Pub Date : 2025-12-31DOI: 10.1016/j.tipsro.2025.100370
Georgios Tsekas, Lisa Wiersema, Sanne Conijn, Jega Sundaram, Uulke A. van der Heide, Tomas Janssen
Background:
Background and Purpose: Offline plan preparation is a time-consuming step in MRI-guided radiotherapy (MRIgRT). This work explores the use of a patient-agnostic reference plan and delineations for direct-to-treatment (DtT) MRI-guided prostate RT, without any patient-specific treatment preparations.
Material and Methods:
The data of ten prostate cancer patients were used to simulate a (DtT) workflow: During fraction 1, patient-specific contour adaptations were performed and a treatment plan was created, which was used for the rest of the fractions. The DtT treatment plans were evaluated against the clinical RT plans using the clinical delineations.
Results:
All DtT plans reached sufficient PTV coverage (V3444cGy > 99%), while resulting in comparable OAR dose distributions to the clinical plans.
Conclusion:
Our DtT workflow resulted in adequate PTV coverage at the cost of small increase to the dose of some organs-at-risk and a high overall efficiency gain.
{"title":"Direct-to-treatment MRI-guided prostate radiotherapy using a generic patient-agnostic reference plan","authors":"Georgios Tsekas, Lisa Wiersema, Sanne Conijn, Jega Sundaram, Uulke A. van der Heide, Tomas Janssen","doi":"10.1016/j.tipsro.2025.100370","DOIUrl":"10.1016/j.tipsro.2025.100370","url":null,"abstract":"<div><h3>Background:</h3><div>Background and Purpose: Offline plan preparation is a time-consuming step in MRI-guided radiotherapy (MRIgRT). This work explores the use of a patient-agnostic reference plan and delineations for direct-to-treatment (DtT) MRI-guided prostate RT, without any patient-specific treatment preparations.</div></div><div><h3>Material and Methods:</h3><div>The data of ten prostate cancer patients were used to simulate a (DtT) workflow: During fraction 1, patient-specific contour adaptations were performed and a treatment plan was created, which was used for the rest of the fractions. The DtT treatment plans were evaluated against the clinical RT plans using the clinical delineations.</div></div><div><h3>Results:</h3><div>All DtT plans reached sufficient PTV coverage (V<sub>3444cGy</sub> > 99%), while resulting in comparable OAR dose distributions to the clinical plans.</div></div><div><h3>Conclusion:</h3><div>Our DtT workflow resulted in adequate PTV coverage at the cost of small increase to the dose of some organs-at-risk and a high overall efficiency gain.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100370"},"PeriodicalIF":2.8,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-28DOI: 10.1016/j.tipsro.2025.100373
Aidan Leong , Keita Ormsby
Background
Generative AI (GenAI) tools, particularly Large Language Models (LLMs), are increasingly used across clinical contexts; including to support patient information needs. As these technologies become more prevalent, understanding their utilisation and evaluation in practice is critical. This scoping review aimed to map existing literature on GenAI applications in education for patients with cancer and identify trends in evaluation practices.
Methods
A scoping review was conducted following PRISMA-ScR guidelines. PubMed and Medline databases were searched for studies published between January 2019 and November 2024. Fifty-four eligible articles were analysed for GenAI models used, treatment modalities, education contexts, prompt sources, and evaluation domains and metrics.
Results
Most studies (81.5 %) were published in 2024, with over half (55.6 %) originating from the USA. ChatGPT-3.5 and ChatGPT-4 were the most frequently used models. Decision-making and general disease information were the predominant education contexts. Evaluation of GenAI outputs was reported in 96 % of studies, with accuracy (61.1%), readability (42.6 %), and quality (29.6 %) as the most common domains. More than half (50.8 %) of evaluation metrics were custom scales, indicating limited use of standardised tools. Patient-centred frameworks were rarely applied.
Conclusion
GenAI shows promise in enhancing patient education for cancer care, but evaluation practices lack standardisation and cultural responsiveness. Future research should prioritise validated frameworks, patient-centred metrics, and prompt engineering strategies to ensure safe, equitable and effective integration of GenAI in clinical care.
{"title":"Generative AI for patient education in cancer care: A scoping review of evaluation practices and emerging trends","authors":"Aidan Leong , Keita Ormsby","doi":"10.1016/j.tipsro.2025.100373","DOIUrl":"10.1016/j.tipsro.2025.100373","url":null,"abstract":"<div><h3>Background</h3><div>Generative AI (GenAI) tools, particularly Large Language Models (LLMs), are increasingly used across clinical contexts; including to support patient information needs. As these technologies become more prevalent, understanding their utilisation and evaluation in practice is critical. This scoping review aimed to map existing literature on GenAI applications in education for patients with cancer and identify trends in evaluation practices.</div></div><div><h3>Methods</h3><div>A scoping review was conducted following PRISMA-ScR guidelines. PubMed and Medline databases were searched for studies published between January 2019 and November 2024. Fifty-four eligible articles were analysed for GenAI models used, treatment modalities, education contexts, prompt sources, and evaluation domains and metrics.</div></div><div><h3>Results</h3><div>Most studies (81.5 %) were published in 2024, with over half (55.6 %) originating from the USA. ChatGPT-3.5 and ChatGPT-4 were the most frequently used models. Decision-making and general disease information were the predominant education contexts. Evaluation of GenAI outputs was reported in 96 % of studies, with accuracy (61.1%), readability (42.6 %), and quality (29.6 %) as the most common domains. More than half (50.8 %) of evaluation metrics were custom scales, indicating limited use of standardised tools. Patient-centred frameworks were rarely applied.</div></div><div><h3>Conclusion</h3><div>GenAI shows promise in enhancing patient education for cancer care, but evaluation practices lack standardisation and cultural responsiveness. Future research should prioritise validated frameworks, patient-centred metrics, and prompt engineering strategies to ensure safe, equitable and effective integration of GenAI in clinical care.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100373"},"PeriodicalIF":2.8,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-18DOI: 10.1016/j.tipsro.2025.100372
Federico Mastroleo , Mariana Borras-Osorio , Shiv P. Patel , Sarah Peterson , Renthony Wilson , Mohammad Javad Namazi , Mi Zhou , Satomi Shiraishi , Andrew Y.K. Foong , David M. Routman , Mark R. Waddle
Background
Toxicity assessment is a fundamental component of radiation therapy patient management. Natural language processing (NLP) and large language models (LLMs) are transforming clinical practice by efficiently extracting and synthesizing information from electronic health records (EHRs). This systematic review evaluates the current literature on the use of NLP and LLMs to extract toxicity data from radiation oncology records.
