Journal of Applied Clinical Medical Physics最新文献_第4页

Developing an automatic decision-assistance tool to choose proton/photon radiotherapy for patients with prostate cancer 开发前列腺癌患者选择质子/光子放疗的自动决策辅助工具。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-18 DOI: 10.1002/acm2.70497

Mengyang Li, Linyi Shen, Xinyuan Chen, Guiyuan Li, Jialin Ding, Kuo Men, Junlin Yi, Jianrong Dai

Purpose

It is important to guide staff in choosing appropriately between photon and proton radiotherapy. This study develops an automatic decision method to select the most clinically beneficial radiotherapy technique (proton or photon) for patients with prostate cancer. An automatic decision method was developed to help staff in choosing appropriately between photon and proton radiotherapy for patients with prostate cancer.

Materials and Methods

Forty-eight patients with prostate cancer were enrolled. First, photon and proton dose prediction models (M_ph and M_pr) were trained using reference plans from previous patients’ data. Second, the predicted values of V_6300cGy (rectum wall) were obtained using the trained models, M_ph and M_pr, and these values were used to calculate the Normal Tissue Complication Probability (NTCP). Finally, if the photon NTCP exceeded 10%, the proton NTCP was calculated, and the difference (ΔNTCP) between the two was used to guide treatment selection. The accuracy of the decision support system was evaluated by comparing dose distributions, NTCPs, and decision outcomes between manual and automatic plans using paired t-tests.

Results

The deep learning (DL) model showed a mean absolute error (MAE) of 4.60 ± 1.80 for the rectum wall in the photon group and 3.64 ± 1.27 in the proton group. There was no statistically significant difference in V_6300cGy (rectum wall) between manual plans and model predictions (photon group p = 0.594, proton group p = 0.057). Similarly, no significant differences were observed in NTCP values for the rectum wall (photon group p = 0.383, proton group p = 0.100). The system correctly predicted the treatment modality in 45 of 48 cases, resulting in an accuracy rate of 93.75%, with AUC values for the decision method at 0.88.

Conclusion

The proposed automatic decision method matches dose distributions, accurately calculates NTCPs, and supports precise radiotherapy technique selection, enhancing the clinical efficiency.

目的：对指导工作人员正确选择光子与质子放射治疗具有重要意义。本研究发展一种自动决策方法，以选择临床上最有益的前列腺癌放射治疗技术（质子或光子）。建立了一种自动决策方法，以帮助工作人员在前列腺癌患者的光子和质子放射治疗中做出适当的选择。材料与方法：纳入48例前列腺癌患者。首先，光子和质子剂量预测模型（Mph和Mpr）使用先前患者数据的参考计划进行训练。其次，利用训练好的模型Mph和Mpr得到V6300cGy（直肠壁）的预测值，并以此值计算正常组织并发症概率（NTCP）。最后，如果光子NTCP超过10%，则计算质子NTCP，并使用两者之间的差值（ΔNTCP）来指导治疗选择。通过使用配对t检验比较剂量分布、nntcp和手动和自动计划之间的决策结果，评估决策支持系统的准确性。结果：深度学习（DL）模型对光子组和质子组的平均绝对误差（MAE）分别为4.60±1.80和3.64±1.27。人工方案与模型预测V6300cGy（直肠壁）差异无统计学意义（光子组p = 0.594，质子组p = 0.057）。同样，在直肠壁上观察到的NTCP值无显著差异（光子组p = 0.383，质子组p = 0.100）。该系统对48例中45例的治疗方式进行了正确预测，准确率为93.75%，决策方法的AUC值为0.88。结论：提出的自动决策方法匹配剂量分布，准确计算nntcp，支持精确的放疗技术选择，提高了临床效率。

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引用次数: 0

An optimized VMAT planning technique for hippocampal-sparing whole-brain radiotherapy 保留海马全脑放疗的VMAT优化规划技术。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-17 DOI: 10.1002/acm2.70518

Bei Liu, An Liu, Terence Williams, Ji Hyun Kim

<div> <section> <h3> Purpose</h3> <p>Whole brain radiation therapy (WBRT) has been shown to provide palliation but with negative neurocognitive effects associated with radiation-induced damage to the hippocampus. Sparing of the hippocampus has been shown to reduce the risk of neurocognitive deficit. The goal of this study is to develop a VMAT planning strategy for WBRT with hippocampal avoidance (HA) that will minimize hippocampal dose while achieving homogeneous coverage of whole brain PTV.</p> </section> <section> <h3> Materials and methods</h3> <p>A retrospective study was performed on 10 patients previously treated for intracranial lesions. CT and MRI fused images were used to delineate the whole brain and hippocampus. Strictly following RTOG 0933 atlas guidelines, the hippocampus was manually delineated by a single radiation oncologist. A 4-arc noncoplanar VMAT approach was studied and compared with a 2-arc coplanar method for a prescription of 30 Gy in 10 fractions. We first generated an intermediate plan that optimized only the portion of the whole-brain PTV located farther from the hippocampus. Optimization was then continued by adding the remaining portions of the whole-brain PTV to the optimization structure. In the 4-arc VMAT optimization, a similar intermediate plan was utilized but in addition to this, the hippocampus was blocked for both entry and exit. Dosimetric parameters from both techniques were compared by paired <i>t</i>-test.</p> </section> <section> <h3> Results</h3> <p>When compared to RTOG 0933 dosimetric criteria, both the 2-arc coplanar plans and 4-arc noncoplanar met them with a great margin. However, the 4-arc noncoplanar VMAT approach achieved dramatically better dose sparing for hippocampus as measured by D<sub>0.03cc</sub> (10.55 Gy vs 12.66 Gy, <i>p</i> < 0.001), and D<sub>mean</sub> (8.43 Gy vs 9.74 Gy, <i>p</i> < 0.001) when compared to the 2-arc coplanar plans. Dose homogeneity of whole brain PTV was also improved substantially in the 4-arc noncoplanar approach as measured by D<sub>2%</sub> (32.49 Gy vs 32.90 Gy, <i>p</i> < 0.001), D<sub>98%</sub> (28.55 Gy vs 27.97 Gy, <i>p</i> < 0.001), and the homogeneity index (HI) (0.126 vs 0.155, <i>p</i> < 0.001).</p> </section> <section> <h3> Conclusion</h3> <p>Using an intermediate plan in VMAT optimization, both the 2-arc coplanar plans and 4-arc noncoplanar plans meet RTOG 0933 criteria with a great margin, while the 4-arc noncoplanar VMAT planning method for HA-WBRT further improves the hippocampus sparing, as well as whole brain PTV coverage and dose h

