Journal of Applied Clinical Medical Physics最新文献

{"title":"Human visual perception-based grayscale contrast enhancement with adaptive window settings in computed tomography images","authors":"Wei Zhou,&nbsp;Yi Tian","doi":"10.1002/acm2.70212","DOIUrl":"10.1002/acm2.70212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Grayscale contrast plays a significant role in medical imaging. This is due to the fact that visual examination, where images are represented with different gray shades on display devices, is essential in current medical applications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The effective contrast enhancement should have the ability to provide sufficient grayscale contrast and natural image appearance in line with human visual perception (HVP). To achieve the goal, the paper proposes a novel method for grayscale contrast improvement in computed tomography (CT) diagnostics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A new quantitative physical metric incorporating certain human visual characteristics, termed as contrast-perceived to spatial frequency ratio (CPSFR), is presented to assess the perceptual quality of grayscale-based images. The window settings achieved by maximizing CPSFR, <i>Window Settings Automatic</i>, was evaluated and compared with <i>Window Settings Preset</i> and <i>Window Settings Manual</i> both of which are most used in CT diagnostics in terms of target detectability and diagnostic satisfaction. Experiments were carried out with 720 phantom images and 80 patient images. In phantom study, images were acquired with the routine body protocol at varying dose levels and assessed by four CT physicists for identifying signal-present or signal-absent. In clinical study, images with liver lesions were evaluated and rated by three radiologists with a 4-point diagnostic quality score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The phantom study indicated a statistically significant improvement with <i>Window Settings Automatic</i>, as compared to <i>Window Settings Preset</i> and <i>Window Settings Manual</i> (all <i>p &lt;</i> 0.01) in accuracy and sensitivity for consensus readings. And the clinical study demonstrated <i>Window Settings Automatic</i> had the distinct advantage over other candidates (highest mean score 3.0; <i>&gt;</i> 40% of all top-scoring votes).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The proposed method is capable of enhancing grayscale contrast in the region that really interests observers and yielding natural image appearance well suited to human visual perception to improve target detectability and diagnostic performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137529","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":"Equivalent squares of circular electron fields","authors":"Patrick N. McDermott","doi":"10.1002/acm2.70264","DOIUrl":"10.1002/acm2.70264","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background/Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;It is useful to be able to make manual estimates of the output (dose rate) of shaped electron fields. Such estimates can be used to check the treatment planning computed output. For rectangular (or approximately rectangular) fields, the square root rule may be used. Many electron apertures, however, are approximately circular and therefore a method for finding the equivalent square from the radius of circular apertures would be useful.&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 grid of Monte Carlo calculated output values for a variety of square and circular field sizes, applicators, and beam energies of 6 and 15 MeV has been used to find an expression for the equivalent square of circular fields. This equivalence has been tested using a larger data set. The test data set consists of electron energies of 6, 9, 12, and 15 MeV and radii ranging from 1.1 to 5.5 cm, for applicators of size 6 × 6, 10 × 10, 14 × 14, 20 × 20, and 25 × 25 cm&lt;sup&gt;2&lt;/sup&gt;. A total of 104 combinations of these parameters have been tested. Some clinical examples are provided to demonstrate how the equivalent square may be used to check treatment planning system MU calculations. Comparisons are made with measured output.