Methods
Three databases were systematically searched on 14 March 2025 for English-language studies. Two reviewers screened the articles and extracted available data. Discrepancies were resolved by a third reviewer. The review adhered to PRISMA guidelines.
Results
We identified 246 manuscripts; after screening, five studies were included. Four studies focused on identifying toxicity terms and linking them to CTCAE terms, while severity grading or longitudinal tracking of toxicities was addressed by two studies. One study explored the summarization capabilities of LLM to convert free text or patient surveys into concise clinician notes/chatbot responses. Included studies utilized transformer models (BERT, BioBERT, Clinical Longformer) for recognition and grading tasks; rule-based systems (Apache cTAKES, IDEAL-X) used dictionaries and negation detection rules for toxicity identification. GPT-4 demonstrated zero-shot summarization and response capabilities for patient-reported outcomes. All included studies were single-center. Common challenges identified were limited generalizability, difficulty recognizing rare or negated toxicities, privacy concerns, and substantial computing requirements for fine-tuning transformer-based models.
Conclusions
Current research primarily focused on three basic tasks and three categories of models. Multi-center datasets and secure, lightweight deployment methods are needed before widespread integration into routine radiation oncology practice can be considered.
{"title":"From BERT to GPT-4: A systematic review of AI-Driven toxicity extraction and grading in radiation oncology","authors":"Federico Mastroleo , Mariana Borras-Osorio , Shiv P. Patel , Sarah Peterson , Renthony Wilson , Mohammad Javad Namazi , Mi Zhou , Satomi Shiraishi , Andrew Y.K. Foong , David M. Routman , Mark R. Waddle","doi":"10.1016/j.tipsro.2025.100372","DOIUrl":"10.1016/j.tipsro.2025.100372","url":null,"abstract":"<div><h3>Background</h3><div>Toxicity assessment is a fundamental component of radiation therapy patient management. Natural language processing (NLP) and large language models (LLMs) are transforming clinical practice by efficiently extracting and synthesizing information from electronic health records (EHRs). This systematic review evaluates the current literature on the use of NLP and LLMs to extract toxicity data from radiation oncology records.</div></div><div><h3>Methods</h3><div>Three databases were systematically searched on 14 March 2025 for English-language studies. Two reviewers screened the articles and extracted available data. Discrepancies were resolved by a third reviewer. The review adhered to PRISMA guidelines.</div></div><div><h3>Results</h3><div>We identified 246 manuscripts; after screening, five studies were included. Four studies focused on identifying toxicity terms and linking them to CTCAE terms, while severity grading or longitudinal tracking of toxicities was addressed by two studies. One study explored the summarization capabilities of LLM to convert free text or patient surveys into concise clinician notes/chatbot responses. Included studies utilized transformer models (BERT, BioBERT, Clinical Longformer) for recognition and grading tasks; rule-based systems (Apache cTAKES, IDEAL-X) used dictionaries and negation detection rules for toxicity identification. GPT-4 demonstrated zero-shot summarization and response capabilities for patient-reported outcomes. All included studies were single-center. Common challenges identified were limited generalizability, difficulty recognizing rare or negated toxicities, privacy concerns, and substantial computing requirements for fine-tuning transformer-based models.</div></div><div><h3>Conclusions</h3><div>Current research primarily focused on three basic tasks and three categories of models. Multi-center datasets and secure, lightweight deployment methods are needed before widespread integration into routine radiation oncology practice can be considered.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100372"},"PeriodicalIF":2.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.tipsro.2025.100371
Biney Pal Singh , Ahmed Ali Chughtai , Jennifer Stock , Philipp Bruners , Michael J. Eble , Ahmed Allam Mohamed
Background
Radiation therapy (RT) plays a central role in the treatment of lung cancer. However, cardiac and pulmonary toxicities remain major concerns. Deep inspiration breath-hold (DIBH) has been shown to improve target stability and reduce organ-at-risk (OAR) exposure, but data in lung cancer, particularly regarding cardiac substructures, remain limited.
Materials and methods
We retrospectively analysed 32 patients with lung cancer treated with RT at our institution between 2020 and 2021. Each patient underwent planning CTs in both DIBH and free breathing (FB), generating a total of 64 treatment plans using VMAT (60 Gy in 30 fractions). Contouring followed ESTRO ACROP guidelines, including detailed segmentation of cardiac chambers and coronary arteries. Dosimetric endpoints included Dmean, D2%, and VxGy for lung, heart, and subcardiac structures. Statistical comparisons between DIBH and FB plans were performed.
