Medical Dosimetry最新文献

{"title":"Dosimetric and radiobiological evaluation of a spatially fractionated core-boost strategy in lung metastases within 5 mm of the esophagus: Single-center plan-comparison study.","authors":"İbrahim Halil Suyusal, Onurhan Çolak, Ahmet Satuk Karagöz","doi":"10.1016/j.meddos.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.08.008","url":null,"abstract":"<p><p>For lung metastases lying within 5 mm of the esophagus, organ-at-risk dose limits often force the prescription below the ablative range, lowering biologically effective dose and tumor control. We evaluated whether a simultaneous integrated boost to the tumor core, rather than dose reduction, is dosimetrically and radiobiologically rational, and which inner-volume retraction (0.3 vs 0.5 cm) is preferable. Using deep-inspiration breath-hold planning computed tomography from 30 consecutive patients, 3 clinically deliverable 5-fraction volumetric modulated arc therapy plans were generated de novo with Monte Carlo calculation: Plan A, a fixed uniform 35 Gy reference (5 × 7 Gy) applied identically to all patients as a standardized comparator; Plan B, a 60 Gy boost to the gross tumor volume retracted 0.5 cm; and Plan C, a 60 Gy boost to the gross tumor volume retracted 0.3 cm, each with a 35 Gy shell. Tumor-control and organ-at-risk endpoints were compared (Friedman and Bonferroni-corrected Wilcoxon tests). The simultaneous integrated boost met the targeted dose-escalation goal: volume-weighted total biologically effective dose rose from 61.5 to 97.4 Gy (Plan A to Plan C; 58.5%), approaching the BED10 level associated with improved local control and modeled tumor control probability increased from 0.77 to 0.93 (15.8%; all p < 0.001). Plan C exceeded Plan B by 5.4% (p < 0.001), the gain scaling with boost-volume fraction and tumor volume. Esophageal maximum dose stayed below 35 Gy with normal-tissue complication probability rising only from 6.1% to 6.9%; mean lung dose increased from 3.60 to 5.46 Gy and the volume receiving 20 Gy to 5%, all within tolerance. High-dose spillage exceeded the 17.5 Gy threshold in 53% of Plan C plans. A 0.3 cm core boost improves modeled tumor control at an acceptable, sub-tolerance organ-at-risk cost, outperforming the 0.5 cm definition. Prospective clinical validation is warranted.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972171","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":"Re-evaluating the α/β ratio in 2026: A systematic review and quantitative reappraisal in the era of molecular radiobiology.","authors":"Noureddine Samai, Aymen Berremdani","doi":"10.1016/j.meddos.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.08.001","url":null,"abstract":"<p><p>The linear-quadratic (LQ) model and its derived ratio, α/β, have served as the cornerstone of radiotherapy dose-fractionation decisions. The period from 2015 to 2026 has witnessed a substantial re-evaluation of this paradigm, driven by the clinical success of hypofractionation in prostate and breast cancer, stereotactic body radiation therapy (SBRT), and radiogenomics. A systematic review with narrative synthesis was conducted to evaluate quantitative estimates of α/β derived from clinical and preclinical studies over the last decade, updating classical assumptions using modern trial data. Extensive Phase III data in prostate cancer consistently define an α/β of 1.2 to 2.0 Gy. Microscopic models in breast cancer align with an α/β of ∼2.7 Gy. Conversely, lung SBRT data present a high modeled α/β driven by hypoxia artifacts. Genomic integration via the Genomic Adjusted Radiation Dose (GARD) reveals that α/β operates as a dynamic, patient-specific phenotype. In the molecular era, static α/β assumptions must be integrated with disease-specific kinetics, microenvironmental data, and genomic intrinsic radiosensitivity.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957195","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":"Evaluation of feasibility DVH-guided re-optimization for RapidPlan-generated prostate VMAT plans.","authors":"Suzuka Hijiyama, Motoharu Sasaki, Yuji Nakaguchi, Takeshi Kamomae, Yuto Yamaji, Moe Ishimoto, Mayuka Kamada, Yuki Tominaga, Masahide Tominaga, Hitoshi Ikushima","doi":"10.1016/j.meddos.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.08.004","url":null,"abstract":"<p><p>Feasibility dose-volume histogram (FDVH) can provide patient-specific information on the anatomically achievable dose range for organs at risk (OARs) and may complement knowledge-based planning using RapidPlan. This study evaluated whether FDVH-guided re-optimization can improve RapidPlan-generated prostate volumetric-modulated arc therapy (VMAT) plans. A total of 50 patients with prostate cancer treated with VMAT were included. Thirty cases were used to construct a RapidPlan model from manually generated clinical plans created with reference to FDVH, and the remaining 20 independent cases were used for evaluation. Plans generated by automatic optimization using RapidPlan were defined as KBP, whereas those re-optimized with reference to FDVH were defined as KBP+FDVH. During re-optimization, mean dose and upper generalized equivalent uniform dose were used as auxiliary DVH-based parameters. Dosimetric parameters for the planning target volume excluding the rectum (PTV-R), rectum, and bladder were compared between KBP and KBP+FDVH using the Wilcoxon signed-rank test. For PTV-R, D2% was significantly reduced with KBP+FDVH compared with KBP (63.69 Gy vs 62.35 Gy, p < 0.001), and D98% was significantly increased (59.02 Gy vs 59.24 Gy, p = 0.009). Rectal V31 Gy was significantly lower with KBP+FDVH (35.51% vs 32.03%, p = 0.010). No clear improvement was observed in bladder dose. FDVH-guided re-optimization improved PTV-R dose homogeneity and reduced the low-dose region of the rectum, suggesting that this approach may serve as an auxiliary workflow for selected RapidPlan-generated prostate VMAT plans.