目的：全脑放射治疗（WBRT）已被证明可以提供缓解，但与辐射引起的海马损伤相关的负面神经认知效应。保留海马体已被证明可以降低神经认知缺陷的风险。本研究的目的是为海马回避（HA）的WBRT制定VMAT计划策略，以最大限度地减少海马剂量，同时实现全脑PTV的均匀覆盖。材料与方法：对10例既往颅内病变患者进行回顾性研究。采用CT和MRI融合图像描绘全脑和海马。严格遵循RTOG 0933图谱指南，海马由一名放射肿瘤学家手动划定。研究了一种4弧非共面VMAT方法，并将其与2弧共面方法进行了比较。我们首先生成了一个中间计划，该计划只优化了远离海马体的全脑PTV部分。然后继续优化，将全脑PTV的剩余部分添加到优化结构中。在4弧VMAT优化中，使用了类似的中间方案，但除此之外，海马的进出都被阻塞。采用配对t检验比较两种技术的剂量学参数。结果：与RTOG 0933剂量学标准比较，2弧共面方案和4弧非共面方案均符合RTOG 0933剂量学标准。然而，4弧非共面VMAT入路对海马的剂量节约效果明显更好，D0.03cc (10.55 Gy vs 12.66 Gy, p mean (8.43 Gy vs 9.74 Gy), p 2% (32.49 Gy vs 32.90 Gy), p 98% （28.55 Gy vs 27.97 Gy, p）。采用中间方案进行VMAT优化，2弧共面方案和4弧非共面方案均满足RTOG 0933标准，且余量较大，而HA-WBRT的4弧非共面VMAT规划方法进一步提高了海马节约性、全脑PTV覆盖率和剂量均匀性。

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引用次数: 0

RapidArc Dynamic (RAD) multi-mechanical axis optimization achieves enhanced OAR sparing in cervical cancer: A dosimetric comparison study RapidArc动态（RAD）多机械轴优化实现增强子宫颈OAR保留：剂量学比较研究。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-17 DOI: 10.1002/acm2.70506

Xiangyin Meng, Zhiqun Wang, Yiming Zhang, Xingliu Wang, Xiaoshen Wang, Weihua Zhu, Fuqiang Chen, Zhen Zhang, Fengchao Xu, Zhufeng Wu, Bo Yang, Jie Qiu

<div> <section> <h3> Purpose</h3> <p>To overcome limitations of conventional VMAT for cervical cancer, specifically restricted OAR sparing due to static collimators and delivery constraints inherent to dynamic modulation, we systematically evaluate RapidArc Dynamic (RAD) technology. This first comprehensive assessment focuses on RAD's multi-axis coordination for optimized pelvic radiotherapy planning.</p> </section> <section> <h3> Methods</h3> <p>Twenty cervical cancer patients treated with TrueBeam whose energy was 6MV X-ray were retrospectively analyzed. The prescription was 45 Gy/25Fractions. Seven RAD-based planning strategies with varying collimator rotation modes (Optimize [OPT] vs. Optimize Between Static Angles [OBSA] vs. Static [STAT]) and aperture sizes (15 vs. 30 cm) and different static angle ports were developed using identical optimization objectives. Re-optimized clinical plan using Eclipse v18.1. All RAD and clinical plans were normalized so that the target received a certain dose with 95% target coverage for final dosimetric comparison. Dosimetric comparisons employed ANOVA (with LSD post hoc) for parametric data or Kruskal–Wallis's test (with Mann–Whitney <i>U</i> post hoc) for non-parametric data, with significance set at <i>p</i> < 0.05.</p> </section> <section> <h3> Results</h3> <p>RAD plans showed slightly inferior conformity and homogeneity compared to clinical plans, they achieved superior dose fall-off gradients. RAD's advantage was particularly evident in sparing organs at risk (OARs). Specifically, for the bladder, significant reductions were noted in <span></span><math> <semantics> <msub> <mi>D</mi> <mrow> <mi>m</mi> <mi>e</mi> <mi>a</mi> <mi>n</mi> </mrow> </msub> <annotation>${{D}_{mean}}$</annotation> </semantics></math>(8.29%–13.05%), <span></span><math> <semantics> <msub> <mi>V</mi> <mrow> <mn>20</mn> <mrow> <mspace></mspace> <mi>Gy</mi> </mrow> </mrow> </msub> <annotation>${{V}_{20{mathrm{ Gy}}}}$</annotation> </semantics></math>(4.04%–26.71%), and <span></sp