Results
DIBH significantly increased lung volume and improved all lung dosimetric parameters, including Dmean (13.13 vs. 14.49 Gy, p < 0.001) and V20Gy (24.37 % vs. 27.28 %, p < 0.001). Cardiac sparing was evident, with lower heart D2% (39.91 vs. 41.67 Gy, p = 0.012) and V45Gy (2.23 % vs. 2.53 %, p = 0.005). Notably, significant reductions were observed in the LAD (Dmean: 5.59 vs. 6.57 Gy, p = 0.004), LCX, and LV. Subgroup analyses demonstrated consistent dosimetric advantages across tumor laterality and level 7 nodal involvement.
Conclusions
DIBH offers substantial and consistent dosimetric benefits in lung cancer RT, reducing radiation burden to pulmonary, cardiac, and coronary structures. Given the known association between cardiac dose and long-term morbidity, these findings support the broader implementation of DIBH, especially in anatomically challenging cases involving subcarinal nodes or left-sided tumors.
放射治疗（RT）在肺癌的治疗中起着核心作用。然而，心脏和肺毒性仍然是主要问题。深吸气屏气（DIBH）已被证明可以提高靶标稳定性并减少器官风险（OAR）暴露，但肺癌的数据，特别是关于心脏亚结构的数据仍然有限。材料和方法我们回顾性分析了2020年至2021年在我院接受放疗的32例肺癌患者。每位患者在DIBH和自由呼吸（FB）中都进行了计划ct检查，使用VMAT（30份60 Gy）共产生64个治疗计划。轮廓遵循ESTRO ACROP指南，包括心室和冠状动脉的详细分割。剂量学终点包括肺、心脏和心下结构的Dmean、D2%和VxGy。对DIBH方案和FB方案进行统计学比较。结果dibh显著增加肺容量，改善肺剂量学参数，包括Dmean （13.13 vs. 14.49 Gy, p < 0.001）和V20Gy （24.37% vs. 27.28%, p < 0.001）。心脏保留明显，心脏d2降低（39.91比41.67 Gy, p = 0.012）， V45Gy降低（2.23%比2.53%,p = 0.005）。值得注意的是，LAD （Dmean: 5.59 Gy vs. 6.57 Gy, p = 0.004）、LCX和LV显著降低。亚组分析表明，放射剂量学在肿瘤侧边和7级淋巴结受累方面具有一致的优势。结论：dibh在肺癌放射治疗中提供了实质性和一致的剂量学益处，减少了肺、心脏和冠状动脉结构的辐射负担。鉴于心脏剂量与长期发病率之间的已知关联，这些发现支持更广泛地实施DIBH，特别是在涉及隆突下淋巴结或左侧肿瘤的解剖挑战性病例中。
{"title":"Comparative dosimetric analysis of deep inspiration breath-hold versus free breathing radiotherapy in lung cancer: special emphasis on cardiac and subcardiac structure protection","authors":"Biney Pal Singh , Ahmed Ali Chughtai , Jennifer Stock , Philipp Bruners , Michael J. Eble , Ahmed Allam Mohamed","doi":"10.1016/j.tipsro.2025.100371","DOIUrl":"10.1016/j.tipsro.2025.100371","url":null,"abstract":"<div><h3>Background</h3><div>Radiation therapy (RT) plays a central role in the treatment of lung cancer. However, cardiac and pulmonary toxicities remain major concerns. Deep inspiration breath-hold (DIBH) has been shown to improve target stability and reduce organ-at-risk (OAR) exposure, but data in lung cancer, particularly regarding cardiac substructures, remain limited.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analysed 32 patients with lung cancer treated with RT at our institution between 2020 and 2021. Each patient underwent planning CTs in both DIBH and free breathing (FB), generating a total of 64 treatment plans using VMAT (60 Gy in 30 fractions). Contouring followed ESTRO ACROP guidelines, including detailed segmentation of cardiac chambers and coronary arteries. Dosimetric endpoints included Dmean, D2%, and VxGy for lung, heart, and subcardiac structures. Statistical comparisons between DIBH and FB plans were performed.</div></div><div><h3>Results</h3><div>DIBH significantly increased lung volume and improved all lung dosimetric parameters, including Dmean (13.13 vs. 14.49 Gy, p < 0.001) and V20Gy (24.37 % vs. 27.28 %, p < 0.001). Cardiac sparing was evident, with lower heart D2% (39.91 vs. 41.67 Gy, p = 0.012) and V45Gy (2.23 % vs. 2.53 %, p = 0.005). Notably, significant reductions were observed in the LAD (Dmean: 5.59 vs. 6.57 Gy, p = 0.004), LCX, and LV. Subgroup analyses demonstrated consistent dosimetric advantages across tumor laterality and level 7 nodal involvement.</div></div><div><h3>Conclusions</h3><div>DIBH offers substantial and consistent dosimetric benefits in lung cancer RT, reducing radiation burden to pulmonary, cardiac, and coronary structures. Given the known association between cardiac dose and long-term morbidity, these findings support the broader implementation of DIBH, especially in anatomically challenging cases involving subcarinal nodes or left-sided tumors.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100371"},"PeriodicalIF":2.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1016/j.tipsro.2025.100369
Kendell Shields-Dowton , Joel Poder , Johnson Yuen , Laurel Schmidt , Yaw Sinn Chin
Introduction
The Mid-Ventilation (MidV) approach is an alternative to internal target volume (ITV) for generating a planning target volume (PTV) in lung stereotactic ablative radiotherapy (SABR). It has been shown to reduce PTV and volume of normal lung tissue irradiated, whilst maintaining high local control rates. However, this approach has not been widely adopted due to difficulties in determining the MidV phase in commercially available treatment planning systems. We hypothesised that a fully integrated MidV workflow could be developed and validated within a single vendor platform, producing accurate contours and dosimetric improvements compared with the ITV based method.
