: </strong>Mean dose enhancement ratios (DERs) of 102%-116% were observed in VMAT for topical agent thicknesses of 0.1-0.5 mm, increasing to 116%-126% at 1.0 and 1.5 mm. Among the evaluated agents, StrataXRT consistently exhibited the lowest DER, with a statistically significant difference (p < 0.05).</p><p><strong>Conclusions: </strong>This study demonstrated that StrataXRT exhibited the lowest DER among the evaluated topical agents in VMAT for breast cancer. Thicknesses exceeding 0.5 mm potentially exceeded the threshold dose for acute skin reactions.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70070"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods for working with problem residents in medical physics residency education.","authors":"Christopher J Watchman, Dandan Zheng","doi":"10.1002/acm2.70068","DOIUrl":"https://doi.org/10.1002/acm2.70068","url":null,"abstract":"<p><p>Medical physics residency training programs may occasionally encounter residents requiring additional intervention beyond normal training efforts. In the literature, these residents are referred to as \"problem\" residents. While the physician literature on the subject is valuable, this paper specifically focuses on dealing with a problem medical physics resident. This work discusses a generalized strategy for addressing and correcting medical physics problem resident issues. A discussion of categories of problems that may be encountered is also presented. Additionally, a standardized process for resident intervention is given, along with a discussion of issues related to transparency and bias. Applying the principles in this work should assist medical physics residency programs in establishing a strong culture where all residents, including those experiencing difficulties, can successfully complete their medical physics residency training. This work is a result of collaborations facilitated by the Society of Directors of Academic Medical Physics Programs (SDAMPP).</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":" ","pages":"e70068"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}