Journal of Applied Clinical Medical Physics最新文献

{"title":"Feasibility of multi-energy CT and fat fraction MRI for characterizing active bone marrow response to pelvic external beam radiation therapy","authors":"Carolyn Eckrich, Kristin Bradley, Bethany Anderson, Diego Hernando, Jessica Miller, Jainil Shah, Patrick Wohlfahrt, Michael Lawless","doi":"10.1002/acm2.70794","DOIUrl":"10.1002/acm2.70794","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pelvic external beam radiation therapy (EBRT), frequently exposes a substantial fraction of active bone marrow (ABM), leading to radiation-induced marrow suppression and associated hematologic toxicity. Accurate delineation and quantitative assessment of ABM are therefore essential to enable marrow-sparing radiotherapy strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To identify and quantify changes in ABM after EBRT using multi-energy CT (MECT) and fat fraction MRI (FFMRI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with gynecological malignancies underwent MECT and FFMRI pre- and post-radiation therapy. ABM was delineated on both imaging modalities using thresholding where ABM was defined as voxels with CT numbers above the mean in MECT-derived virtual non-calcium (VNCa) datasets and voxels with percent fat fraction (%FF) below the mean on the FFMRI. ABM volumes and mean HU/%FF values were evaluated before and after treatment. A Wilcoxon-signed rank test was computed to compare paired MECT versus FFMRI ABM volume percent changes. Changes in ABM as a function of dose were also evaluated. A paired t-test was computed for each dose gradient (significant <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The average Dice Similarity Coefficient (DSC) between the MECT and FFMRI pre-treatment ABM volumes was 0.57 (range: 0.50–0.68). The mean volumetric change in ABM volume between pre- and post-treatment scans was −37%<span></span><math>\u0000 <semantics>\u0000 <mo>±</mo>\u0000 <annotation>$ pm $</annotation>\u0000 </semantics></math>15% (range −57% to −12%) and −66%<span></span><math>\u0000 <semantics>\u0000 <mo>±</mo>\u0000 <annotation>$ pm $</annotation>\u0000 </semantics></math>27% (range 8% to −94%) for MECT and FFMRI, respectively. All paired patients demonstrated greater ABM volume reduction with FFMRI than with MECT, and this difference was statistically significant (<i>p</i> = 0.0078). ABM changes were observed as a function of dose: A decrease in mean CT numbers and an increase in %FF corresponds to an increase in dose. CT number decreased significantly at doses ≥10 Gy (<i>p</i> ≤ 0.005), while %FF increased significantly across all dose gradients (<i>p</i> ≤ 0.0017), with both metrics showing strong dose‑response behavior at higher doses (<i>p</i> < 10<sup>−</sup><sup>6</sup>).</p>\u0000 </section>\u0000 \u0000 <s","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70794","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990082","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 4D-CT MIP reconstruction method on iGTV definition: A clinical case report","authors":"Suhong Yu,&nbsp;Itai Pashtan","doi":"10.1002/acm2.70799","DOIUrl":"10.1002/acm2.70799","url":null,"abstract":"<p>To present a clinical case demonstrating the impact of 4D-CT maximum intensity projection (MIP) reconstruction methodology on internal gross tumor volume (iGTV) definition and to highlight implications for motion management quality assurance. During routine thoracic radiation therapy treatment planning, a discrepancy in tumor extent was identified during physician contouring. The inferior extent of the tumor appeared artificially truncated on the MIP dataset used for target delineation. Further review revealed that the default MIP had been generated from phase-sorted 4D-CT images. A comparison was performed between the phase-sorted MIP and a MIP reconstructed from the original cine images to evaluate differences in motion representation. The phase-sorted MIP under-represented the full tumor motion envelope, most notably in the inferior direction. In contrast, the cine-based MIP demonstrated a more complete representation of tumor extent throughout respiration. This discrepancy was not readily apparent during the routine clinical workflow, and verification of the MIP reconstruction method was not part of the standard QA review process at the time. Differences in MIP reconstruction methodology can impact iGTV definition. Although these differences may be subtle in most cases, clinically meaningful discrepancies may occur, particularly in patients with irregular breathing patterns. This case highlights the importance of awareness and verification of 4D-CT MIP reconstruction methods and supports comprehensive QA across CT simulation, treatment planning, and motion management workflows.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70799","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990093","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":"Correction to “Improving image quality in terbium-161 phantom imaging: Quantitative evaluation of DEW and TEW scatter correction methods”","authors":"","doi":"10.1002/acm2.70762","DOIUrl":"https://doi.org/10.1002/acm2.70762","url":null,"abstract":"<p>Can M, Çapa Kaya G, Gümüşer G, Parlak Y. Improving image quality in terbium-161 phantom imaging: Quantitative evaluation of DEW and TEW scatter correction methods. <i>J Appl Clin Med Phys</i>. 