Methods
A MidV workflow was implemented using Eclipse/Aria, incorporating deformable image registration (DIR) of 4DCT images, automated 4D contour statistics for MidV phase selection and an embedded PTV margin calculation spreadsheet. Ten patients from a multi-centre Phase II lung SABR study were retrospectively analysed. The following metrics were used to compare the DIR method with the manually contoured iGTV: mean distance to agreement (MDA), dice similarity coefficient (DSC) and accurate selection of the MidV Phase (±10 %). Corresponding ITV and MidV PTV based plans were generated and compared using absolute PTV volumes, mean lung dose (MLD) and V20Gy.
Results
DIR generated iGTVs demonstrated high geometric accuracy (mean MDA 0.86 mm; DSC 0.86). MidV phase selection aligned with manual selection in all patients. MidV based planning produced smaller PTVs than ITV based in 8/10 cases (mean 47.0 cm3 vs 54.6 cm3). Lung dose metrics improved consistently: MLD decreased by 14 % (3.46 Gy to 2.97 Gy) and V20Gy by 16 % (3.78 % to 3.19 %).
Conclusion
A streamlined, vendor integrated MidV workflow was successfully developed and validated, producing accurate DIR based contours and meaningful dosimetric reductions compared with ITV based method. These findings support broader clinical implementation of MidV based lung SABR.
在肺立体定向消融放疗（SABR）中，中期通气（MidV）入路是产生计划靶容积（PTV）的一种替代方法，可替代内部靶容积（ITV）。它已被证明可以降低PTV和正常肺组织的体积，同时保持较高的局部控制率。然而，由于在商业上可用的治疗计划系统中难以确定MidV阶段，这种方法尚未被广泛采用。我们假设完全集成的MidV工作流程可以在单一供应商平台内开发和验证，与基于ITV的方法相比，可以产生准确的轮廓和剂量学改进。方法采用Eclipse/Aria实现MidV工作流程，包括4DCT图像的可变形图像配准（DIR）、用于MidV相位选择的自动4D轮廓统计和嵌入式PTV余量计算电子表格。回顾性分析来自多中心二期肺SABR研究的10例患者。以下指标用于比较DIR方法与手动绘制的iGTV：平均一致距离（MDA），骰子相似系数（DSC）和MidV相的准确选择（±10%）。生成相应的ITV和MidV PTV计划，并使用绝对PTV体积、平均肺剂量（MLD）和V20Gy进行比较。结果dir生成的igtv具有较高的几何精度（平均MDA 0.86 mm, DSC 0.86）。所有患者的中期期选择与人工选择一致。在8/10的情况下，基于MidV的规划比基于ITV的规划产生更小的ptv（平均47.0 cm3 vs 54.6 cm3）。肺剂量指标持续改善：MLD下降14% (3.46 Gy至2.97 Gy)， V20Gy下降16%（3.78%至3.19%）。结论：与基于ITV的方法相比，成功开发并验证了一种简化的、供应商集成的MidV工作流程，可产生准确的基于DIR的轮廓和有意义的剂量降低。这些发现支持基于MidV的肺SABR更广泛的临床应用。
{"title":"Mid-ventilation PTV approach for stereotactic ablative body radiotherapy in stage I non-small-cell lung carcinoma: Implementation of a single-system workflow","authors":"Kendell Shields-Dowton , Joel Poder , Johnson Yuen , Laurel Schmidt , Yaw Sinn Chin","doi":"10.1016/j.tipsro.2025.100369","DOIUrl":"10.1016/j.tipsro.2025.100369","url":null,"abstract":"<div><h3>Introduction</h3><div>The Mid-Ventilation (MidV) approach is an alternative to internal target volume (ITV) for generating a planning target volume (PTV) in lung stereotactic ablative radiotherapy (SABR). It has been shown to reduce PTV and volume of normal lung tissue irradiated, whilst maintaining high local control rates. However, this approach has not been widely adopted due to difficulties in determining the MidV phase in commercially available treatment planning systems. We hypothesised that a fully integrated MidV workflow could be developed and validated within a single vendor platform, producing accurate contours and dosimetric improvements compared with the ITV based method.</div></div><div><h3>Methods</h3><div>A MidV workflow was implemented using Eclipse/Aria, incorporating deformable image registration (DIR) of 4DCT images, automated 4D contour statistics for MidV phase selection and an embedded PTV margin calculation spreadsheet. Ten patients from a multi-centre Phase II lung SABR study were retrospectively analysed. The following metrics were used to compare the DIR method with the manually contoured iGTV: mean distance to agreement (MDA), dice similarity coefficient (DSC) and accurate selection of the MidV Phase (±10 %). Corresponding ITV and MidV PTV based plans were generated and compared using absolute PTV volumes, mean lung dose (MLD) and V20Gy.</div></div><div><h3>Results</h3><div>DIR generated iGTVs demonstrated high geometric accuracy (mean MDA 0.86 mm; DSC 0.86). MidV phase selection aligned with manual selection in all patients. MidV based planning produced smaller PTVs than ITV based in 8/10 cases (mean 47.0 cm<sup>3</sup> vs 54.6 cm<sup>3</sup>). Lung dose metrics improved consistently: MLD decreased by 14 % (3.46 Gy to 2.97 Gy) and V20Gy by 16 % (3.78 % to 3.19 %).</div></div><div><h3>Conclusion</h3><div>A streamlined, vendor integrated MidV workflow was successfully developed and validated, producing accurate DIR based contours and meaningful dosimetric reductions compared with ITV based method. These findings support broader clinical implementation of MidV based lung SABR.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100369"},"PeriodicalIF":2.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1016/j.tipsro.2025.100368
Pia Krause Møller , Helle Pappot , Tine Schytte , Uffe Bernchou , Karin Brochstedt Dieperink
Introduction
Frequent electronic patient-reported outcomes (ePROs) may become an important tool for monitoring outcomes in ultrahypofractionated MRgRT for prostate cancer, enabling real-time remote tracking of toxicity. By integrating weekly ePROs and health-related quality of life (HRQoL) assessments into the early prostate MRgRT workflow, this study aimed to explore real-time acute symptom trajectories and the impact on HRQoL.
