Physica Medica-European Journal of Medical Physics最新文献

{"title":"Estimation liver radiomics from postmortem CT: Development of interpretable models for postmortem interval estimation.","authors":"Fabio De-Giorgio, Davide Cusumano, Luca Vellini, Roberto Gatta, Luca Boldrini, Matteo Mancino, Michail E Klontzas, Elena F Kranioti, Evis Sala, Vincenzo L Pascali","doi":"10.1016/j.ejmp.2025.105186","DOIUrl":"https://doi.org/10.1016/j.ejmp.2025.105186","url":null,"abstract":"<p><strong>Introduction: </strong>Postmortem computed tomography (PMCT) is increasingly used in forensic investigations, offering a non-invasive and objective approach to estimating the postmortem interval (PMI). This study aimed to develop and externally validate radiomic models to distinguish deaths within versus beyond 24 h, using liver radiomic features from PMCT scans..</p><p><strong>Methods: </strong>A retrospective analysis was performed on 51 cadavers for model development and validated on 80 independent cases. In the training set, 173 PMCT scans across different PMIs were analyzed. The liver was manually segmented, and 40 radiomic features-statistical, morphological, and fractal-were extracted. Robustness to segmentation variability was assessed with autocontoured segmentations using the Intraclass Correlation Coefficient (ICC). PMI was dichotomized as ≤ 24 versus > 24 h. Univariate analyses identified predictive features, and logistic regression models were built from significant variables. Model performance was evaluated with receiver operating characteristic (ROC) curves, with sensitivity and specificity at the optimal threshold.</p><p><strong>Results: </strong>Four features were significantly associated with PMI, with liver skewness emerging as the most predictive (p = 9.13 × 10^-4) and robust (ICC = 0.75). A logistic regression model based on skewness achieved an AUC of 0.75 (95 % CI: 0.65-0.86) and 100 % specificity at the optimal threshold, reliably identifying deaths beyond 24 h. Adding a second feature did not improve performance (p = 0.54, DeLong test). External validation confirmed specificity of the skewness model (70 % at the optimal threshold).</p><p><strong>Conclusion: </strong>Liver skewness extracted from PMCT shows potential as a biomarker for identifying deaths beyond 24 h, with performance confirmed on an independent cohort.</p>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"105186"},"PeriodicalIF":2.7,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of end-to-end beam hold latency using Surface Guided Radiotherapy gating, and cross-vendor linac comparison","authors":"J. Naylor ,&nbsp;R. Barlow ,&nbsp;A. Papangelou","doi":"10.1016/j.ejmp.2025.105181","DOIUrl":"10.1016/j.ejmp.2025.105181","url":null,"abstract":"<div><h3>Background</h3><div>Measuring latency of radiation beam-hold is challenging and published guidance on thresholds/tolerances is inconsistent. Two independent Radiotherapy Centres in the South of England collaborated to determine an accurate and simple method applicable to linacs from any vendor.</div></div><div><h3>Purpose</h3><div>There are an assortment of published methods for measuring SGRT latency, and it is not clear which is optimal (accuracy and efficiency). This project’s aim was to develop a simple method that could accurately measure beam-hold latency, that could be shared with other centres for SGRT commissioning and QA without the need for specialist equipment.</div></div><div><h3>Method</h3><div>A simple phantom was created using a cardboard bowl and a lead marker. This was placed on a moving platform that was programmed with a variety of constant velocities.</div><div>A 10 mm vertical tolerance was set on the SGRT software (v6.3, AlignRT), which when exceeded would trigger a beam-hold. Images of the phantom were taken using the megavoltage panel for each velocity.</div><div>The displacement of the lead marker from its initial reference position was plotted against the velocity. The gradient of the best-fit line was used to determine the latency.</div></div><div><h3>Results</h3><div>The average latency measured on four Elekta Versa HD Linacs with Horizon cameras was 149 ms and that measured across four Varian TrueBeams with HD cameras was 131 ms.</div></div><div><h3>Conclusion</h3><div>The collaboration between the two centres yielded a simple and reproducible method for measuring latency using AlignRT for gating which is accessible to most centres using both Elekta and Varian linacs.