2026;e70672. https://doi.org/10.1002/acm2.70672</p><p>In the original publication, a reference for the LIFEx software was inadvertently omitted in the Materials and Methods section.</p><p>Under the subheading “<b>2.4. VOI and Image Quality Parameters</b>”, the first sentence should be corrected to include the relevant software citation as follows:</p><p>Image quality parameters were calculated by drawing the volume of interest (VOIs) using LifeX software (version 25.06.1).¹⁸</p><p><b>Reference to be added</b>: Nioche C, Orlhac F, Boughdad S, et al. Lifex: A freeware for radiomic feature calculation in multimodality imaging to accelerate advances in the characterization of tumor heterogeneity. <i>Cancer Res</i>. 2018;78(16):4786-4789. doi:10.1158/0008-5472.CAN-18-0125</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 10","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148974911","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":"Preclinical feasibility of EPID-based transit dosimetry for total body irradiation","authors":"Tetsu Nakaichi,&nbsp;Hiroyuki Okamoto,&nbsp;Mitsuhiro Kon,&nbsp;Kazuki Takaso,&nbsp;Ako Aikawa,&nbsp;Satoshi Nakamura,&nbsp;Kotaro Iijima,&nbsp;Takahito Chiba,&nbsp;Hiroki Nakayama,&nbsp;Tomonori Goka,&nbsp;Hiroshi Igaki","doi":"10.1002/acm2.70790","DOIUrl":"10.1002/acm2.70790","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;Conventional extended-distance total body irradiation (TBI) is commonly verified using point dosimeters, which provide limited spatial information and require additional handling during a prolonged treatment procedure. A portable charge-coupled device (CCD)-based electronic portal imaging device (EPID) positioned downstream of the patient may provide wider-area transit information in a geometry in which a gantry-mounted EPID cannot readily be used.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To develop and perform preclinical phantom validation of a CCD-EPID method for transit dose estimation during fixed-field long-SSD TBI and to identify the calibration and normalization factors relevant to subsequent patient validation.&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 portable CCD-based EPID was positioned at 400 cm, with water-equivalent or anthropomorphic phantoms centered at 350 cm. Direct-irradiation characteristics were evaluated for 4- and 10-MV photon beams, including signal response to dose-rate/delivered MU, field size, short-term frame reproducibility, and in-plane response. For ETD calibration, 6–36-cm-thick water-equivalent phantoms were irradiated with 10-MV photons using 1000 MU at 600 MU/min and a 10 × 10 cm&lt;sup&gt;2&lt;/sup&gt; jaw setting at isocenter, corresponding to approximately 35 × 35 cm&lt;sup&gt;2&lt;/sup&gt; at the phantom and 40 × 40 cm&lt;sup&gt;2&lt;/sup&gt; at the EPID. Summed EPID signals were related to midplane absorbed dose measured using a Farmer-type ionization chamber. ETD was independently compared with radiophotoluminescent dosimeters (RPLDs) in 12-, 24-, and 36-cm slab phantoms and at 11 locations in a RANDO phantom. Four separate RANDO irradiations were centered on the head, chest, abdomen, and pelvis.&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 10-MV EPID signal was highly linear with dose rate/delivered MU (&lt;i&gt;r&lt;/i&gt; = .999) and field size (&lt;i&gt;r&lt;/i&gt; = .995). Flatness was 1.4% and 1.3%, and symmetry was .3% and 1.4%, in the ceiling-floor and gun-target directions, respectively. The summed EPID signal-to-ionization-chamber dose relationship showed &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = .999. ETD differed from RPLD dose by −1.6%, −1.4%, and .0% in the 12-, 24-, and 36-cm slab phantoms, respectively, within the expanded RPLD uncertainty. In the RANDO phantom, ETD was consistently higher than RPLD dose, with a mean relative difference of 7.7 ± 3.9%. Because calibration and RANDO verification used the same field size and the detector showed high dose/MU linearity, a field-size mismatch or gross signal nonlineari","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976904","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":"Motion correction algorithm improves right coronary artery image quality at heart rates > 75 bpm in non-ECG-gated coronary CT angiography","authors":"Meiqi Wang,&nbsp;Li Tao,&nbsp;Wen Li,&nbsp;YouHong Cao,&nbsp;Hao Wu,&nbsp;Zhiwei Zhang","doi":"10.1002/acm2.70803","DOIUrl":"10.1002/acm2.70803","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Motion artifacts caused by cardiac pulsation remain a major technical challenge in coronary CT angiography (CCTA). Although an advanced cardiac motion correction (CMC) algorithm has been developed and successfully implemented in clinical practice, the effectiveness of this algorithm in improving coronary image quality in clinical settings has not yet been fully investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>To evaluate the impact and clinical value of a motion correction algorithm on image quality in non-ECG-gated CCTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively enrolled 76 patients who underwent CCTA for suspected coronary artery disease. Based on the mean heart rate (HR) recorded during scanning, patients were divided into three groups: low HR (HR ≤ 60 bpm), intermediate HR (60 &lt; HR &lt; 75 bpm), and high HR (HR ≥ 75 bpm). All images were reconstructed using both standard algorithm (STD) and CMC algorithms. The performance of STD and CMC was compared across different HR conditions in terms of subjective (4-point Likert scale, interpretability) and objective image quality (signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and vessel sharpness).