Methods
Two cohorts were followed: Patients receiving MRgRT for localised PCa (60Gy/20fx) or low-volume metastatic (M1) PCa (36Gy/6fx) and eligible to complete weekly ePROs and HRQoL measures (EQ-5D-5L, EORTC QLQ-C30) during and up to 24 weeks of follow-up. Linear mixed models were used to evaluate symptom changes over time.
Results
Of 76 included PCa patients, 42 had localised PCa and 34 low-volume M1 PCa. The linear model revealed significant changes in urinary symptoms from treatment week one, persisting 2 weeks post-MRgRT in the 36 Gy cohort, and 3–4 weeks in the 60 Gy cohort. Bowel symptoms increased early post-treatment in both cohorts, with diarrhoea being most frequent. Clinically relevant changes in HRQoL were observed during follow-up: patients in the 60 Gy cohort showed HRQoL improvements after 12 and 24 weeks. In the 36 Gy cohort, patients reported improved self-rated Global health status/QoL and emotional functioning.
Conclusion
Frequent ePROs during and after MRgRT provide critical insights into the timing, fluctuation and severity of acute toxicity, potentially missed with standard follow-up schedules. Integrating real-time ePROs into the MRgRT workflow is a feasible patient-centered method to systematically optimize the outcome assessments of MRgRT.
{"title":"Optimising acute toxicity monitoring in prostate MR-guided radiotherapy workflow: Results from a prospective study using multiple electronic PRO assessments","authors":"Pia Krause Møller , Helle Pappot , Tine Schytte , Uffe Bernchou , Karin Brochstedt Dieperink","doi":"10.1016/j.tipsro.2025.100368","DOIUrl":"10.1016/j.tipsro.2025.100368","url":null,"abstract":"<div><h3>Introduction</h3><div>Frequent electronic patient-reported outcomes (ePROs) may become an important tool for monitoring outcomes in ultrahypofractionated MRgRT for prostate cancer, enabling real-time remote tracking of toxicity. By integrating weekly ePROs and health-related quality of life (HRQoL) assessments into the early prostate MRgRT workflow, this study aimed to explore real-time acute symptom trajectories and the impact on HRQoL.</div></div><div><h3>Methods</h3><div>Two cohorts were followed: Patients receiving MRgRT for localised PCa (60Gy/20fx) or low-volume metastatic (M1) PCa (36Gy/6fx) and eligible to complete weekly ePROs and HRQoL measures (EQ-5D-5L, EORTC QLQ-C30) during and up to 24 weeks of follow-up. Linear mixed models were used to evaluate symptom changes over time.</div></div><div><h3>Results</h3><div>Of 76 included PCa patients, 42 had localised PCa and 34 low-volume M1 PCa. The linear model revealed significant changes in urinary symptoms from treatment week one, persisting 2 weeks post-MRgRT in the 36 Gy cohort, and 3–4 weeks in the 60 Gy cohort. Bowel symptoms increased early post-treatment in both cohorts, with diarrhoea being most frequent. Clinically relevant changes in HRQoL were observed during follow-up: patients in the 60 Gy cohort showed HRQoL improvements after 12 and 24 weeks. In the 36 Gy cohort, patients reported improved self-rated Global health status/QoL and emotional functioning.</div></div><div><h3>Conclusion</h3><div>Frequent ePROs during and after MRgRT provide critical insights into the timing, fluctuation and severity of acute toxicity, potentially missed with standard follow-up schedules. Integrating real-time ePROs into the MRgRT workflow is a feasible patient-centered method to systematically optimize the outcome assessments of MRgRT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100368"},"PeriodicalIF":2.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reirradiation (reRT) is a clinical challenge and requires organisational and technical efforts to standardise and ensure safety of practices. An institutional clinical workflow developed to manage and support systematic approach for patients’ reRT was presented in this work.
Materials and Methods
The workflow included a standardised approach for reRT detection and identification in patient folder in the oncology information system, previous treatment data collection, pre-treatment planning analysis of overlaps and acceptable cumulative radiobiological equieffective doses (EQD2Gy) to organs at risk, a final validation of new treatment plan using image registration and EQD2Gy dose accumulation, and a multidisciplinary peer review meeting. Statistics were compiled on reRT activity at our institution between 2020 and 2023 and the reRT peer-review meeting and the workflow were assessed through a survey addressed to young radiation oncologists (RO).