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results/Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The results show that there is an exceptionally simple and remarkably accurate relationship for the equivalent square of circular electron fields, namely: &lt;i&gt;X&lt;/i&gt; = 1.83 &lt;i&gt;R&lt;/i&gt;, where &lt;i&gt;R&lt;/i&gt; is the radius and &lt;i&gt;X&lt;/i&gt; is the side length of the equivalent square. This is approximately midway between the two limiting values predicted by Fermi–Eyges theory (&lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;mrow&gt;\u0000 &lt;msqrt&gt;\u0000 &lt;mi&gt;π&lt;/mi&gt;\u0000 &lt;/msqrt&gt;\u0000 &lt;mo&gt;≤&lt;/mo&gt;\u0000 &lt;mi&gt;X&lt;/mi&gt;\u0000 &lt;mo&gt;/&lt;/mo&gt;\u0000 &lt;mi&gt;R&lt;/mi&gt;\u0000 &lt;mo&gt;≤&lt;/mo&gt;\u0000 &lt;mn&gt;2&lt;/mn&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;annotation&gt;$sqrt pi le X/R le 2$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt;).&lt;/p&gt;\u0000 \u0000 &lt;p&gt;For the 104 combinations of the parameters described above, the average ratio of the circular field output to the equivalent square output is 1.000, and the standard deviation is 0.003. In every case, the accuracy is better than 1% and, in most cases, better than 0.5%. Almost all the ratios fall within the ±0.4% accuracy expected based on the statistical uncertainty in the Monte Carlo calculations. It","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70264","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137505","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":"Comparison of Dance and AAPM/EFOMP TG282 breast dosimetry methodologies for a screening population: Evaluation of model-based median breast density metrics","authors":"Ioannis Delakis","doi":"10.1002/acm2.70260","DOIUrl":"10.1002/acm2.70260","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 mean glandular dose (MGD) estimation is important in breast cancer screening programs to balance diagnostic benefit with radiation risk.&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 aimed to compare the performance of the Dance and AAPM/EFOMP Task Group 282 (TG282) breast dosimetry methodologies using model versus image-derived breast density metrics.&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;This study analyzed over 80,000 digital mammography images acquired in 2023 from BreastScreen Queensland (BSQ). Data were obtained from Siemens and Hologic systems and included 2D cranio-caudal and mediolateral oblique views. Images with compressed breast thickness (CBT) between 20 and 100 mm were included. Volumetric breast density (VBD) and glandularity were extracted using Volpara software. MGD was estimated using both Dance and AAPM/EFOMP TG282 models, employing model-based median and image-measured breast density metrics. The ratios of MGD estimated using model medians to those using measured values (&lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;msub&gt;\u0000 &lt;mi&gt;R&lt;/mi&gt;\u0000 &lt;mi&gt;Dance&lt;/mi&gt;\u0000 &lt;/msub&gt;\u0000 &lt;annotation&gt;${{mathrm{R}}_{{mathrm{Dance}}}}$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; and &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;msub&gt;\u0000 &lt;mi&gt;R&lt;/mi&gt;\u0000 &lt;mrow&gt;\u0000 &lt;mi&gt;TG&lt;/mi&gt;\u0000 &lt;mn&gt;282&lt;/mn&gt;\u0000 &lt;/mrow&gt;\u0000 &lt;/msub&gt;\u0000 &lt;annotation&gt;${{mathrm{R}}_{{mathrm{TG}}282}}$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt;) were analyzed across CBT, and Pearson correlations (r) were computed.&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 Dance model median glandularity overestimates population-derived glandularity for most CBT, resulting in &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;msub&gt;\u0000 &lt;mi&gt;R&lt;/mi&gt;\u0000 &lt;mi&gt;Dance&lt;/mi&gt;\u0000 &lt;/msub&gt;\u0000 &lt;annotation&gt;${{mathrm{R}}_{{mathrm{Dance}}}}$&lt;/annotation&gt;\u0000 &lt;/semantics&gt;&lt;/math&gt; &gt; 1 at low CBT, with the trend reversed for CBT &gt; 80 mm. &lt;span&gt;&lt;/span&gt;&lt;math&gt;\u0000 &lt;semantics&gt;\u0000 &lt;msub&gt;\u0000 &lt;mi&gt;R&lt;/mi&gt;\u0000 &lt;mi&gt;Da","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137549","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":"Assessing dosimetric benefit from daily online adaptive radiation therapy for esophageal cancer","authors":"Antonia Kubiatowicz,&nbsp;Michael Sherer,&nbsp;Ayaka Owaga,&nbsp;Andrew Sharabi,&nbsp;Xenia Ray","doi":"10.1002/acm2.70244","DOIUrl":"10.1002/acm2.70244","url":null,"abstract":"<p>A cohort of 19 esophageal cancer patients treated at our institution were analyzed to assess the clinical feasibility and dosimetric benefit from daily adaptive radiation therapy (ART). An Ethos-planning template