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At high HRs, the difference in subjective image quality of the right coronary artery (RCA) between STD and CMC reached statistical significance (<i>p</i> &lt; 0.05). Compared with STD, CMC significantly improved the interpretability of the RCA at high HRs (<i>p</i> &lt; 0.001). No statistically significant differences were observed between the two algorithms in terms of SNR or CNR (<i>p</i> &gt; 0.05). However, at high HRs, CMC was significantly superior to STD with respect to vessel sharpness of the RCA (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CMC improves image quality in CCTA, with particularly notable benefits for the RCA under high HR conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976865","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":"Commissioning a single photon counting CT simulator for radiotherapy planning: Methods, challenges, and initial results","authors":"Parminder S. Basran,&nbsp;Devon Richtsmeier","doi":"10.1002/acm2.70798","DOIUrl":"10.1002/acm2.70798","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;Photon counting computed tomography (PCCT) offers distinct advantages over standard energy-integrated detector (EID) CT by offering energy-resolved measurements, enhanced spatial resolution, and improved soft-tissue contrast. While PCCT shows great utility in diagnostic imaging, its application as a radiotherapy simulator has not been explored. Commissioning procedures for EID-based CT simulators are well-documented, but commissioning a PCCT scanner in a radiotherapy setting has not been investigated.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We investigated whether PCCT can be used for radiotherapy simulation by evaluating the geometric accuracy, image quality, dosimetric performance, and relative electron density calibration of a Siemens Naeotom Alpha PCCT scanner with a commercially available carbon-fiber couch top.&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;Commissioning followed AAPM Task Group 66 guidelines, involving electromechanical evaluation, image quality assessment, and radiation safety verification. The CATPHAN 604 phantom was used to evaluate CT number accuracy, uniformity, spatial resolution, low contrast detectability, and geometric accuracy across multiple clinical protocols. Dosimetric measurements were performed using CTDI phantoms with a 100-mm pencil ion chamber. Relative electron density (RED) calibration was performed using an Advanced Electron Density phantom at selected tube voltages (120 and 140 kVp), slice thicknesses (0.4–10 mm), and reconstruction filters. Statistical analyses included repeated-measures ANOVA with post-hoc pairwise comparisons to assess protocol and position effects on Hounsfield unit values.&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;Geometric accuracy measurements revealed in-plane spatial linearity of 50.00 ± 0.06 mm (nominal 50 mm). CT number accuracy aligned with manufacturer specifications, except for bone, using specific protocols. The mean discrepancy between measured and nominal CTDI&lt;sub&gt;vol&lt;/sub&gt; was 3.8 ± 4.6%, with excellent agreement on the dose-length product (0.9 ± 2.3%). Relative electron density measurements suggested statistically significant, but clinically insignificant, variations across protocols (mean HU shifts: -23.0 to 7.9 HU). Position-dependent effects suggested mean HU reductions up to 23.2 HU at peripheral locations. Iterative metal artifact reduction (iMAR) differentiated Titanium and Stainless Steel metallic implants without significantly affecting surrounding tissue CT numbers (&lt;i&gt;P &gt;&lt;/i&gt; 0.08).&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968846","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":"Log file-based treatment efficiency analysis of TrueBeam and Halcyon delivery systems","authors":"Ruiming C. Edmondson,&nbsp;Douglas J. Moseley,&nbsp;Satomi Shiraishi,&nbsp;James A. Kavanaugh","doi":"10.1002/acm2.70802","DOIUrl":"10.1002/acm2.70802","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;TrueBeam (TB) and Halcyon (HC) are state-of-the-art linear accelerators (linacs) widely utilized for external beam radiotherapy. As clinical demand increases, expanding treatment capacity through new machine installations or extended operating hours remains costly and resource intensive. Retrospective analyses of treatment delivery performance can help guide machine assignment strategies that optimize machine utilization, reduce patient time alone on the treatment couch, and improve overall departmental throughput.