Results
During the studied period, 1920 treatments were declared as reRT at our institution. The first reRT site was the brain, followed by spine, thorax and breast. The most commonly used techniques for reRT were stereotactic radiotherapy or volumetric modulated arc therapy. The youngRO survey showed that more than 80% of respondents found a benefit of peer-review meeting, with a particular interest in discussions on cumulative equieffective dose limits and cumulative doses validation. The majority of them declared they gained confidence in their reRT practice.
Conclusions
The implementation of a standardized institutional workflow for reRT management helped harmonize practices within our institution to support our reRT workload. Feedback from young RO highlighted the value of peer-review meetings which contributed to increase their confidence in reRT practices.
{"title":"A dedicated institutional clinical workflow and peer-review meeting for reirradiation","authors":"Pauline Dupuis , Magali Sandt , Guillaume Beldjoudi , Coralie Moncharmont , Anne-Agathe Serre , Line Claude , Marie-Pierre Sunyach , Myriam Ayadi","doi":"10.1016/j.tipsro.2025.100366","DOIUrl":"10.1016/j.tipsro.2025.100366","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Reirradiation (reRT) is a clinical challenge and requires organisational and technical efforts to standardise and ensure safety of practices. An institutional clinical workflow developed to manage and support systematic approach for patients’ reRT was presented in this work.</div></div><div><h3>Materials and Methods</h3><div>The workflow included a standardised approach for reRT detection and identification in patient folder in the oncology information system, previous treatment data collection, pre-treatment planning analysis of overlaps and acceptable cumulative radiobiological equieffective doses (EQD2Gy) to organs at risk, a final validation of new treatment plan using image registration and EQD2Gy dose accumulation, and a multidisciplinary peer review meeting. Statistics were compiled on reRT activity at our institution between 2020 and 2023 and the reRT peer-review meeting and the workflow were assessed through a survey addressed to young radiation oncologists (RO).</div></div><div><h3>Results</h3><div>During the studied period, 1920 treatments were declared as reRT at our institution. The first reRT site was the brain, followed by spine, thorax and breast. The most commonly used techniques for reRT were stereotactic radiotherapy or volumetric modulated arc therapy. The youngRO survey showed that more than 80% of respondents found a benefit of peer-review meeting, with a particular interest in discussions on cumulative equieffective dose limits and cumulative doses validation. The majority of them declared they gained confidence in their reRT practice.</div></div><div><h3>Conclusions</h3><div>The implementation of a standardized institutional workflow for reRT management helped harmonize practices within our institution to support our reRT workload. Feedback from young RO highlighted the value of peer-review meetings which contributed to increase their confidence in reRT practices.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100366"},"PeriodicalIF":2.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.tipsro.2025.100359
Giovanna Mantello , Elena Galofaro , Cihan Gani , Daniel Portik , Lynsey Devlin , Robin De Roover , Ane Appelt , Rianne de Jong
Introduction
This systematic literature review aimed to evaluate treatment uncertainties associated with modern rectal cancer radiotherapy, focusing on systematic and random errors in setup and target volume (TV) shape variation, with the aim of supporting clinics in optimizing treatment accuracy and consistency in daily practice.
Methods
A systematic literature review was conducted to quantify geometrical uncertainties with respect to setup and TV shape variations in the treatment of rectal cancer. It included studies reporting uncertainties for setup, CTV (Clinical Target Volume) shape variations (rectum and mesorectum), GTVp (Gross Tumor Volume – Primary Tumor), GTVn (Gross Tumor Volume − Nodes), and/or elective pelvic lymph nodes; excluding non-English language publications.
Results
196 reports were assessed for full text screening and 32 publications were selected for final reporting. Most authors utilized on board imaging to calculate setup errors and TV shape variation, and all reported substantial uncertainties. Setup uncertainty was reported to be very different for prone (w/o belly board) vs supine position, in favour of supine position. TV shape variation showed large systematic and random errors, especially for GTVp and the upper anterior part of the mesorectum. A subset of publications analyzed the positional uncertainties of elective draining lymph nodes, which are typically not removed during surgery, showing their small positional variations in relation to bone structures.
Conclusion
Setup and TV shape variation are significant and non-negligible geometric uncertainties. Setup errors can largely be minimized with daily (2D or 3D) IGRT, whereas TV shape variations—particularly in the mesorectum—needs to be assessed daily with 3D imaging and requires anisotropic margins.