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931795","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 and robustness comparison of single- and double-arc volumetric-modulated arc therapy incorporating avoidance structures for prostate cancer with simulated bilateral hip prostheses.","authors":"Takahiro Kato, Takaomi Harada, Yuki Moriya, Hisashi Sato","doi":"10.1016/j.meddos.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.08.005","url":null,"abstract":"<p><p>This study compared the dosimetric performance and robustness of single-arc (SA) versus double-arc (DA) volumetric-modulated arc therapy (VMAT) incorporating avoidance structures (AS) for prostate cancer with simulated bilateral hip prostheses. A total of 15 prostate cancer cases without hip prostheses were retrospectively analyzed. Bilateral hip prostheses were simulated by assigning titanium-equivalent Hounsfield unit values to both femoral heads. Identical dose constraints and full-arc geometry with AS configured to suppress beam entry through prosthetic regions were used to generate SA and DA plans. Dosimetric indices for target volumes and organs at risk were compared. Plan robustness was evaluated by simulating image-guided position correction with 5-mm and 10-mm shifts of the clinical target volume (CTV) in the anterior-posterior and superior-inferior directions; CTV D_98% served as the primary robustness metric. Under identical planning conditions, DA demonstrated statistically superior performance for several planning target volume and rectal dose parameters; however, absolute differences were small. SA plans showed greater asymmetry in the intermediate-dose region. With posterior and inferior position corrections, DA demonstrated significantly better robustness than SA, whereas superior position correction showed only borderline significance. Absolute differences in CTV D_98% between SA and DA under posterior and inferior position corrections were ≤0.6 Gy, indicating limited clinical relevance. No significant difference in CTV D_98% was observed under anterior position correction. Both approaches showed reduced CTV coverage at a 10-mm anterior shift, with mean decreases of 1.7% for SA and 1.6% for DA. DA VMAT showed marginally superior robustness under posterior and inferior position corrections, whereas SA achieved comparable overall plan quality with theoretically shorter delivery times. Careful consideration of anterior internal error, including treatment planning optimization strategies accounting for hip prostheses and strict patient preparation protocols, remains crucial for both approaches.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921751","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":"Application of statistical process control for quality assurance in radiotherapy planning of nasopharyngeal carcinoma.","authors":"Bin Chen, Lu Lv, Xiao Chen, Sheng Lin, Haowen Pang, Xiangxiang Shi","doi":"10.1016/j.meddos.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.08.003","url":null,"abstract":"<p><p>To evaluate whether a statistical process control (SPC) method can improve the safety and stability of radiotherapy planning for patients with nasopharyngeal carcinoma. A total of 200 patients were retrospectively enrolled and divided into 2 sequential phases. The first phase (100 patients) was used to establish baseline statistical parameters including centerlines and control limits. The second phase (100 patients) used these parameters to guide plan optimization. Dose indicators of organs at risk, target coverage, process stability, and process capability index were analyzed and compared between the 2 phases. After applying SPC, radiation doses to the larynx and parotid glands were significantly reduced, while target volume coverage was adequately maintained. All plans remained within stable statistical control limits, and process capability indices were improved, indicating enhanced process stability and reliability. SPC provides an effective, data-driven, and easy-to-implement tool for improving nasopharyngeal carcinoma radiotherapy planning. It reduces unnecessary radiation exposure to normal tissues, enhances process stability, and promotes consistent high-quality treatment. This method is clinically feasible and suitable for widespread application in routine radiotherapy quality assurance.