was developed to generate the initial ethos reference plan and daily adaptive plans using 9-field IMRT for reduced on-treatment optimization time. The template included relevant OAR goals and used an institutionally validated esophagus RapidPlan model. Clinical planning margins were used. Ethos-generated plans were validated against the clinically-approved plans which used 2-arc VMAT. Weekly on-treatment CBCT images were used to simulate doses from daily nonadaptive and adaptive techniques using the Ethos 2.0 Emulator. Timing data was recorded for each fraction. Dose metrics from institutional guidelines were compared between standard-of-care (SOC) and adaptive plans using a Wilcoxon signed rank test; these included mean dose for heart, lungs and liver, lungs V20Gy, and max dose for heart, spinal canal, and stomach. All Ethos template-generated plans were found equivalent to clinical plans. The daily adaptive workflow required 14.1 ± 6.8 min. Dosimetric improvements were variable by patient. Some patients experienced large metric reductions while others saw very minor benefits if any. For a sub cohort of patients that received high benefit, statistically significant (<i>p</i> &lt; 0.05) reductions in the lung mean, lung V20, heart mean, and heart V30 and V40 were observed. From these results we conclude that Ethos ART is feasible in terms of plan quality and on-treatment time for esophageal cancer. ART can produce significant normal tissue dose reductions; however, not all patients benefited equally. Thus, identifying high-benefit patients prior to treatment is necessary. Preliminary modeling results suggest this can be done prospectively, but these models are internally validated and require larger datasets to fully develop.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129286","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":"Independent secondary dose calculation for patient-specific quality assurance: Quantitative benefit of Monte–Carlo and custom beam modeling","authors":"Lone Hoffmann,&nbsp;Mai-Britt Linaa,&nbsp;Ditte Sloth Møller","doi":"10.1002/acm2.70265","DOIUrl":"10.1002/acm2.70265","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Independent secondary dose calculation (ISDC) is becoming increasingly important for patient specific quality assurance. The most widely used analytical algorithms in ISDC are becoming challenged by Monte Carlo systems, which offer a potentially higher accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Quantify the benefit of Monte Carlo over analytical algorithms, and of customized beam models over generic beam models, in terms of clinically relevant parameters, action level, and workload.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A set of 100 patients across 20 case classes, all planned with Acuros XB (Siemens Healthineers) was analyzed with Mobius3D (M3D) (Siemens Healthineers) and SciMoCa (Radialogica LLC), both with custom beam models (SMCcbm) and generic beam models (SMCgen). Gamma pass rate (GPR) and mean target dose difference |ΔD| action levels were determined for various rates of QA failures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At a workload of &lt; 10%, the action level for M3D was GPR (3%, 3 mm) &lt; 90% and |ΔD| &gt; 4.5%. For SMCgen, the action level was GPR (2%, 2 mm) &lt; 95% and |ΔD| &gt; 1.5%. For SMCcbm, it was GPR (2%, 1 mm) &lt; 95% and |ΔD | &gt; 1%. The combination of both criteria reduced the workload to &lt; 5%. SMC failures could be traced back to differences in the patient density model of Acuros XB. Some M3D failures could be traced back to the handling of tissue heterogeneities. The different performance between SMCcbm and SMCgen was due to one (of three) generic beam models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Monte Carlo allows substantially stricter acceptance criteria and is sensitive enough to capture TPS commissioning errors. Generic beam models must be validated thoroughly before being put to use in ISDC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129285","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 comparative study of clinically used fast Monte Carlo dose engines for proton therapy","authors":"Sherif M. Gadoue,&nbsp;Narayan Sahoo","doi":"10.1002/acm2.70266","DOIUrl":"10.1002/acm2.70266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Several fast Monte Carlo (MC) codes have been implemented and used to simulate proton transport and calculate patient doses in proton therapy. The resulting dose is