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105181"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-contrast detectability of a mobile head CT compared with conventional CT","authors":"Robert Vorbau ,&nbsp;Markus Hulthén ,&nbsp;Pierre Hillergren ,&nbsp;Artur Omar","doi":"10.1016/j.ejmp.2025.105177","DOIUrl":"10.1016/j.ejmp.2025.105177","url":null,"abstract":"<div><h3>Purpose:</h3><div>To investigate the image quality of a newly introduced mobile head CT system in comparison with a modern stationary CT scanner, emphasizing low-contrast detectability pertinent to brain imaging.</div></div><div><h3>Methods:</h3><div>The Siemens On.site mobile head CT system has been compared with the conventional Siemens X.ceed scanner under matching imaging conditions. Measures of spatial resolution (TTF), noise (NPS), and noise equivalent quanta (NEQ), along with low-contrast detectability in terms of the spatial-domain channelized Hotelling observer, have been assessed. These quantitative evaluations were performed by scanning the Catphan 191 (head) MITA phantom using typical head CT imaging settings. This phantom, which is about the size of an adult head, contains a uniform section to measure noise, and a section with cylindrical features of varying diameters (2–15 mm) and contrasts (3–9 HU) to measure resolution and low-contrast detectability. Statistical significance was tested with a paired two-sample t-test.</div></div><div><h3>Results:</h3><div>The two scanners exhibited similar spatial resolution. However, the mobile head CT was associated with less noise, thereby improving the NEQ by approximately 10%, suggesting a higher efficiency of scanner dose utilization. In terms of low contrast detectability, the mobile head CT performed better by 5%–34%, depending on the size of the feature, its contrast, and whether iterative reconstruction was used or not. This improvement was found to be statistically significant (<span><math><mi>p</mi></math></span>-value less than 0.02).</div></div><div><h3>Conclusion:</h3><div>The On.site mobile head CT system represents progress in mobile scanning technology, providing low-contrast detectability that is non-inferior compared with modern stationary CT scanners.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105177"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of photon counting CT to the detectability of lung nodules using ultra-low dose CT protocols: a phantom study","authors":"Joël Greffier ,&nbsp;Isabelle Fitton ,&nbsp;Fabien de Oliveira ,&nbsp;Kim Diep Dang Tran ,&nbsp;Jean-Paul Beregi ,&nbsp;Cédric Croisille ,&nbsp;Djamel Dabli ,&nbsp;Claire Van Ngoc Ty","doi":"10.1016/j.ejmp.2025.105180","DOIUrl":"10.1016/j.ejmp.2025.105180","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the image quality obtained with an energy-integrating detector CT (EID-CT) and a photon-counting CT (PCCT) in ultra-low dose (ULD) chest CT protocols for three patient morphology configurations.</div></div><div><h3>Materials and methods</h3><div>ULD-CT acquisitions were performed at Sn100 kV on PCCT and EID-CT using an image quality phantom. Different phantom sections were used to simulate standard, overweight and obese patients and the ULD levels were adapted to each section: 0.4, 0.8 and 1.6 mGy, respectively. Noise power spectrum (NPS) and task-based transfer function (TTF) were computed to assess noise magnitude, noise texture and spatial resolution, respectively. Detectability indexes (d′) were computed to model the detection of a high-contrast solid nodule (HCN).</div></div><div><h3>Results</h3><div>At all dose levels, noise magnitude values were significantly lower with PCCT than with EID-CT (−8.9 ± 0.4 %; p &lt; 0.05). Values of average NPS spatial frequencies were significantly higher (p &lt; 0.05) with PCCT (0.446 ± 0.010 mm⁻¹) than with EID-CT mode (0.323 ± 0.011 mm⁻¹). For the air insert, TTF values at 50 % were significantly lower for PCCT (0.719 ± 0.045 mm⁻¹) than with EID-CT (0.916 ± 0.030 mm⁻¹) at 1.6 mGy but similar for other dose levels (p &lt; 0.05). For the simulated chest lesion, d′ values were significantly higher (p &lt; 0.05) with PCCT than with EID-CT. The improvements in d′ values was 23.6 ± 5.5 % for HCN.</div></div><div><h3>Conclusion</h3><div>Compared with EID-CT, using PCCT makes it possible to reduce noise, improve noise texture and, above all, improve the detection of simulated high-contrast thoracic lesion in ULD CT protocols.