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882231","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":"Beam data and model validation for Elekta SRS cone collimator in 6MV and 6MVFFF beams.","authors":"Ke Zhang, Hualin Wang, Linyi Shen, Minghui Li, Tianyu Jiang, Yan Liang, Mengyang Li, Guiyuan Li, Jialin Ding, Xinyuan Chen, Shouping Xu, Jianrong Dai, Yuan Tian","doi":"10.1016/j.meddos.2026.07.004","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.07.004","url":null,"abstract":"<p><p>This study aimed to evaluate the beam data of Elekta stereotactic radiosurgery (SRS) cone collimators for 6MV and 6MV flattening filter-free (6MVFFF) beams and to assess the feasibility of implementing a shared beam model across beam-matched linear accelerators (linacs). Percentage depth dose (PDD), beam profiles, and output factors were measured using IBA SFD and PTW microDiamond detectors for fixed (current clinical practice) and variable (previous clinical practice) jaw configurations. A Monaco X-ray voxelized Monte Carlo (XVMC)-based SRS model was developed on one linac and validated using SNC SRS MapCHECK and StereoPHAN^TM. The model's applicability was further tested on a second linac. The depth of maximum dose (D_max) and PDD beyond D_max decreased with smaller cones, while penumbra widened for larger cones. Compared to 6MVFFF, 6MV beams exhibited 5% higher in-field off-axis ratios (OARs) and 15% higher out-of-field OARs. The output factors for 6MVFFF exceeded those of 6MV by up to 5.83% (7.5-mm cone). Fixed jaw configurations increased out-of-field OARs by 15% and output factors by 0.57% compared to variable jaws. Measurements from IBA SFD and microDiamond detectors showed excellent agreement in PDD and beam profiles, with output factors differing by less than 2.33%. The Monaco XVMC model achieved >99.10% gamma passing rates (2%/2 mm) and <3.0% central axis point dose differences during validation. Both linacs demonstrated minimal discrepancies when using shared beam models. Fixed jaw settings increase out-of-field scatter and output factors for cones <35 mm. The comprehensive beam data for 6MV and 6MVFFF beams presented in this study provide a valuable reference for commissioning and quality assurance (QA) in clinical practice. IBA SFD and microDiamond detectors are suitable for SRS cone beam data collection and QA when appropriate corrections as per TRS-483 are applied. Shared beam models are feasible for beam-matched linacs, offering a streamlined approach to clinical work.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875703","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":"Deep learning for CT-less attenuation correction synthesis in non-small cell lung cancer: A proof-of-concept evaluated for quantitative and physical characteristics.","authors":"Omar Hamzaoui, Yassine Oulhouq, Mohammed Rezzoug, Mustapha Zerfaoui, Dikra Bakkari, Abdeslem Rrhioua","doi":"10.1016/j.meddos.2026.07.003","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.07.003","url":null,"abstract":"<p><p>To develop and rigorously validate a deep learning framework for CT-free positron emission tomography (PET) attenuation correction in non-small cell lung cancer (NSCLC), with a comprehensive assessment of both quantitative and physical integrity to establish a proof-of-concept for its technical feasibility. A U-Net was trained on a multi-center dataset of 100 NSCLC patients to synthesize attenuation-corrected (AC) from nonattenuation-corrected (NAC) PET data. The framework's performance was evaluated on an independent 30-patient test set. The multi-faceted validation protocol included global image fidelity (peak signal-to-noise ratio [PSNR], structural similarity index measure [SSIM]), quantitative lesion integrity (SUV_max/SUV_mean bias, dice similarity coefficient [DSC]), and fundamental physical characteristics (contrast recovery, spatial resolution). Bland-Altman analysis and paired statistical tests were used. The framework generated images with state-of-the-art global fidelity (PSNR: 36.2 dB; SSIM: 0.967). For lesion-specific analysis, the model introduced a negligible and statistically insignificant mean bias in both SUV_max (+0.72%;p=0.067). While SUV_mean showed a statistically significant difference due to per-patient aggregation, the absolute bias remained clinically negligible (-1.23%;p=0.005). Spatial accuracy was excellent (mean DSC: 0.89). Critically, physical performance was preserved, with 99.2% contrast recovery and no significant degradation in spatial resolution. Deep learning-based attenuation correction synthesis is a highly promising proof-of-concept for CT-less thoracic PET. By demonstrating quantitative fidelity and preserved image-derived physical characteristics, this work establishes a foundational step toward a prospective emission-only workflow, which has the future potential to enhance patient safety by eliminating CT-associated radiation dose.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714387","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":"Comparison of helical tomotherapy, VMAT, and DMLC-IMRT techniques used in radiotherapy of pleural disseminated thymic tumors.","authors":"Tingting Li, Qian Zhang, Yang Zhang, Yujie Zhang, Yongkang Zhou, Weixing Ji, Zhihan Chen, Zhaochong Zeng, Shisuo Du","doi":"10.1016/j.meddos.