目的：为了克服传统VMAT治疗宫颈癌的局限性，特别是由于静态准直器和动态调制固有的传输限制而限制了OAR的保留，我们系统地评估了RapidArc dynamic （RAD）技术。首次综合评估侧重于RAD的多轴协调以优化盆腔放疗计划。方法：对20例应用能量为6MV的TrueBeam治疗宫颈癌的患者进行回顾性分析。处方为45 Gy/25Fractions。使用相同的优化目标，开发了7种基于rad的规划策略，包括不同准直器旋转模式（优化[OPT] vs.优化静态角度[OBSA] vs.静态[STAT]）、孔径大小（15 cm vs. 30 cm）和不同的静态角端口。使用Eclipse v18.1重新优化临床计划。所有RAD和临床计划均归一化，使目标接受一定剂量，目标覆盖率为95%，用于最终剂量学比较。剂量学比较对参数数据采用方差分析（采用LSD事后分析），对非参数数据采用Kruskal-Wallis检验（采用Mann-Whitney U事后分析），显著性设置为p。结果：与临床计划相比，RAD计划的符合性和均匀性略差，它们获得了更好的剂量衰减梯度。RAD的优势在保留危险器官（OARs）方面尤为明显。具体而言，与临床计划相比，膀胱的D mean ${D}_{mean}}$（8.29%-13.05%）、V 20 Gy ${V}_{20 mathrm{ Gy}}}}$（4.04%-26.71%）和V 30 Gy ${V}_{30 mathrm{ Gy}}}}$（26.98%-32.46%）显著降低。同样,直肠,减少D m e n $ {{D} _{意味着}}$ (9.21% - -15.58%),V 20 Gy $ {{V} _ {20 { mathrm { Gy}}}} $ (5.03% - -14.77%), V 30 Gy $ {{V} _ {30 { mathrm { Gy}}}} $(18.24% - -28.11%)和V 40 Gy $ {{V} _ {40 { mathrm { Gy}}}} $(23.73% - -31.22%)。其他桨也受益于改进的剂量学参数。虽然2ARC+OBSA+15和2ARC+STAT+15方案都优于其他RAD配置，但2ARC+OBSA+15方案通常提供更好的结果。值得注意的是，尽管RAD方案总体上显示小肠D2cc显著较高，但2ARC+OBSA+15方案的剂量与临床方案相当。在监控单元（MU）和计划复杂性方面，RAD计划更复杂，但保持了超过97%的高验证通过率。结论：RAD方案的初步探索显示出其在节省桨叶剂量方面的优势。此外，在RAD方案中，准直角度和孔径在15 cm处的优化获得了更好的剂量学结果。因此，进一步探索不同的机械轴组合对今后的研究具有重要意义。

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引用次数: 0

Evaluation of the InTempo path set for CyberKnife prostate and lung SBRT: A single-institution experience 对射波刀前列腺和肺部SBRT的InTempo路径的评估：单一机构的经验。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-17 DOI: 10.1002/acm2.70509

Yingcui Jia, Lei Fu, Shari Rudoler, Eric Gressen, Yevgeniy Vinogradskiy, Qianyi Xu

<div> <section> <h3> Purpose</h3> <p>The InTempo adaptive imaging system is an important component of the Accuray CyberKnife System, designed to enhance the system's ability to track and correct tumor motion during treatment. However, a limitation of this feature is the reduction of available nodes for treatment planning. The impact of a reduced number of nodes on the quality of InTempo-based treatment plans has not previously been evaluated. This retrospective study aims to compare the dosimetry of CyberKnife plans with and without The InTempo path set for both prostate and lung stereotactic body radiotherapy (SBRT).</p> </section> <section> <h3> Methods</h3> <p>This study included twelve consecutive prostate SBRT patients and twenty selected lung SBRT patients. The selection criteria for the 20 lung patients were motivated by being able to construct a data set representative of common treatment tracking methods and dose prescriptions. To evaluate the impact of InTempo imaging, treatment plans were re-optimized using the same optimization parameters and machine settings, except for the path set with the maximum number of nodes. To ensure a fair comparison, the study plans were prescribed using identical planning target volume coverage as the clinical treatment plans. Statistical analyses were performed using mean and standard deviation, dose metric plots, and a two-sided Wilcoxon signed rank test with multiple testing correction to compare dose metrics between different path sets.</p> </section> <section> <h3> Results</h3> <p>No statistically significant differences were observed among the Prostate, Prostate_Short, and their corresponding InTempo path sets in at least 8 of the 14 evaluated plan metrics, including prostate clinical tumor volume (CTV) V40Gy(%), conformity index, and homogeneity index. For example, the mean prostate CTV V40Gy (%) for the Prostate, Prostate_Short, and their corresponding InTempo path sets was 90.8 ± 4.7, 89.4 ± 4.7, 90.2 ± 3.9, 91.0 ± 7.0, respectively. However, compared with the Prostate path set, the Prostate_InTempo path set exhibited a statistically significant reduction in delivery time (<i>p</i> = 0.0010), number of beams, and bladder V18Gy (%), along with a statistically significant increase in the number of imaging beams (<i>p</i> = 0.0010). Additionally, Prostate_Short demonstrated statistically significant reductions in delivery time and number of beams compared with the Prostate path set, while the number of imaging beams remained statistically equivalent. In contrast, the Reduced_Prostate and Reduced_Prostate_InTempo sets consistently resulted in inferior dosimetric outcomes, with several plans deemed unop