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105180"},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surface guided radiotherapy in proton therapy: An outlook on the opportunities and challenges","authors":"James Kuan Huei Lee ,&nbsp;Yun Ming Wong ,&nbsp;Eric Pei Ping Pang ,&nbsp;Calvin Wei Yang Koh ,&nbsp;Kah Seng Lew ,&nbsp;Clifford Ghee Ann Chua ,&nbsp;Li Hoon Lim ,&nbsp;Andrew Anthony Bettiol ,&nbsp;James Cheow Lei Lee ,&nbsp;Sung Yong Park ,&nbsp;Hong Qi Tan","doi":"10.1016/j.ejmp.2025.105174","DOIUrl":"10.1016/j.ejmp.2025.105174","url":null,"abstract":"<div><div>Surface-guided radiotherapy (SGRT), a type of image-guided radiotherapy (IGRT), has gained widespread clinical adoption due to its ability to provide real-time, non-invasive patient positioning and motion monitoring during treatment. Its clinical versatility allows seamless integration into various areas of a radiotherapy workflow. Further, unlike conventional IGRT techniques, SGRT uses non-ionizing radiation for surface tracking, reducing unnecessary imaging dose, which is particularly beneficial for pediatric and young adult patients. While SGRT has been widely studied across various treatment sites, its role in proton therapy remains an area of active research. This review aims to provide a comprehensive overview of recent SGRT technologies, clinical applications, and its value in proton therapy.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105174"},"PeriodicalIF":2.7,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicentre study to compare previous and new breast dosimetry for Digital Mammography, Digital Breast Tomosynthesis and Contrast Enhanced Mammography","authors":"Laura Soprani ,&nbsp;Valentina Ravaglia ,&nbsp;Sara Dalmonte ,&nbsp;Lidia Angelini ,&nbsp;Chiara Bassetti ,&nbsp;Camilla Scabbio ,&nbsp;Nicoletta Paruccini ,&nbsp;Raffaele Villa ,&nbsp;Paolo De Marco ,&nbsp;Daniela Origgi ,&nbsp;Sabina Strocchi ,&nbsp;Eleonora Bortoli ,&nbsp;Michelangelo Biondi ,&nbsp;Maria Cristina Cimmino ,&nbsp;Massimiliano Porzio ,&nbsp;Noemi Cucurachi ,&nbsp;Martina Iacco ,&nbsp;Massimiliano Paolucci ,&nbsp;Rossana Bona ,&nbsp;Maria Chiara Angiocchi ,&nbsp;Anna Sardo","doi":"10.1016/j.ejmp.2025.105171","DOIUrl":"10.1016/j.ejmp.2025.105171","url":null,"abstract":"<div><h3>Purpose</h3><div>The most widely used method in Europe to estimate breast dosimetry in mammography is based on Dance’s publications. Recently, AAPM and EFOMP joint Task Group 282 (TG282) has published a new breast dosimetry model, which improves the accuracy in Average Glandular Dose (AGD) estimation. This multicentre study aims to evaluate variations in AGD between conventional and new dosimetry across different modalities and mammography systems.</div></div><div><h3>Methods</h3><div>Measurements were conducted on 74 mammography systems from six vendors, installed in hospitals across Italy. Each facility used its own equipment while adhering to the same protocol and spreadsheets. Tube output and Half-Value Layer (HVL) were measured in the two configurations for Digital Mammography (DM), Digital Breast Tomosynthesis (DBT), and Contrast-Enhanced Mammography (CEM). Exposures were performed using a breast-shaped PMMA phantom of different thicknesses. Data were centrally collected to compute AGD using appropriate correction factors for conventional dosimetry and the BreastAGD282 software for TG282 dosimetry, using EU legacy model.</div></div><div><h3>Results</h3><div>The sample allows for the identification of typical AGD values for both methodologies. The study highlights a reduction in median AGD with the new dosimetry model compared to Dance method across all modalities and vendors. Furthermore, the reduction magnitude depends on x-ray beam quality, modality and compressed breast thickness, ranging from 6.1–8.4 % at 21 mm to 27.3–38.3 % at 90 mm.</div></div><div><h3>Conclusions</h3><div>The new TG282 dosimetry model showed a reduction in the estimated median AGD. Notably, the magnitude of this reduction depended on x-ray beam quality, modality and compressed breast thickness.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105171"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric advantages of a novel X-Ray/γ-Ray integrated radiotherapy platform in cervical carcinoma: A comparative treatment planning study","authors":"Zhongfei Wang ,&nbsp;Qinghui Yun ,&nbsp;Te Zhang ,&nbsp;Xiaohuan Sun ,&nbsp;Wei Wang ,&nbsp;Jie Duan ,&nbsp;Liting Chen ,&nbsp;Yue Gao ,&nbsp;Ziqi An ,&nbsp;Pengfei Zhang ,&nbsp;Jian Zang ,&nbsp;Lina Zhao","doi":"10.1016/j.ejmp.2025.105098","DOIUrl":"10.1016/j.ejmp.2025.105098","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates the dosimetric benefits of TaiChi, a novel radiotherapy platform combining 6MV linac-based volumetric-modulated arc therapy (VMAT) and γ-ray stereotactic radiotherapy, for locally advanced cervical carcinoma (LACC) with pelvic lymph node metastases.