Anh Lam, Kirk Luca, Mandeep Kaur, Keyur D. Shah et al.
BACKGROUND: Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) is used to treat brain metastases while preserving cognitive function by sparing the hippocampi. Volumetric modulated arc therapy (VMAT) is commonly used due to its ability to generate conformal dose distributions. However, treatment planning remains challenging due to the need for sharp dose fall-off near cen…
BACKGROUND: Patient-Specific Quality Assurance (PSQA) for Elekta Unity MR-Linac treatments delivered under Comprehensive Motion Management (CMM) is challenging because beam gating, unexpected interruptions, and split sub-segments introduce delivery complexities that are not fully addressed by conventional quality assurance workflows. PURPOSE: This study aimed to develop and eva…
Nishitani M, Okamoto H, Chang W, Kuwahara J et al.
Current quality assurance phantoms often lack MR signal, deformability, or real-time dosimetry capability, limiting comprehensive end-to-end evaluation for MR-guided online adaptive radiotherapy (MRgOART), including verification of deformable image registration (DIR) accuracy and the adaptive workflow within a single phantom. This study aimed to develop a CT/MRI-compatible anth…
Deepikaa Balaji, Sonja Wegener, Sebastian Klüter, Sara L. Hackett
BACKGROUND: The accuracy of radiotherapy is limited by anatomical variations occurring over time scales ranging from sub-seconds to days. Online Adaptive Radiotherapy (OART) addresses this by enabling daily plan adaptation based on real-time imaging. While OART offers improved dose conformity, its dynamic, time-constrained workflow introduces novel failure modes that challenge …
Existing volumetric MRI techniques are constrained by the trade-off between acquisition time and image quality, limiting accuracy in motion-impacted sites such as the liver. To enable fast, high-quality volumetric imaging with sufficient spatiotemporal resolution, we developed a time-resolved volumetric MRI technique that recovers 3D volumes from two orthogonally acquired MR sl…
Ultra-high dose rate (FLASH) radiotherapy has demonstrated promising normal tissue sparing in preclinical studies; however, the lack of standardized dosimetry, commissioning, and quality assurance (QA) methodologies remains a major barrier to its reproducible and safe implementation. In particular, conventional clinical commissioning and QA protocols are not directly applicable…
In modern radiation oncology departments, safe and accurate delivery of prescribed radiation doses relies on a tightly integrated clinical workflow that spans imaging systems, treatment planning systems, electronic medical record systems, oncology information system, hospital information systems, quality assurance tools, treatment delivery systems, and IT infrastructures. To ma…
Lara Žarkovič, Iza Zupan, Larisa Hankić, Valerija Žager Marciuš et al.
Radiotherapy is a cornerstone of modern cancer treatment, offering high precision in tumor targeting while minimizing damage to surrounding healthy tissues. Due to the use of high-energy ionizing radiation and highly complex planning and delivery workflows, patient safety represents a critical aspect of radiotherapy practice. This review provides an overview of patient safety i…
Siyang Huang, Songhua Yang, Yang Dong, Sheng Huang et al.
OBJECTIVE: This study proposes a 2π solid angle-based heuristic framework for non-coplanar volumetric modulated arc therapy (VMAT) in patients with multiple brain metastases (MBM) to automate treatment angle selection. Approach: Fifty-two patients with MBM (2-8 targets) were retrospectively included. A hybrid heuristic framework was constructed: first, a volume-weighted cumulat…
This study provides a review of recent publications on different quality control (QC) techniques for radiotherapy linear accelerators (linacs). QC in radiotherapy is essential to ensure patient safety, deliver optimal quality treatments, monitor equipment performance over time and to satisfy statutory or recommended testing. Whilst conventional QC methods are still widely used …
Pisaturo O, Ghandour S, Miéville F, Pitteloud N et al.
ObjectiveAccurate modelling of dose deposition remains a central challenge in external beam radiotherapy, particularly for modern treatment systems involving complex beam configurations and magnetic field effects. While convolution/superposition (CS) algorithms are widely used in clinical treatment planning systems, they typically rely on numerical implementations and symmetric…
BackgroundSurface-guided radiation therapy (SGRT) has been increasingly adopted in modern radiotherapy, enabling radiation-dose-free, marker-free patient positioning with high accuracy. A novel SGRT system, LUNA 3D (LAP, Lüneburg, Germany), featuring a browser-based interface, GPU-accelerated surface reconstruction, high frame rates, large field-of-view and virtual laser projec…
PurposeThis study provides a comprehensive evaluation of the newly implemented electron Monte Carlo dose calculation algorithm in the commercial treatment planning system, uTPS. It investigates the performance of the algorithm by examining its dosimetric accuracy and calculation speed, which have not been previously reported in the literature.MethodsTo evaluate the dose calcula…
Pantelis E, Moutsatsos A, Sideri L, Archontakis P et al.