typically compared to full MC codes, rather than other fast MC codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The primary goal of this study was to compare the gamma pass rates (GPRs) of dose calculation from different fast MC codes to evaluate the accuracy of the computation and modeling among these codes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two GPU codes and one CPU MC code were commissioned to model our clinical proton beamline at University of Texas MD Anderson Cancer Center. The GPU models use single 2D Gaussian models, whereas the CPU model uses a double 2D Gaussian model. For comparative evaluation, 70 cancer patients were randomly selected from our clinical practice, 10 from each of the following treatment sites: head and neck, brain, esophagus, lung, mediastinum, spine, and prostate. The calculated dose was compared with the dose from the verification plan created in the clinical treatment planning system (TPS) using 3D gamma analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The accuracy of dose calculation for all fast MC codes compared very well with the calculation from the TPS for the examined patient plans. GPR for all treatment sites ranged from 96.29% to 99.99%. In general, the double Gaussian model pass rate surpassed the single Gaussian model rate despite a slight accuracy reduction for prostate cases. GPRs for the single Gaussian codes ranged from 96.29% to 99.34%, whereas the double Gaussian model achieved a range of 98.68% to 99.99%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>All commissioned codes we examined demonstrated acceptable 3D GPR across all patients and treatment sites tested. Although the CPU MC code was commissioned using a double 2D Gaussian model, the single 2D Gaussian model used in the GPU codes proved to be sufficiently effective, yielding a high GPR.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70266","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129284","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":"Initial three- and half-year machine performance assessment of a superficial radiation therapy unit","authors":"Yongsook C. Lee,&nbsp;William Romaguera,&nbsp;Stephen D. Davis,&nbsp;D Jay Wieczorek,&nbsp;Vibha Chaswal,&nbsp;Ranjini Tolakanahalli,&nbsp;Minesh P. Mehta,&nbsp;Noah S. Kalman,&nbsp;Alonso N. Gutierrez","doi":"10.1002/acm2.70258","DOIUrl":"10.1002/acm2.70258","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This work reports on results of periodic machine quality assurance (QA) tests for our superficial radiation therapy (SRT) unit (SRT-100 Vision) performed for the first three- and half- year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Results of machine warm-up, dosimetry, mechanical, safety and imaging QA tests for our SRT-100 Vision unit were reviewed and analyzed. Dosimetry tests included output constancy, backup timer, timer accuracy, beam quality (half value layer [HVL]), applicator factors (AFs), absolute output calibration, output constancy with varying x-ray tube head rotation, output reproducibility, output linearity, timer and end-effect error, percent depth dose (PDD) verification and congruence between radiation field and applicator size. Mechanical tests encompassed unit stability as well as applicator integrity and indicators. Safety tests consisted of visual and audio monitors, beam-on indicator, interlocks, and energy/filter indicators. Imaging tests for ultrasound covered functional check, spatial integrity, and image quality check. The QA tests were performed for three kilovoltage (kV) x-ray energies (50, 70, and 100 kV_p) and six applicators (1.5, 2.0, 2.5, 3.0, 4.0, and 5.0 cm in diameter).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Daily mandatory machine warm-up was successfully completed on each day of treatment. The results of all dosimetry tests for three energies were within the recommended tolerance. Daily, and monthly outputs and annual absolute outputs were &lt; ± 3.0%, &lt; ± 2.0%, and &lt; ± 1.3%, respectively. Backup timer displayed timer set ± 0.0%. Timer accuracy was &lt; ± 1.0 sec. HVLs and AFs were &lt; ± 1.1% and &lt; ± 0.3%, respectively. Outputs for different head angles were &lt; ± 1.0% and output reproducibility was within 0.1%. Output linearity was &lt; ± 0.6% and end-effect errors were &lt; ± 0.0006 min. PDDs were &lt; ± 2.2%. Congruence was &lt; ± 0.5 mm. Monthly mechanical tests confirmed mechanical robustness of our unit. Daily safety features were verified to be functional each