</div></div><div><h3>Methods</h3><div>Twelve LACC cases were retrospectively analyzed, comparing TaiChi plans with conventional treatment plans. The prescribed doses were standardized at 50 Gy for the planning target volume (PTV) and 12.5 Gy for the PTVLn-a boost volume delivering focal dose escalation to metastatic lymph nodes.Conventional treatment plans were developed using the Varian Eclipse 13.5 treatment planning system (TPS) with VMAT techniques. In contrast, TaiChi plans were generated using the RTPRO TPS (OUR United Corp., China), leveraging the platform’s unique dual-modality capabilities: a 6MV linac-based VMAT plan was optimized for PTV coverage, while gamma knife was utilized for PTVLn dose escalation. A comprehensive dosimetric comparison was conducted to evaluate the system’s ability to simultaneously achieve PTVLn dose escalation and organs-at-risk (OARs) sparing.</div></div><div><h3>Results</h3><div>TaiChi achieved comparable PTVLn conformity (CI: 0.86 ± 0.06 vs. 0.87 ± 0.02, p = 0.299) but superior dose gradient (GI: 2.03 ± 0.27 vs. 2.21 ± 0.32, p &lt; 0.001). Significant PTVLn dose escalation was observed with TaiChi: mean dose (68.58 ± 0.52 Gy vs. 63.55 ± 1.01 Gy, p &lt; 0.001), D₉₈ (61.81 ± 0.55 Gy vs. 57.09 ± 1.70 Gy, p &lt; 0.001), and D₂ (75.02 ± 1.61 Gy vs. 65.36 ± 2.74 Gy, p &lt; 0.001). PTV D2 was moderately higher with TaiChi (64.11 ± 4.01 Gy vs. 62.17 ± 2.68 Gy, p = 0.04). OAR sparing improved significantly: bladder, rectum, and small intestine V45Gy decreased by 3.7 %, 5.1 %, and 3.9 %, respectively.</div></div><div><h3>Conclusion</h3><div>TaiChi’s synergistic X-ray/γ-ray approach enables safe dose escalation to metastatic nodes while reducing OAR exposure, potentially enhancing tumor control and toxicity outcomes for node-positive cervical carcinoma.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105098"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of two generations of digital detectors in a radiography system: Technical image quality metrics, low-contrast detectability, and visual grading analysis","authors":"Shahla Mobini kesheh ,&nbsp;Robert Vorbau ,&nbsp;Evangelos Mourtos ,&nbsp;Francisco Sanchez Montiel ,&nbsp;Sandra Diaz Ruiz ,&nbsp;Gavin Poludniowski","doi":"10.1016/j.ejmp.2025.105179","DOIUrl":"10.1016/j.ejmp.2025.105179","url":null,"abstract":"<div><h3>Purpose</h3><div>Characterize and compare the performance of different generations of digital detectors in the Discovery XR656 Plus and HD systems (GE Healthcare) for a chest imaging protocol.</div></div><div><h3>Methods</h3><div>An older digital detector (FlashPad) was replaced with a newer model (FlashPad HD), featuring higher pixel resolution and, according to vendor specifications, improved detective quantum efficiency (DQE). To evaluate its performance, three studies were conducted focusing on a chest imaging protocol: DQE measurements using a commercial meter following IEC 62220–1:2003, CDRAD phantom evaluation (Artinis Medical Systems) assessed via the image quality factor (IQFinv), and a visual grading study using the LUNGMAN anthropomorphic phantom (Kyoto Kagaku), scored across eight criteria by four radiologists.</div></div><div><h3>Results</h3><div>FlashPad HD outperformed the older model on all metrics, showing an approximate 15 % increase in DQE (0), a 70 % increase in IQFinv, and superior visual grading for all criteria. A weak dependence on dose level was observed in the CDRAD study, and dose dependence was statistically significant only for two of the eight visual grading criteria. DQE (0) measurements were lower for the 120 kV tube potential than for the 70 kV: 0.47 vs. 0.73 for FlashPad and 0.54 vs. 0.86 for FlashPad HD. The advantage of FlashPad HD in efficiency (DQE) was increased at higher spatial frequencies.</div></div><div><h3>Conclusion</h3><div>Two generations of digital detectors were well characterized based on technical metrics and phantom studies, and the effects of smaller pixel size and improved detector efficiency were verified. The newer FlashPad HD outperforms the older FlashPad receptor on all metrics investigated.