目的：InTempo自适应成像系统是Accuray射波刀系统的重要组成部分，旨在增强系统在治疗过程中跟踪和纠正肿瘤运动的能力。然而，该特性的一个限制是减少了治疗计划的可用节点。减少淋巴结数量对以intempo为基础的治疗计划质量的影响以前没有被评估过。本回顾性研究旨在比较射波刀计划在前列腺和肺立体定向放射治疗（SBRT）中使用和不使用InTempo路径设置的剂量学。方法：本研究纳入12例连续的前列腺SBRT患者和20例选择的肺部SBRT患者。20例肺部患者的选择标准的动机是能够构建一个代表常用治疗跟踪方法和剂量处方的数据集。为了评估InTempo成像的影响，使用相同的优化参数和机器设置对治疗方案进行了重新优化，除了具有最大节点数的路径设置。为确保公平比较，研究计划与临床治疗计划采用相同的计划目标体积覆盖率。采用均数和标准差、剂量计量图和双侧Wilcoxon sign rank检验（多重检验校正）进行统计分析，比较不同路径集之间的剂量计量。结果：在14个评估的计划指标中，前列腺临床肿瘤体积（CTV） V40Gy（%）、符合性指数和均匀性指数等至少8个指标中，前列腺、Prostate_Short及其相应的InTempo路径组之间无统计学差异。例如，前列腺、Prostate_Short及其对应的InTempo路径集的平均前列腺CTV V40Gy（%）分别为90.8±4.7、89.4±4.7、90.2±3.9、91.0±7.0。然而，与前列腺路径组相比，Prostate_InTempo路径组在递送时间（p = 0.0010）、光束数和膀胱V18Gy（%）方面具有统计学意义的减少，同时在成像光束数方面具有统计学意义的增加（p = 0.0010）。此外，与前列腺路径设置相比，Prostate_Short显示在传送时间和光束数量上有统计学意义的减少，而成像光束数量在统计学上保持相等。相比之下，Reduced_Prostate和Reduced_Prostate_InTempo集合一致导致较差的剂量学结果，由于节点可用性不足，一些计划被认为是不可优化的。对于肺部SBRT，在使用和不使用InTempo的方案之间，在交付时间和成像光束数量上观察到统计学上的显著差异。然而，两组间剂量分布指标无统计学差异。结论：如果提供足够的淋巴结可用性，intempo兼容路径集不会显著影响前列腺或肺部SBRT的计划质量。具体来说，与前列腺路径组相比，Prostate_InTempo和Prostate_Short路径组显示了递送时间的减少和自适应成像频率的增加。然而，reduced_前列腺和Reduced_Prostate_InTempo会导致较差的计划质量和降低交付性，应谨慎使用。这些发现支持在不牺牲剂量学完整性的情况下选择性地使用InTempo成像进行SBRT计划。

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引用次数: 0

In-Silico Trial of Same-Day Simulation-Free Spatially Fractionated Adaptive Radiotherapy (SF2-ART) 当日无模拟的空间分割自适应放射治疗（SF2-ART）的计算机试验。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-16 DOI: 10.1002/acm2.70517

Dennis N. Stanley, Alyssa R. Birchmeier, Carlos E. Cardenas, Richard A. Popple, Natalie Viscariello, Joel A. Pogue, Courtney B. Stanley, Mehran Yusuf, Michael Soike, Samuel R. Marcrom, Joseph Harms

Purpose

Here we present an in-silico trial of the feasibility and deliverability of a same-day, simulation-free workflow for spatially fractionated adaptive radiotherapy (SF²-ART) using the Varian Ethos platform.

Methods and Materials

Ten patients (five thoracic and five extremity), previously treated with spatially fractionated radiotherapy (SFRT), were selected for this in silico trial. A two-phase regimen was simulated: Phase 1 delivered 12 Gy SBRT to a uniform, predefined high-dose lattice and 4 Gy to the gross tumor volume (GTV); Phase 2 consisted of 4 additional fractions of 4 Gy to the GTV. The planning workflow was performed entirely in silico, without the need for CT simulation. High-dose sphere matrices were generated with a custom script and aligned to physician-defined GTVs. Adaptive plans were created based on CBCT anatomy and evaluated for dosimetric quality, deliverability, and workflow timing. Comparisons were made to the original clinically delivered plans. Mobius3D was used for secondary dose verification.

Results

All 10 cases were successfully replanned using the SF²-ART workflow without simulation-based imaging. The entire planning and treatment process, including consultation, contouring, adaptive plan generation, and QA, was performed within a single session. Dosimetric comparisons showed minimal differences between simulation-free adaptive and clinically delivered plans, with target coverage and normal tissue constraints maintained across all cases. Median total estimated workflow time was 166.4 min.

Conclusions

This in-silico study demonstrates the feasibility of delivering spatially fractionated SBRT without simulation CT using a same-day adaptive workflow. The SF²-ART approach may enable rapid, high-quality treatment for patients with urgent or symptomatic presentations and supports future prospective clinical implementation.