{"title":"Setup and target volume shape variation in rectal cancer radiotherapy: a systematic literature review","authors":"Giovanna Mantello , Elena Galofaro , Cihan Gani , Daniel Portik , Lynsey Devlin , Robin De Roover , Ane Appelt , Rianne de Jong","doi":"10.1016/j.tipsro.2025.100359","DOIUrl":"10.1016/j.tipsro.2025.100359","url":null,"abstract":"<div><h3>Introduction</h3><div>This systematic literature review aimed to evaluate treatment uncertainties associated with modern rectal cancer radiotherapy, focusing on systematic and random errors in setup and target volume (TV) shape variation, with the aim of supporting clinics in optimizing treatment accuracy and consistency in daily practice.</div></div><div><h3>Methods</h3><div>A systematic literature review was conducted to quantify geometrical uncertainties with respect to setup and TV shape variations in the treatment of rectal cancer. It included studies reporting uncertainties for setup, CTV (Clinical Target Volume) shape variations (rectum and mesorectum), GTVp (Gross Tumor Volume – Primary Tumor), GTVn (Gross Tumor Volume − Nodes), and/or elective pelvic lymph nodes; excluding non-English language publications.</div></div><div><h3>Results</h3><div>196 reports were assessed for full text screening and 32 publications were selected for final reporting. Most authors utilized on board imaging to calculate setup errors and TV shape variation, and all reported substantial uncertainties. Setup uncertainty was reported to be very different for prone (w/o belly board) vs supine position, in favour of supine position. TV shape variation showed large systematic and random errors, especially for GTVp and the upper anterior part of the mesorectum. A subset of publications analyzed the positional uncertainties of elective draining lymph nodes, which are typically not removed during surgery, showing their small positional variations in relation to bone structures.</div></div><div><h3>Conclusion</h3><div>Setup and TV shape variation are significant and non-negligible geometric uncertainties. Setup errors can largely be minimized with daily (2D or 3D) IGRT, whereas TV shape variations—particularly in the mesorectum—needs to be assessed daily with 3D imaging and requires anisotropic margins.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100359"},"PeriodicalIF":2.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.tipsro.2025.100363
Whoon Jong Kil , Wyatt Smith , David Cousins
Purpose
To describe organs at risk (OARs)-sparing breast cancer (BC) radiotherapy (RT) for patients with ipsilateral (Ipsi-diaphragm) paralysis using continuously positive airway pressure (CPAP) and supine tangential RT-field.
Material and method
Breast RT plans with free-breathing (FB) for a patient with right-sided BC (patient1) and another patient with left-sided BC (patient2) showed an elevated Ipsi-diaphragm and displaced portions of liver (patient1) and the heart and intestine (patient2) into supine tangential RT-field. Although both patients denied cardiopulmonary symptoms, their elevated diaphragm, liver, intestine and the heart were unchanged with deep-inspiration breath hold (DIBH) while contralateral diaphragm moved caudally suggesting clinical diagnosis of Ipsi-diaphragm paralysis. Subsequently, patients underwent CT-sim under CPAP to create supine tangential breast RT plan.
Result
Compared with FB, CPAP inflated lungs and moved both patients paralyzed diaphragm, liver, heart, and intestine caudally and displaced these OARs away from breast RT-field. The liver volume within right supine tangential RT-fields in patient1 was 163 cc with FB versus 12 cc with CPAP (93 % reduction). The heart and intestine were completely outside the left supine tangential RT-field with CPAP in patient2. For dosimetric comparison, supine tangential RT-fields for breast-only RT were used with prescription of 40 Gy in 15 fractions on each patients’ CT-sim with FB and CPAP, respectively. Compared with FB, CPAP reduced liver volume receiving ≥ 30 Gy by 94 % (FB:140 vs CPAP:8 cc) in patient1 and mean dose to the heart by 67 % (FB:2.7 vs CPAP:0.9 Gy) and left anterior descending artery by 84 % (FB:25 vs CPAP:3.9 Gy), maximum dose to the intestine by 90 % (FB:40.6 vs CPAP:4.4 Gy).
Conclusion
BC patients with Ipsi-diaphragm paralysis, CPAP provided an effective and practical technique for OARs-sparing breast RT.
目的探讨持续气道正压通气（CPAP）和仰卧切向放射野对同侧（单侧膈肌）麻痹患者的保危（OARs）乳腺癌放射治疗（RT）效果。材料与方法：一名右侧BC患者（患者1）和另一名左侧BC患者（患者2）的自由呼吸（FB）乳房RT计划显示，ipsi隔膜升高，肝脏（患者1）、心脏和肠道（患者2）部分移位至仰卧切向RT野。虽然两例患者均否认有心肺症状，但深吸气屏气（DIBH）时膈肌、肝、肠、心脏均未见升高，对侧膈肌尾侧移动，提示临床诊断为膈肌麻痹。随后，患者在CPAP下行CT-sim，建立仰卧位切向乳房RT计划。结果与FB相比，CPAP使两例瘫痪的膈、肝、心、肠均向尾部移动，使这些桨远离乳房造影场。患者1右侧仰卧位切向rt野内的肝脏体积，FB组为163 cc， CPAP组为12 cc（减少93%）。患者2的心脏和肠完全位于左侧仰卧位切向rt -野外。为了进行剂量学比较，在每位患者的CT-sim中分别使用FB和CPAP，使用仰卧切向RT场进行仅乳房RT，处方为40 Gy，分15个分量。与FB相比，CPAP使患者1接受≥30 Gy的肝体积减少94% (FB:140 vs CPAP:8 cc)，心脏平均剂量减少67% (FB:2.7 vs CPAP:0.9 Gy)，左前降支平均剂量减少84% (FB:25 vs CPAP:3.9 Gy)，肠最大剂量减少90% （FB:40.6 vs CPAP:4.4 Gy）。结论：CPAP是bc患者单侧膈肌麻痹的有效、实用的方法。