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105179"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-criteria optimization for comparing free-breathing and breath-hold techniques in helical and volumetric treatment of locoregional left-sided breast cancer","authors":"Romain Cayez ,&nbsp;Thomas Lacornerie ,&nbsp;Séverine Risbourg ,&nbsp;Kaoutar Lodyga ,&nbsp;Alexandre Ba ,&nbsp;Frederik Crop","doi":"10.1016/j.ejmp.2025.105175","DOIUrl":"10.1016/j.ejmp.2025.105175","url":null,"abstract":"<div><h3>Purpose</h3><div>Combining breath-hold (BH) with volumetric modulated arc therapy (VMAT) or helical treatment can be challenging for locoregional left-sided breast cancer. We aimed to use multi-criteria optimization (MCO) to provide objective comparisons of BH with free breathing (FB) techniques.</div></div><div><h3>Methods</h3><div>Thirty-one consecutive treatment plans were optimized using pareto-navigated MCO for FB tomotherapy (TFB), FB VMAT Halcyon (HFB), and BH VMAT Halcyon (HDIBH). The heart dose was minimized while maintaining target coverage. Quantitative comparisons focused on dose indicators, correlations and adherence to constraints, whereas blinded qualitative ratings, along with planning study guidelines, were used to identify possible biases.</div></div><div><h3>Results</h3><div>VMAT provided better-than-required coverage (D95% 38.6 Gy vs. 37.7 Gy for TFB), whereas TFB offered better sparing of the left anterior descending artery (LAD) and contralateral breast dose. HDIBH resulted in a mean heart dose Dm(heart) of 3.7 Gy compared to 5.2 Gy in HFB and TFB groups. Dm(heart), 2 % LAD and mean LAD in DIBH resulted in 70–74 % of the FB dose, but with residual standard deviation of ± 0.9, 6 and 3.5 Gy respectively. Qualitative ratings showed a significant preference order: HDIBH, HFB, and TFB. No significant lung dose improvements were observed for DIBH. Finally, Dm(heart) showed correlations with FB V17Gy and D2% heart but not in DIBH and also not with both 2 % LAD or mean LAD.</div></div><div><h3>Conclusion</h3><div>Trade-offs were observed between VMAT and tomotherapy techniques while DIBH improved heart doses by 30%, albeit with per-patient variability. Additionally, mean heart dose correlation with other indicators varied between structures and techniques.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105175"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating Live EPID based Inspiration Level Assessment (LEILA) into clinical practice","authors":"Jose A. Baeza-Ortega ,&nbsp;Natalie Kong ,&nbsp;Jane Ludbrook ,&nbsp;Peter B. Greer ,&nbsp;Joerg Lehmann","doi":"10.1016/j.ejmp.2025.105176","DOIUrl":"10.1016/j.ejmp.2025.105176","url":null,"abstract":"<div><h3>Purpose</h3><div>Deep inspiration breath hold (DIBH) minimises patient motion and reduces radiation exposure to organs at risk during breast radiotherapy. An effective DIBH strategy relies on patients maintaining consistent and reproducible breathing patterns, which is typically guided by monitoring external surrogates. The LEILA system is a real-time verification system, utilising electronic portal imaging device (EPID) images to monitor internal anatomy during DIBH breast radiotherapy. This work describes the development and implementation of LEILA as a clinic-ready application.</div></div><div><h3>Methods</h3><div>For the treatment planning phase, the LEILA system includes a fluence model to automatically predict EPID images, enabling the estimation of lung depths (LDs) and skin distances (SDs) for each control point. During treatment delivery, EPID images are acquired and LDs and SDs differences are quantified.</div><div>A pilot study was conducted to validate the LEILA system’s feasibility, by monitoring DIBH alongside existing motion management strategy in our clinic.</div></div><div><h3>Results</h3><div>The LEILA system was deployed on two Varian TrueBeam linear accelerators with aS1200 EPIDs. It showed low latency, with an average image processing time of 74.0 ms (StDev = 9.4 ms). Differences in mid LDs and SDs, categorised by breath-holds, for the 17 monitored beams resulted in averages and standard deviations of −1.2 mm ± 3.1 mm and 1.5 mm ± 4.1 mm respectively.</div></div><div><h3>Conclusions</h3><div>The LEILA system’s streamlined and automated workflow meets clinical needs at minimal extra workload. LEILA assesses the accuracy and reproducibility of DIBH, providing immediate feedback with deviations and retrospective insights to refine DIBH monitoring strategies.</div></div>","PeriodicalId":56092,"journal":{"name":"Physica Medica-European Journal of Medical Physics","volume":"138 ","pages":"Article 105176"},"PeriodicalIF":2.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}