BackgroundThe CyberKnife™ system requires extensive beam data acquisition across multiple collimation systems. The CyberComm™ framework integrates a linac output tuning procedure with a hybrid Golden Beam Data (GBD) model to accelerate and standardize CyberKnife commissioning while maintaining dosimetric accuracy.PurposeIn this study, CyberComm was employed for the commissionin…
ObjectivesElectronic portal imaging devices (EPID) are well suited to radiotherapy in-vivo dosimetry (IVD), but limited guidance remains a barrier to routine clinical use. This SunCHECK (Sun Nuclear Corporation) user survey captured real-world configurations and tolerances for EPID-based patient-specific verification, as well as other aspects of patient-related QA, to establish…
Peer-ReviewedPubMedPhysica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) · 2026
PurposeTo evaluate a multipurpose MZ CUBE-based workflow for selected CBCT QA endpoints, including translational IGRT-relevant geometric verification and core image quality (IQ) assessment, across three clinical Varian CBCT systems and multiple phantom units.MethodsCBCT was acquired on three Varian linacs under Head and Pelvis protocols. Unless otherwise specified, analyses use…
Peer-ReviewedPubMedPhysica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) · 2026
PurposeThis study evaluates the feasibility, dosimetric optimization, and delivery efficiency of c_arm linac-based and TomoTherapy-based Lattice Radiotherapy (LRT) across head and neck, thoracic, and abdominal tumors.Materials and methods72 patients meeting inclusion criteria (GTV > 480 cc, at least eight lattice vertices) were planned with both VMAT and Helical techniques. Eac…
García-Garduño OA, Ávila-Muñoz Y, Gamboa-deBuen I, Lárraga-Gutiérrez JM.
Radiochromic films are widely used in radiotherapy dosimetry for their high spatial resolution and near-water-equivalence. Nonetheless, these films are frequently purchased in bulk, leading clinical departments to accumulate stock beyond the manufacturer's expiration date. Assessing the dosimetric performance of expired films may confer economic and environmental advantages. Th…
Accurate dose calculation in spatially fractionated radiotherapy (SFRT) is challenging 
because highly heterogeneous dose distributions and charged-particle disequilibrium can 
reduce the accuracy of fast analytical algorithms, including the anisotropic analytical 
algorithm (AAA) used in commercial treatment planning systems (TPS). Monte Carlo 
(MC) methods are…
Linear accelerator-based stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT) are commonly used in the treatment of ocular malignancies. However, a substantial portion of the treatment planning process relies on manual plan optimization to achieve acceptable plan quality, leading to increased planning time and variability among planners. In this work, we demonstrat…
Background: Independent end-to-end verification of adaptive radiotherapy on MR-Linac systems is limited by the lack of patient-specific phantoms able to reproduce imaging and dosimetric properties from CT and MRI scanners. We present a method for automated generation of 4D, patient-specific, multi-material 3D-printable phantoms for quality assurance of adaptive radiotherapy on …
Background and purposeMR-guided radiotherapy (MRgRT) offers superior soft-tissue contrast and enables adaptive treatments which improve tumor targeting and organ-at-risk sparing. However, integrated MR-Linac systems remain financially and logistically inaccessible for many hospitals. To address this gap, we implemented a modular MRgRT workflow - termed the "Virtual MR-Linac"- w…
This study aims to evaluate the impact of two dose reconstruction techniques, standard and composite, on gamma passing rates (GPRs) during pre-treatment quality assurance of large-field pelvic RapidArc plans using the Octavius 4D system with a 1500 2D ionization chamber array. The investigation focuses on quantifying the effect of reconstruction methodology across varying gamma…
BackgroundCone-beam computed tomography (CBCT) is routinely used for image guidance in radiation therapy, but conventional full-field CBCT acquisition may expose anatomically irrelevant regions and generate substantial scatter, which degrades soft-tissue contrast and limits the accuracy of target localization and adaptive radiotherapy workflows. A clinically practical imaging s…
FLASH radiotherapy shows promise in reducing normal tissue toxicity while maintaining tumor control. However, preclinical and early clinical evidence reveal biological and technical uncertainties. We review preclinical and veterinary studies, highlight unexpected toxicities, and argue that the fundamental principles of precision and safety in radiotherapy-particularly conformal…
BackgroundPatient-specific quality assurance (PSQA) plays a pivotal role in intensity-modulated radiotherapy (IMRT) to ensure accurate dose delivery. However, conventional measurement-based PSQA approaches are labor-intensive and provide limited insight into the underlying factors contributing to variations in gamma passing rates (GPRs). Anatomical characteristics of the planni…
BackgroundAccurate heterogeneity correction in high-precision radiotherapy relies on precise computed tomography (CT) number-to-density conversion via the Hounsfield unit look-up table (HLUT). While physical properties of tissue-equivalent materials are generally assumed consistent with manufacturer specifications, an independent audit identified clinically significant density …
BackgroundRunning VMAT plan-complexity surveillance directly inside an oncology information system (OIS) makes it practical to monitor plan quality across a large, multi-linac program. Complexity metrics are increasingly used to anticipate patient-specific QA (PSQA) outcomes, but few studies span multiple years or tie complexity monitoring to the OIS at scale, which leaves publ…
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