day. Monthly imaging tests for ultrasound showed good functionality, image quality, and spatial integrity meeting the set tolerance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The QA results demonstrated high performance and stability of our SRT-100 Vision unit over the first three and a half years of operation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70258","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102291","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 personalized tumor kV-IORT navigation system based on hybrid twin","authors":"Shan Jiang,&nbsp;Shuo Yang,&nbsp;Zhiyong Yang,&nbsp;Daguang Zhang,&nbsp;Yingkai Luan,&nbsp;Zeyang Zhou","doi":"10.1002/acm2.70243","DOIUrl":"10.1002/acm2.70243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study proposes a multidimensional hybrid twin navigation system to enhance applicator placement accuracy in low-energy x-ray intraoperative radiotherapy (kV-IORT), particularly for less-experienced practitioners. The system integrates augmented reality (AR) and digital twin technologies to improve intraoperative precision and usability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The system comprises three core modules: (1) a holographic dose (Holo-dose) model visualizing clinically relevant radiation layers based on Zeiss TARGIT data, (2) a patient-specific applicator positioning strategy with real-time AR feedback adapted to tumor bed geometry, and (3) a bidirectional hybrid twin control linking a physical radiotherapy robot with its virtual twin for precise navigation. Phantom experiments utilized a 20 mm spherical applicator within a 30 mm tumor bed boundary. Target dose range was 18.50–19.50 Gy (15 mm radius) over 25 min. Accuracy was evaluated via root mean square error (RMSE) and target registration error (TRE). Mean RMSE was 0.383 mm (phantom) and 0.106 mm (robot); mean TRE was 0.41 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The system significantly enhanced positioning accuracy for novice users. Medical students achieved an average precision of 2.971 mm (<i>p</i> = 0.00015), and inexperienced physicians reached 2.803 mm (<i>p</i> = 0.00038). No significant improvement was observed for experienced surgeons (<i>p</i> &gt; 0.05), indicating the system's potential as a training and assistance tool. The average System Usability Scale (SUS) score was 83.5, suggesting high user satisfaction, especially among younger participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The hybrid twin navigation system significantly improved applicator placement accuracy for novice users, demonstrating its value as an effective training and assistance tool for kV-IORT. High user satisfaction and sub-millimeter registration and alignment accuracy confirm its potential for clinical translation, particularly in enhancing usability and precision for less-experienced practitioners.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 10","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70243","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091797","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":"The effect of interfractional variation on delivered dose with ultrahypofractionated pencil beam scanning proton therapy for localized prostate cancer","authors":"Keyur D. Shah,&nbsp;Duncan H. Bohannon,&nbsp;Sagar A. Patel,&nbsp;Chih-Wei Chang,&nbsp;Vishal R. Dhere,&nbsp;Yinan Wang,&nbsp;Anees Dhabaan,&nbsp;Hania Al-Hallaq,&nbsp;Xiaofeng Yang,&nbsp;Jun Zhou","doi":"10.1002/acm2.70223","DOIUrl":"10.1002/acm2.70223","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose/objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Proton stereotactic body radiotherapy (SBRT) using the pencil beam scanning (PBS) technique is increasingly used for localized prostate cancer (PCa) due to its potential for superior normal tissue sparing. However, interfractional anatomical variations pose challenges for accurate dose delivery, especially in ultrahypofractionation. This study investigates the dosimetric impact of these variations in PCa patients treated with PBS-SBRT.