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To introduce a trajectory log-based methodology for assessing treatment delivery efficiency on Halcyon and TrueBeam systems by quantifying gantry speed, MLC speed, and dose-rate utilization, and to integrate these machine-level parameters with beam-on time and modulation factor (MF) to guide treatment machine assignment and patient triaging.&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;Volumetric modulated arc therapy (VMAT) trajectory logs acquired between February 2025 and February 2026 were collected from fourteen clinical linacs across a main institution and its affiliated regional clinics. The percentages of beam-on time during which the machine operated at ≥95% of its maximum dose rate (max_DR), gantry speed (max_GS), or MLC speed (max_MLC) were quantified. Plans were categorized by procedure type and disease site, and delivery efficiencies were compared using Mann-Whitney U test.&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;A total of 4347 VMAT plans were included in the study. For stereotactic body radiation therapy (SBRT) plans, Halcyon had a significantly higher max_DR (0.96 ± 0.14 vs. 0.51 ± 0.39 for TrueBeam), suggesting its max dose rate might be a bottleneck for treatment efficiency. For non-SBRT plans, Halcyon demonstrated greater max_GS (0.68 ± 0.32 vs. 0.43 ± 0.22 for TrueBeam) and max_MLC (0.66 ± 0.32 vs. 0.38 ± 0.23 for TrueBeam), which is reflected in its higher MF and faster beam-on time compared to TrueBeam, saving over 50 seconds of on-table time per plan for each patient.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Halcyon demonstrates superior delivery efficiency for non-SBRT plans compared to TrueBeam through higher usage of its maximum MLC speed and gantry speed throughout treatment, especially for pelvis plans. In contrast, TrueBeam has significantly shorter beam-on time for higher-dose treatments (e.g. prostate SBRT)","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968842","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":"Automated planning architectures for online adaptive radiotherapy: A narrative review of the Ethos and Unity/Monaco platforms","authors":"Songye Cui,&nbsp;Maria F. Chan,&nbsp;Dandan Zheng","doi":"10.1002/acm2.70797","DOIUrl":"10.1002/acm2.70797","url":null,"abstract":"<p>Online adaptive radiotherapy (OART) modifies treatment plans using anatomy-of-the-day imaging, but successful clinical implementation depends on automated planning strategies that can generate high-quality plans within the constraints of an online workflow. This narrative review compares the automated planning architectures of the Varian Ethos and Elekta Unity/Monaco systems using a targeted literature search through July 2026. Ethos generates a daily adapted plan through goal-prioritized supervisory optimization governed by an unchanged clinical directive. Unity/Monaco provides Adapt-to-Position (ATP) and Adapt-to-Shape (ATS) pathways, with methods ranging from reference-segment recalculation and refinement to full online replanning with newly optimized fluence and segments. Rather than representing opposing planning paradigms, these systems differ in how ordered clinical goals or reference-plan information guide a selected adaptation method and in the degrees of freedom available within that method. Representative workflow and implementation studies are reviewed to provide clinical context, but they do not support direct comparisons of platform performance or superiority. MRIdian is acknowledged as another established MR-guided adaptive platform, although its planning architecture is beyond the scope of this focused review. Accordingly, the comparison is best understood by asking what guides the selected adaptation method and which degrees of freedom that method permits, rather than as a binary distinction between flexible and reference-based planning. This framework provides a conceptual basis for interpreting current commercial OART systems and may help guide the future development and evaluation of automated adaptive planning technologies.</p>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968861","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":"Density override-based VMAT optimization to improve robustness at tissue-air interfaces in head and neck radiotherapy","authors":"Sagarika Jain,&nbsp;Ashlee Ewing,&nbsp;Michael Weldon,&nbsp;Allison Palmiero,&nbsp;Daniel Christ,&nbsp;Emile Gogineni,&nbsp;Simeng Zhu,&nbsp;Sung Jun Ma,&nbsp;John C Grecula,&nbsp;Darrion L Mitchell,&nbsp;Sujith Baliga,&nbsp;Dukagjin M Blakaj,&nbsp;David J Konieczkowski","doi":"10.1002/acm2.70737","DOIUrl":"10.1002/acm2.70737","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;Volumetric Modulated Arc Therapy (VMAT) is integral to head and neck (HN) radiation therapy; however, plan robustness may be compromised at air-tissue interfaces. Highly modulated fluence directed at these areas can produce significant unexpected high-dose regions in the event of minor variations in tissue density.