目的：在这里，我们提出了一项利用Varian Ethos平台进行空间分割自适应放疗（SF2-ART）当日无模拟工作流程的可行性和可交付性的计算机试验。方法和材料：选择10例（5例胸部和5例四肢）先前接受过空间分割放疗（SFRT）的患者进行这项硅试验。模拟了两期方案：第一阶段将12 Gy的SBRT输送到均匀的、预定义的高剂量晶格，并将4 Gy输送到总肿瘤体积（GTV）；第2阶段包括4个额外的4gy到GTV的馏分。规划工作流程完全在计算机上完成，不需要CT模拟。使用自定义脚本生成高剂量球体矩阵，并与医生定义的gtv对齐。根据CBCT解剖创建适应性计划，并评估剂量学质量、可交付性和工作流程时间。与最初的临床交付计划进行比较。使用Mobius3D进行二次剂量验证。结果：所有10例患者均成功通过SF2-ART流程重新规划，无需基于模拟的成像。整个计划和治疗过程，包括咨询、轮廓、自适应计划生成和QA，都在一次会议中完成。剂量学比较显示，无模拟适应性计划和临床交付计划之间的差异很小，所有病例的目标覆盖范围和正常组织约束都保持不变。中位总估计工作流程时间为166.4分钟。结论：这项计算机研究证明了使用当日自适应工作流在没有模拟CT的情况下提供空间分馏SBRT的可行性。SF2-ART方法可以为紧急或有症状的患者提供快速、高质量的治疗，并支持未来的前瞻性临床实施。

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引用次数: 0

Evaluation of QUASAR Insight Phantom for daily imaging QA of MRgRT linacs QUASAR Insight Phantom对MRgRT直线机日常成像质量的评价。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-16 DOI: 10.1002/acm2.70463

Eli Grant, Jiayi Liu, Ronak Etemadpour, Chengyu Shi, Huisi Ai, Percy Lee, Terence Williams, An Liu, Borna Maraghechi

Purpose

Magnetic resonance imaging (MRI) and its importance in modern radiation therapy requires a standardized daily quality assurance (QA) procedure that is both comprehensive and efficient. Current imaging QA guidelines require a more inclusive analysis of imaging characteristics, as well as a simplification of setup procedures. We have studied the feasibility of using the Insight Phantom to provide consistent images for analyses of uniformity, slice thickness, spatial resolution, and distortion across a large field of view (FOV).

Methods

The large imaging region of the Insight Phantom was imaged using 3D True Fast Imaging with Steady State Precession (TruFi) and analyzed using the Modus QA software. The base and upright section were imaged in coronal, axial, and sagittal orientations over 3 months.

Results

Geometric distortion analysis yielded average maximum distortions within a 210 mm diameter of 0.57, 0.73, and 0.45 mm for axial, sagittal, and coronal orientations, respectively. Similarly, within a 310 mm diameter, average maximum distortions were 0.58, 0.73, and 0.74 mm with no distortions greater than or equal to 1 mm. Average modulation transfer function (MTF) values were 0.431 ± 0.007, 0.436 ± 0.007, and 0.433 ± 0.010 lp/mm for axial, sagittal, and coronal images, respectively. Finally, slice thickness values were consistent at 2.19 ± 0.04, 2.22 ± 0.06, and 2.24 ± 0.07 mm for axial, sagittal, and coronal imaging orientations, respectively. Images were repeatable and setup procedures were quick and straightforward, enhancing therapist workflow and efficiency.

Conclusion

The Insight Phantom's large coverage allows a more in-depth analysis of the MRI's large FOV, and its simple setup ensures a repeatable daily QA procedure for therapists. The software also provides a comprehensive analysis of key imaging parameters in a detailed report that can be used to monitor MRI functionality and quality.

目的：磁共振成像（MRI）及其在现代放射治疗中的重要性需要一个标准化的日常质量保证（QA）程序，该程序既全面又高效。当前的成像QA指南要求对成像特征进行更全面的分析，并简化设置程序。我们已经研究了使用Insight Phantom为分析均匀性、切片厚度、空间分辨率和大视场（FOV）失真提供一致图像的可行性。方法：采用稳态进动3D真快速成像技术（TruFi）对Insight Phantom的大成像区域进行成像，并用Modus QA软件进行分析。在3个月的时间里，在冠状、轴状和矢状方向上对基底和直立切片进行成像。结果：几何畸变分析显示，210 mm直径内的轴向、矢状和冠状方向的平均最大畸变分别为0.57、0.73和0.45 mm。同样，在310毫米直径内，平均最大畸变为0.58、0.73和0.74毫米，没有畸变大于或等于1毫米。轴位、矢状位和冠状位的平均调制传递函数（MTF）分别为0.431±0.007、0.436±0.007和0.433±0.010 lp/mm。最后，轴位、矢状位和冠状位的切片厚度值分别为2.19±0.04、2.22±0.06和2.24±0.07 mm。图像可重复，设置程序快速直接，提高了治疗师的工作流程和效率。结论：Insight Phantom的大覆盖范围允许对MRI的大视场进行更深入的分析，其简单的设置确保了治疗师可重复的日常QA程序。该软件还在详细报告中提供了关键成像参数的全面分析，可用于监测MRI功能和质量。

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引用次数: 0

Dosimetric impact of port number in TomoDirect-based lower-body total body irradiation 基于tomodirect的下体全身照射中端口号的剂量学影响。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-16 DOI: 10.1002/acm2.70504

Yoshiki Suetsugu, Naoki Higashi, Yukihide Fukuyama, Yuka Yamanaka, Keiki Inoue, Shun Nakano, Hiromi Terashima, Tomonari Sasaki

Background

The feasibility of total body irradiation (TBI) delivery using the TomoDirect mode of a TomoTherapy system has been demonstrated. In clinical practice, TomoTherapy-based TBI is typically performed in two parts: upper and lower body.

Purpose

This study aimed to evaluate the dosimetric impact of varying port numbers on dose evaluation indices for lower body irradiation using TomoDirect and to compare these results with those of TomoHelical in a simulation setting.

Methods

Sixteen patients who underwent myeloablative TBI using TomoHelical between October 2017 and March 2021 were retrospectively analyzed. TomoDirect plans with 2 to 12 ports at approximately equal beam angles were generated (modulation factor = 1.5, field width = 5.0 cm, pitch = 0.500). TomoHelical plans used identical parameters except for a pitch of 0.397. The prescribed dose was 12 Gy in six fractions. Dose indices (D2, D98, D50, homogeneity index [HI]) and beam-on time were compared.