&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;Forty-two low- or intermediate-risk PCa patients treated with PBS-SBRT (36.25/ 40 Gy in 5 fractions) were included. Delivered doses were calculated by applying the initial plans to HU and artifact-corrected pre-treatment cone-beam computed tomography (CBCT) images. Dosimetric parameters were evaluated per fraction. Key anatomical features included clinical target volume (CTV) shifts in the superior-inferior (SI) and anterior-posterior (AP) directions, and volume changes in the bladder and rectum. These features were used to predict deviations in CTV D&lt;sub&gt;99&lt;/sub&gt; and D&lt;sub&gt;0.03cc&lt;/sub&gt;, as well as maximum bladder and rectum doses. Univariate and multivariate logistic regression models were developed to identify significant anatomical predictors of dosimetric deviations, with odds ratios (OR) and area under the curve (AUC) values reported for predictive performance evaluation.&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;CTV AP shifts and bladder/rectum volume changes were significant predictors of dosimetric deviations. Univariate analyses indicated that bladder volume increases &gt; 109.80 cc were strongly associated with deviations in CTV D&lt;sub&gt;0.03cc&lt;/sub&gt; (mean deviation = 0.33 Gy, OR = 5.78, &lt;i&gt;p&lt;/i&gt; = 0.03). Rectum volume changes &gt; 9.22 cc were the strongest predictor of rectum D&lt;sub&gt;0.03cc&lt;/sub&gt; deviations (mean deviation = 0.68 Gy, OR = 4.23, &lt;i&gt;p&lt;/i&gt; = 0.01). AP shifts &gt; −0.27 cm were also predictive of CTV D&lt;sub&gt;0.03cc&lt;/sub&gt; deviations (OR = 0.35, &lt;i&gt;p&lt;/i&gt; = 0.01). Multivariate model predicting rectum D&lt;sub&gt;0.03cc&lt;/sub&gt; achieved the highest AUC (0.73), followed by CTV D&lt;sub&gt;0.03cc&lt;/sub&gt; (AUC = 0.68).&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;Multivariate models incorporating bladder volume changes and CTV shifts accurately predict dosimetric deviations in PBS-SBRT. These findings highlight the need for adaptive strategies during PBS-SBRT to mitigate the impact of interfractional variations, optimize dose delivery precision, and reduce toxicity in high-risk patients.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70223","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057805","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":"Implementation of intelligent All-in-one technology in rectal cancer radiotherapy: A retrospective study on automation efficiency and safety","authors":"Haoyang Zhai,&nbsp;Jiazhou Wang,&nbsp;Weigang Hu","doi":"10.1002/acm2.70236","DOIUrl":"10.1002/acm2.70236","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aims to assess percentage of automated AIO plans that met clinical treatment standards of radiotherapy plans generated by the fully automated All-in-one (AIO) process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study involved 117 rectal cancer patients who underwent AIO treatment. Fully automated regions of interest (ROI) and treatment plans were developed without manual intervention, comparing them to manually generated plans used in clinical practice. Geometric and dosimetric metrics were collected from both automated and manual plans. The relationship between the geometric and dosimetric metrics of the planning target volume (PTV) was evaluated using Spearman correlation analysis. The interquartile range (IQR) method was applied to determine the percentage of automated plans meeting clinical requirements. Additionally, dosimetric metrics for organs at risk (OAR) were compared between automated and manual plans using paired <i>t</i>-tests. The reasons for dose discrepancies were examined based on target volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Spearman correlation analysis showed a moderate correlation between geometric metrics and the conformity index (△CI) in dosimetric metrics. The correlation coefficients were as follows: Hausdorff distance (HD, |ρ| = 0.458, <i>p</i> &lt; 0.01), Mean deviation area (MDA, |ρ| = 0.565, <i>p</i> &lt; 0.01), Dice similarity coefficient (DSC, |ρ| = 0.631, <i>p</i> &lt; 0.01), and Jaccard index (JI, |ρ| = 0.632, <i>p</i> &lt; 0.01). Statistical analysis revealed that the mean doses to the bladder and bilateral femoral heads were significantly lower in automated plans compared to manual ones (<i>p</i> &lt; 0.01). This difference is likely due to variations in ROI delineation between automated and manual methods. The IQR method showed that 81.2% of automated AIO plans met clinical requirements without manual intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In routine clinical practice, approximately 81.2% of automated AIO plans met clinical requirements without requiring manual intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 9","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145021948","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}