&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 characterizes an instability in VMAT planning for HN radiation therapy (RT) occurring at the interface between target volume (e.g. mucosal primary tumor) and internal air spaces (e.g. pharyngeal lumen, sinuses, nasal cavity, etc.). A density-override based planning technique is presented and validated to mitigate this instability.&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;Treatment plans for fifteen HN patients receiving VMAT RT at our institution between 2023 and 2024 were retrospectively analyzed. All patients received 60–69.96 Gy in 30–33 daily fractions using 6 MV photons. To model swelling or tumor growth near the air–tumor interface, verification plans were generated by overriding internal air within 3 mm of the planning target volume (PTV) to soft tissue density (HU = 0). A robustness-enhancing technique was evaluated, wherein optimization was performed with luminal air overridden to HU = –300, followed by recalculation and renormalization using the original CT HU values. Robustness was then reassessed after overriding luminal air to HU = 0.&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;Baseline plans demonstrated controlled hotspot magnitudes within the BODY, with a median D0.1cc of 109.0% [Interquartile range: 107.8–110.4]. Simulated tissue-air interface changes produced substantially elevated hotspots in verification plans, increasing to a median D0.1cc of 115.6% [111.9–126.9], corresponding to a median paired increase of 9.0% (Wilcoxon &lt;i&gt;p&lt;/i&gt; = 1.22 × 10&lt;sup&gt;−&lt;/sup&gt;&lt;sup&gt;4&lt;/sup&gt;). Robust plans generated using the proposed density-override optimization maintained comparable baseline dosimetry (median D0.1cc 108.1% [107.4–108.7]) while demonstrating stable hotspot behavior under simulated density perturbations (median D0.1cc 108.1% [107.1–108.6], &lt;i&gt;p&lt;/i&gt; = 0.18). Target coverage remained preserved, with robust verification plan D95 values ranging from 99.7% to 100.5% (&lt;i&gt;p&lt;/i&gt; = 0.26).&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;A density-override optimization approach mitigates hotspot formation at air–tumor interfaces, p","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919783","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 centralized hybrid model for regulatory inspection readiness in a multi-site radiation oncology system","authors":"Chaitanya Kalavagunta,&nbsp;Dustin Simonson,&nbsp;Mariana Guerrero","doi":"10.1002/acm2.70791","DOIUrl":"10.1002/acm2.70791","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;State regulatory inspections of radiation-producing treatment equipment combine a review of quality assurance and regulatory records with direct verification of facility and safety systems. When these activities are performed entirely on-site across multiple facilities, real-time document retrieval can prolong visits and divert clinical staff.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To develop and evaluate a centralized hybrid framework that separates advance document review from focused on-site verification during state-mandated annual inspections of photon linear accelerators.&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;The framework was implemented across five photon treatment sites comprising 10 linear accelerators using an institutionally deployed cloud-based quality assurance platform (TotalQA, Image Owl Inc., Greenwich, NY). Site physicists uploaded machine- and site-specific records directly. A dedicated guest account allowed the inspector to review documents approximately 14 days before each visit. Document-verifiable items and photographs of required postings were reviewed remotely; audio/video monitoring systems, linac-on warning lights, staff access to applicable state regulatory requirements and personnel dosimetry records, written operating and emergency procedures, direct questions, and unresolved items remained on-site. A system-wide clinical deviation logbook containing protected health information was reviewed once in person at a central location. Operational outcomes included on-site duration, daily throughput, physicist support, schedule adherence, treatment impact, and inspection findings.&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;Historical inspections required approximately 120 min of on-site time per facility, based on calendar records, prior schedules, and staff recollection. During the hybrid implementation, on-site inspection time was approximately 30 minutes per facility based on records documented at the time of each inspection, representing an estimated 75% reduction. Daily throughput increased from approximately three sites per day to four sites per day. The inspector estimated that advance review required 1 to 2 h per site, generally closer to 2 h during the first cycle. All visits remained within scheduled blocks, no inspection-related treatment delays or interruptions occurred, and no documentation-related citations were identified.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 ","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 9","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919741","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}