Results

In TomoDirect plans, all dose evaluation indices worsened as the number of ports increased up to five, but changes became minimal beyond eight ports. D2 was significantly improved in all TomoDirect plans compared with those of TomoHelical plan. D98 was significantly lower for the three- and five-port TomoDirect plans, and no TomoDirect plan achieved higher D98 than TomoHelical. The D50 and HI were significantly improved in all TomoDirect plans except the five-port configuration. The two-port TomoDirect plan achieved the most favorable dose indices and the shortest beam-on time.

Conclusions

The two-port TomoDirect approach with anterior-posterior beam configuration provides an efficient and clinically reasonable option for lower-body irradiation, offering improved dose homogeneity and reduced treatment time compared with TomoHelical.

背景：使用TomoDirect模式的TomoTherapy系统的全身照射（TBI）递送的可行性已经被证明。在临床实践中，基于断层治疗的TBI通常在两个部分进行：上半身和下半身。目的：本研究旨在评估不同端口号对使用TomoDirect进行下体照射剂量评估指标的剂量学影响，并在模拟环境下将这些结果与TomoHelical的结果进行比较。方法：回顾性分析2017年10月至2021年3月期间使用TomoHelical进行清髓性TBI手术的16例患者。生成2 ~ 12个端口的TomoDirect图，波束角大致相等（调制因子= 1.5，场宽= 5.0 cm，节距= 0.500）。TomoHelical计划使用相同的参数，除了间距为0.397。处方剂量为12戈瑞，分6份服用。比较剂量指数（D2、D98、D50、均匀性指数[HI]）和照射时间。结果：在TomoDirect计划中，当端口数增加到5个时，所有剂量评价指标都恶化，但超过8个端口变化最小。与TomoDirect计划相比，所有TomoDirect计划的D2均显著提高。三端口和五端口TomoDirect计划的D98明显低于TomoDirect计划，没有TomoDirect计划的D98高于TomoHelical。除五端口配置外，所有TomoDirect计划的D50和HI都有显着改善。双端口TomoDirect计划获得了最有利的剂量指数和最短的光束照射时间。结论：与TomoHelical相比，采用前后光束配置的双端口TomoDirect入路为下体照射提供了一种有效且临床上合理的选择，可改善剂量均匀性并缩短治疗时间。

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引用次数: 0

Multi-institutional validation of hypersight CBCT-based dose calculation on O-ring linacs 基于cbct的o型环直线机剂量计算的多机构验证。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-16 DOI: 10.1002/acm2.70512

Chih-Yuan Lin, Yi-Ling Chen, Chia-Chi Chang, Yin-Hsun Hu, Chia-Peng Pan, Fang-Hui Liu, Hsiang-Ping Chao, Yang-Wei Hsieh, Yu-Wei Lin, Chi-Yuan Yeh, Tzu-Yuan Chao, Shih-Ming Hsu

<div> <section> <h3> Background</h3> <p>Conventional cone-beam computed tomography (CBCT) systems are limited by suboptimal image quality, inaccurate Hounsfield unit (HU) calibration, and reduced reliability for dose calculation. HyperSight CBCT on the Halcyon platform offers improved HU accuracy, expanded field-of-view (FOV), and enhanced image quality.</p> </section> <section> <h3> Purpose</h3> <p>This study aimed to assess the dosimetric accuracy of treatment planning using HyperSight CBCT through phantom-based dose verification.</p> </section> <section> <h3> Methods</h3> <p>This study included three institutions equipped with the HyperSight imaging system on the Halcyon platform, with all procedures performed after acceptance testing and calibration. Each institution generated HU-to-density calibration curves using computed tomography (CT) scanners and standardized phantoms, and corresponding CBCT for planning (CBCTp) scans were also acquired. Additional CBCTp scans were acquired using a consistent phantom model (062 M) across the three institutions. Reference treatment plans were created on CT images and transferred to CBCTp and CBCT datasets for dose recalculation using identical parameters. Dosimetric assessment included gamma analysis and comparisons of DVH-based dosimetric metrics for relevant regions of interest (ROIs). End-to-end testing with an anthropomorphic phantom was performed using ion chamber measurements and film dosimetry at brain, bone, and thorax locations.</p> </section> <section> <h3> Results</h3> <p>HU-to-density curves showed consistent behavior across institutions, with larger variability only at higher densities. CBCTp calibrations agreed well with vendor references. DVH-based dosimetric metrics showed differences generally within 1% for both CBCTp and CBCT when compared with CT. Across institutions, gamma analysis of both CBCTp and CBCT yielded high passing rates (≥ 98.5% at 3%/2 mm). End-to-end testing with film dosimetry showed that CBCT-based plans agreed with measured doses within ± 4%, while CT-based plans were within ± 3%. Ion chamber measurements showed all dose differences within ± 2.3%, with both CBCTp and CBCT within ± 1.0% of CT.</p> </section> <section> <h3> Conclusions</h3> <p>HyperSight CBCT provides accurate dose calculations when properly calibrated. Phantom-based validation demonstrated sub-2% deviations and strong agreement with CT, supporting its clinical use in adaptive radiotherapy.</p>