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.04.001","url":null,"abstract":"<p><p>Pleural disseminated thymic tumors are therapeutically challenging due to their complex target volumes and the need to preserve lung function. This retrospective study aimed to compare the dosimetric parameters of helical tomotherapy (TOMO), volumetric modulated arc therapy (VMAT), and dynamic multileaf collimator intensity-modulated radiotherapy (DMLC-IMRT) for the treatment of pleural disseminated thymic tumors, focusing on target coverage and organ at risk (OAR) sparing, particularly the lungs. Twenty patients requiring ipsilateral whole-pleural irradiation were enrolled. Three distinct radiotherapy plans (TOMO, VMAT, and DMLC-IMRT) were designed for each patient and collaboratively evaluated by radiation oncologists and medical physicists. Dosimetric parameters for the planning target volume (PTV) and OARs, including the lungs, spinal cord, heart, esophagus, liver, and whole body, were compared. The optimal plan for each technique was selected for dosimetric comparison. All enrolled patients ultimately underwent TOMO-based radiation treatment planning. TOMO demonstrated superior PTV coverage (95.12% ± 2.76%) compared with VMAT and DMLC-IMRT (p < 0.0001). TOMO also demonstrated better control of hotspots and dose gradients outside the target area. For OARs, TOMO significantly reduced the mean dose and V₅, V₁₀, and V₂₀ values for the ipsilateral and total lungs compared with VMAT and DMLC-IMRT (p < 0.05). Specifically, the ipsilateral lung V₂₀ was reduced by more than 12% (TOMO: 60.15% ± 16.21%; VMAT: 72.61% ± 20.26%; DMLC-IMRT: 72.03% ± 18.82%), and the contralateral lung V₅ was reduced by 11% (TOMO: 34.07% ± 24.35%; VMAT: 45.91% ± 25.88%; DMLC-IMRT: 44.57% ± 21.63%). The mean lung dose with TOMO was 13.45 Gy, with V₂₀ < 30% and V₅ < 65%, meeting stringent lung-sparing criteria. No significant differences were observed in the dose to other OARs between the 3 techniques. For the treatment of pleural disseminated thymomas, TOMO offered significant dosimetric advantages over VMAT and DMLC-IMRT in terms of target coverage and protection of the lungs. These differences could be clinically meaningful, with the potential to reduce the risk of radiation pneumonitis, a critical consideration in thoracic radiotherapy. Therefore, we recommend TOMO as the first-line clinical approach in these cases, with further studies required to validate long-term clinical outcomes.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609469","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":"Comment on \"assessing proton plans with 3 different beam lines vs photon plans for early-stage lung cancer\".","authors":"Leela Kumaran, Renuka Sharma","doi":"10.1016/j.meddos.2025.10.002","DOIUrl":"https://doi.org/10.1016/j.meddos.2025.10.002","url":null,"abstract":"","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609486","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":"A dosimetric study of single-fraction stereotactic body radiotherapy using proton versus photon for spinal metastases.","authors":"Kitwadee Saksornchai, Sornjarod Oonsiri, Puntiwa Oonsiri, Sakda Kingkaew, Mananchaya Vimolnoch, Kanjana Shotelersuk, Napapat Amornwichet","doi":"10.1016/j.meddos.2026.05.006","DOIUrl":"https://doi.org/10.1016/j.meddos.2026.05.006","url":null,"abstract":"<p><p>Bone metastases are a common indication for palliative radiotherapy. Stereotactic body radiotherapy (SBRT) enables the delivery of ablative doses in 5 or fewer fractions, potentially improving local control and symptom relief. Proton-based SBRT (SBPT) may enhance sparing of organs at risk (OARs) due to its favorable dose distribution. This study compared the dosimetric profiles of single-fraction photon versus proton SBRT for spine metastases. Twelve patients with thoracic or lumbar spine metastases were included in this IRB-approved dosimetric analysis. Each patient had SBRT (photon) and SBPT (proton) plans generated to deliver 20 Gy in one fraction. Target volumes and OARs were contoured following international guidelines. Plans were evaluated using dose-volume histograms, and comparisons were performed using Wilcoxon signed-rank test with significance defined as p < 0.05. Target coverage was similar between modalities, with no significant differences in clinical target volume Dmax, D90, or D95. SBPT resulted in significantly lower spinal cord dose (Dmax 0.5 cc: 7.1 Gy vs 11.9 Gy, p = 0.008) and lower lung mean dose (0.2 Gy vs 0.7 Gy, p = 0.040). Bowel doses were also significantly reduced with SBPT (Dmax 0.5 cc: 3.2 Gy vs 6.1 Gy, p = 0.016). The esophageal D5cc was significantly lower in SBPT plans (8.0 Gy vs 1.9 Gy for proton, p < 0.001), although all values were within safe clinical thresholds. SBPT offers equivalent target coverage with improved sparing of critical organs, including the spinal cord, lungs, bowel, and esophagus, supporting its potential clinical advantages in spinal metastases treatment.</p>","PeriodicalId":49837,"journal":{"name":"Medical Dosimetry","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585938","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}