{"title":"Breast cancer patients with ipsilateral diaphragm paralysis: practical breast radiotherapy using continuous positive airway pressure-assisted breathing to spare normal organs","authors":"Whoon Jong Kil , Wyatt Smith , David Cousins","doi":"10.1016/j.tipsro.2025.100363","DOIUrl":"10.1016/j.tipsro.2025.100363","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe organs at risk (OARs)-sparing breast cancer (BC) radiotherapy (RT) for patients with ipsilateral (Ipsi-diaphragm) paralysis using continuously positive airway pressure (CPAP) and supine tangential RT-field.</div></div><div><h3>Material and method</h3><div>Breast RT plans with free-breathing (FB) for a patient with right-sided BC (patient1) and another patient with left-sided BC (patient2) showed an elevated Ipsi-diaphragm and displaced portions of liver (patient1) and the heart and intestine (patient2) into supine tangential RT-field. Although both patients denied cardiopulmonary symptoms, their elevated diaphragm, liver, intestine and the heart were unchanged with deep-inspiration breath hold (DIBH) while contralateral diaphragm moved caudally suggesting clinical diagnosis of Ipsi-diaphragm paralysis. Subsequently, patients underwent CT-sim under CPAP to create supine tangential breast RT plan.</div></div><div><h3>Result</h3><div>Compared with FB, CPAP inflated lungs and moved both patients paralyzed diaphragm, liver, heart, and intestine caudally and displaced these OARs away from breast RT-field. The liver volume within right supine tangential RT-fields in patient1 was 163 cc with FB versus 12 cc with CPAP (93 % reduction). The heart and intestine were completely outside the left supine tangential RT-field with CPAP in patient2. For dosimetric comparison, supine tangential RT-fields for breast-only RT were used with prescription of 40 Gy in 15 fractions on each patients’ CT-sim with FB and CPAP, respectively. Compared with FB, CPAP reduced liver volume receiving ≥ 30 Gy by 94 % (FB:140 vs CPAP:8 cc) in patient1 and mean dose to the heart by 67 % (FB:2.7 vs CPAP:0.9 Gy) and left anterior descending artery by 84 % (FB:25 vs CPAP:3.9 Gy), maximum dose to the intestine by 90 % (FB:40.6 vs CPAP:4.4 Gy).</div></div><div><h3>Conclusion</h3><div>BC patients with Ipsi-diaphragm paralysis, CPAP provided an effective and practical technique for OARs-sparing breast RT.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100363"},"PeriodicalIF":2.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiation dermatitis and oral mucositis are common acute toxicities from carbon-ion radiotherapy (CIRT) for head and neck cancers. These toxicities often impair quality of life (QOL) and can lead to treatment interruption. This study evaluated a dose surface model (DSM) shared by patients and nurses to determine whether it helped patients become more aware of their symptoms and improve their self-care.
Methods
This prospective study enrolled 46 patients with head and neck malignancies who underwent CIRT between July 2017 and December 2019. The study program included nurse interviews and administration of the DSM-based patient self-care instructions, which were conducted before treatment, every week during CIRT, and at 1 and 2 months post-treatment. The self-care checklist and daily care frequency data were assessed. QOL was evaluated using the Short Form 8 at baseline, end of CIRT, and 2 months post-CIRT.
Results
Radiation dermatitis occurred in 98% of the patients (grades 2–3 in 24%) and oral mucositis in 48% (grades 2–3). The self-care checklist scores improved significantly throughout the latter half of the treatment and post-treatment periods. Self-care frequency did not significantly correlate with adverse event severity, although mouth rinsing frequency tended to increase. Two months after treatment, QOL improved across several domains, particularly mental health.
Conclusion
The DSM-based nursing intervention program effectively enhanced patient awareness and confidence in managing radiation-induced skin and mucosal toxicities. This strategy may enhance supportive care and QOL during CIRT for head and neck cancers.
{"title":"Efficacy of nursing intervention using an adverse event predictive model for head and neck carbon-ion radiotherapy: A prospective clinical study","authors":"Chika Hirai , Atsushi Musha , Hirofumi Shimada , Yoko Kitada , Tatsuya Ohno","doi":"10.1016/j.tipsro.2025.100364","DOIUrl":"10.1016/j.tipsro.2025.100364","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiation dermatitis and oral mucositis are common acute toxicities from carbon-ion radiotherapy (CIRT) for head and neck cancers. These toxicities often impair quality of life (QOL) and can lead to treatment interruption. This study evaluated a dose surface model (DSM) shared by patients and nurses to determine whether it helped patients become more aware of their symptoms and improve their self-care.</div></div><div><h3>Methods</h3><div>This prospective study enrolled 46 patients with head and neck malignancies who underwent CIRT between July 2017 and December 2019. The study program included nurse interviews and administration of the DSM-based patient self-care instructions, which were conducted before treatment, every week during CIRT, and at 1 and 2 months post-treatment. The self-care checklist and daily care frequency data were assessed. QOL was evaluated using the Short Form 8 at baseline, end of CIRT, and 2 months post-CIRT.</div></div><div><h3>Results</h3><div>Radiation dermatitis occurred in 98% of the patients (grades 2–3 in 24%) and oral mucositis in 48% (grades 2–3). The self-care checklist scores improved significantly throughout the latter half of the treatment and post-treatment periods. Self-care frequency did not significantly correlate with adverse event severity, although mouth rinsing frequency tended to increase. Two months after treatment, QOL improved across several domains, particularly mental health.</div></div><div><h3>Conclusion</h3><div>The DSM-based nursing intervention program effectively enhanced patient awareness and confidence in managing radiation-induced skin and mucosal toxicities. This strategy may enhance supportive care and QOL during CIRT for head and neck cancers.</div></div>","PeriodicalId":36328,"journal":{"name":"Technical Innovations and Patient Support in Radiation Oncology","volume":"37 ","pages":"Article 100364"},"PeriodicalIF":2.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145738702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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