背景：传统的锥束计算机断层扫描（CBCT）系统受到图像质量不理想、Hounsfield单位（HU）校准不准确以及剂量计算可靠性降低的限制。HyperSight CBCT在Halcyon平台上提供了更高的HU精度、扩大的视场（FOV）和增强的图像质量。目的：本研究旨在通过基于幻象的剂量验证来评估HyperSight CBCT治疗计划的剂量学准确性。方法：在Halcyon平台上安装HyperSight成像系统的三家机构，所有程序均在验收测试和校准后进行。每个机构都使用计算机断层扫描（CT）扫描仪和标准化模型生成了HU-to-density校准曲线，并获得了相应的CBCT规划（CBCTp）扫描。在三个机构使用一致的幻影模型（062 M）获得额外的CBCTp扫描。在CT图像上创建参考治疗方案，并将其转移到CBCTp和CBCT数据集中，使用相同的参数重新计算剂量。剂量学评估包括伽马分析和相关感兴趣区域（roi）基于dvh的剂量学指标的比较。在脑、骨和胸腔位置使用离子室测量和膜剂量法对拟人化幻影进行端到端测试。结果：hu -密度曲线在各个机构中表现出一致的行为，只有在较高的密度下才有较大的变异性。CBCTp校准与供应商的参考资料一致。与CT相比，基于dvh的剂量学指标显示CBCTp和CBCT的差异通常在1%以内。在所有机构中，CBCTp和CBCT的伽玛分析都获得了高通过率（≥98.5%,3%/ 2mm）。胶片剂量学的端到端测试显示，基于cbct的方案与测量剂量在±4%内一致，而基于ct的方案在±3%内一致。离子室测量显示，所有剂量差异在±2.3%内，CBCTp和CBCT均在CT的±1.0%内。结论：HyperSight CBCT在适当校准时提供准确的剂量计算。基于幻影的验证显示偏差低于2%，与CT高度一致，支持其在适应性放疗中的临床应用。

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引用次数: 0

Dynamic range optimization for treatment time reduction in respiratory-gated proton therapy using RayStation v2025 使用RayStation v2025对呼吸门控质子治疗减少治疗时间的动态范围进行优化。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-16 DOI: 10.1002/acm2.70510

Sungkoo Cho, Jung Il Yu, Hee Chul Park, Kwanghyun Jo

<div> <section> <h3> Purpose</h3> <p>This study introduces dynamic range optimization, which constrains the lower limit of the minimum MU per spot, as a planning-based strategy to enhance efficiency in respiratory-gated proton therapy and evaluates the resultant dosimetric trade-offs.</p> </section> <section> <h3> Methods</h3> <p>We analyzed 101 hepatocellular carcinoma patients who received line-scanning proton therapy. We developed a computational framework to predict the total treatment time, integrating dynamic range-mediated changes in beam-on time (BoT) with respiratory gating dynamics. The model was validated against fully dynamic range-optimized plans generated by RayStation v2025 across five dynamic range values (no constraint, 200, 100, 50, and 10). These values represent the ratio of maximum to minimum MU allowed within an energy layer; specifically, a lower dynamic range value imposes a stricter constraint by elevating the minimum MU floor, thereby reducing intensity modulation flexibility while increasing delivery speed. Dosimetric trade-offs were quantified using fully re-optimized plans for a representative case under dynamic range = 100 and 10 constraints. The study used a layer switching time (T<sub>LS</sub>) of 2 s and amplitude-based respiratory gating. A RayStation-integrated Python script was developed for clinical decision support.</p> </section> <section> <h3> Results</h3> <p>Decreasing the dynamic range systematically reduced beam-on time in a sigmoid-shape pattern. The computational model's predictions for beam-on time showed a maximum error of 10.4% compared to RayStation v2025 calculations, confirming its accuracy. Total treatment time reduction reached a plateau at certain dynamic range thresholds, particularly when layer delivery plus switching was completed within a single gating-on period, indicating no further efficiency gain from additional dynamic range reduction. While target coverage remained equivalent across dynamic range values, lower dynamic range values systematically increased normal tissue doses due to reduced intensity modulation capability, with organs proximal to the target experiencing the largest relative increases (e.g., gallbladder mean dose increased 16.4% at DR = 10).</p> </section> <section> <h3> Conclusion</h3> <p>Dynamic range optimization is an effective, planning-based method to reduce treatment time in respiratory-gated proton therapy, operating independently of patient cooperation or system modifications. The developed RayStation-integrated tool enables clinicians to identify the optimal pa

目的：本研究引入动态范围优化，该优化限制了每个点的最小MU下限，作为一种基于计划的策略来提高呼吸门控质子治疗的效率，并评估由此产生的剂量学权衡。方法：对101例肝癌患者行线扫描质子治疗进行分析。我们开发了一个计算框架来预测总治疗时间，将动态范围介导的光束照射时间（BoT）变化与呼吸门控动力学相结合。该模型通过RayStation v2025生成的全动态范围优化方案在5个动态范围值（无约束、200、100、50和10）下进行验证。这些值表示能量层内允许的最大和最小MU的比值；具体来说，较低的动态范围值通过提高最小MU下限施加了更严格的约束，从而降低了强度调制的灵活性，同时提高了传输速度。在动态范围= 100和10约束下，使用完全重新优化的方案对典型病例的剂量学权衡进行量化。该研究使用了2秒的层切换时间（TLS）和基于振幅的呼吸门控。为临床决策支持开发了一个集成raystation的Python脚本。结果：降低动态范围系统地减少了光束的时间，呈s形模式。与RayStation v2025计算相比，该计算模型对光束照射时间的预测显示最大误差为10.4%，证实了其准确性。在一定的动态范围阈值下，总处理时间的减少达到了一个平台，特别是当层输送和开关在单个门控周期内完成时，这表明额外的动态范围减少不会进一步提高效率。虽然目标覆盖范围在动态范围内保持相等，但由于强度调节能力降低，较低的动态范围值系统性地增加了正常组织的剂量，其中靠近目标的器官的相对增加最大（例如，在DR = 10时，胆囊的平均剂量增加了16.4%）。结论：动态范围优化是一种有效的、基于计划的方法，可缩短呼吸门控质子治疗的治疗时间，无需患者配合或系统修改。开发的raystation集成工具使临床医生能够确定最佳的患者特异性动态范围，平衡效率增益和可接受的剂量学质量，特别是对于目标附近有风险的器官。该方法为治疗计划中个性化动态范围的选择提供了技术基础。

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引用次数: 0

Checklist and quality assurance tools for integration of two radiation oncology information systems (ROISs) 两个放射肿瘤学信息系统（ROISs）集成的核对表和质量保证工具。

IF 2.2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics

Pub Date : 2026-02-15 DOI: 10.1002/acm2.70435

ByongYong Yi, Shafiq Ur Rahman, Shifeng Chen, Baoshe Zhang

Background

Merging two radiation oncology information systems (ROISs) is often necessary due to system changes or hospital integrations. ROIS integration is a high-risk procedure, that requires clear procedural guidelines and comprehensive QA methods to ensure safe practice.

Purpose

This paper presents checklists, procedures, and challenges associated with integrating a ROIS into a centralized system, providing procedural guidelines and QA methods. It also shares our experience of merging with one ROIS into another.

Method

The integration process comprised five major components: machine information; under-treatment patients’ information (treatment plans, history, images, and electronic medical records [EMR]); user-generated workflows; ROIS user information; and beam-related information, if any (e.g., beam calibration). The procedures were divided into three parts: site survey and preparation-phase activities, QA during integration, and QA after integration. Software tools were developed to compare data before and after the merger. Integration of legacy data was not considered in this process.

Results

We successfully integrated a standalone practice site into a main ROIS, which may serve multiple sites, over the course of a single weekend using the developed tools and checklists. By the following Monday, after 45-person hours of integration work by therapists, dosimetrists and physicists, the newly integrated practice site was able to seamlessly use the centralized ROIS to continue radiation treatment for its patients already under care. The entire procedure was completed without any downtime at any site.

Conclusion

We have developed and successfully tested a structured set of checklists, procedures, and tools for the seamless integration of a practice site into an existing ROIS. This approach provides the radiation oncology community with a framework for achieving safe and efficient practice integration.

背景：由于系统变更或医院整合，合并两个放射肿瘤学信息系统（ROISs）往往是必要的。ROIS集成是一个高风险的过程，需要明确的程序指南和全面的QA方法来确保安全操作。目的：本文介绍了与将roi集成到集中系统相关的检查清单、程序和挑战，提供了程序指南和QA方法。它还分享了我们将一个roi合并为另一个roi的经验。方法：集成过程包括五个主要部分：机器信息；未接受治疗患者的信息（治疗计划、病史、图像和电子病历[EMR]）；用户工作流程;ROIS用户信息；和光束相关的信息，如果有的话（例如，光束校准）。程序分为三个部分：现场调查和准备阶段活动、集成期间的QA和集成后的QA。开发了软件工具来比较合并前后的数据。在这个过程中没有考虑遗留数据的集成。结果：我们成功地将一个独立的实践站点集成到一个主要的roi中，它可以服务于多个站点，在一个周末的过程中使用开发的工具和检查表。在接下来的周一，经过治疗师、剂量师和物理学家45个小时的整合工作，新整合的实践站点能够无缝地使用集中式ROIS继续对已经接受治疗的患者进行放射治疗。整个过程在没有任何停机的情况下完成。结论：我们已经开发并成功地测试了一套结构化的检查表、程序和工具，用于将实践站点无缝集成到现有的roi中。这种方法为放射肿瘤学社区提供了一个框架，以实现安全和有效的实践整合。

{"title":"Checklist and quality assurance tools for integration of two radiation oncology information systems (ROISs)","authors":"ByongYong Yi, Shafiq Ur Rahman, Shifeng Chen, Baoshe Zhang","doi":"10.1002/acm2.70435","DOIUrl":"10.1002/acm2.70435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Merging two radiation oncology information systems (ROISs) is often necessary due to system changes or hospital integrations. ROIS integration is a high-risk procedure, that requires clear procedural guidelines and comprehensive QA methods to ensure safe practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This paper presents checklists, procedures, and challenges associated with integrating a ROIS into a centralized system, providing procedural guidelines and QA methods. It also shares our experience of merging with one ROIS into another.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The integration process comprised five major components: machine information; under-treatment patients’ information (treatment plans, history, images, and electronic medical records [EMR]); user-generated workflows; ROIS user information; and beam-related information, if any (e.g., beam calibration). The procedures were divided into three parts: site survey and preparation-phase activities, QA during integration, and QA after integration. Software tools were developed to compare data before and after the merger. Integration of legacy data was not considered in this process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We successfully integrated a standalone practice site into a main ROIS, which may serve multiple sites, over the course of a single weekend using the developed tools and checklists. By the following Monday, after 45-person hours of integration work by therapists, dosimetrists and physicists, the newly integrated practice site was able to seamlessly use the centralized ROIS to continue radiation treatment for its patients already under care. The entire procedure was completed without any downtime at any site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We have developed and successfully tested a structured set of checklists, procedures, and tools for the seamless integration of a practice site into an existing ROIS. This approach provides the radiation oncology community with a framework for achieving safe and efficient practice integration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"27 2","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197608","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}

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