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Additionally, heightened attention to imaging doses is necessary to minimize long\u2010term toxicity in survivors. Many of these challenges must be addressed during the process of simulation. This report provides guidelines for pediatric radiotherapy simulation from the Children's Oncology Group. These guidelines cover all anatomic sites and include recommendations for photon and proton therapies, as well as specialized procedures such as stereotactic body radiation therapy, brachytherapy, and total body irradiation. These guidelines are presented as recommendations rather than prescriptive standards as the practice will vary depending on patient age, diagnosis, clinical judgment, and institutional resources.<\/jats:p>","DOI":"10.1002\/1545-5017.70460","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T21:07:50Z","timestamp":1785272870000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guidelines for Pediatric Radiotherapy Simulation: A Report From the Children's Oncology Group Radiation Oncology Discipline"],"prefix":"10.1002","volume":"73","author":[{"given":"Parham","family":"Alaei","sequence":"first","affiliation":[{"name":"University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Mihalcik","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujith","family":"Baliga","sequence":"additional","affiliation":[{"name":"The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young","family":"Kwok","sequence":"additional","affiliation":[{"name":"University of Maryland  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-7653","authenticated-orcid":false,"given":"Dana","family":"Casey","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Ehler","sequence":"additional","affiliation":[{"name":"University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Burton","sequence":"additional","affiliation":[{"name":"Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Breneman","sequence":"additional","affiliation":[{"name":"University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne A.","family":"Haas\u2010Kogan","sequence":"additional","affiliation":[{"name":"Massachusetts General Brigham, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne L.","family":"Wolden","sequence":"additional","affiliation":[{"name":"Memorial Sloan\u2010Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold C.","family":"Paulino","sequence":"additional","affiliation":[{"name":"MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia N.","family":"Laack","sequence":"additional","affiliation":[{"name":"Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natia","family":"Esiashvili","sequence":"additional","affiliation":[{"name":"Winship Cancer Institute of Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Milgrom","sequence":"additional","affiliation":[{"name":"University of Colorado Anschutz  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Hill\u2010Kayser","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"University of Massachusetts Chan Medical School  Worcester Massachusetts USA"},{"name":"IROC Rhode Island QA Center  Lincoln Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Kalapurakal","sequence":"additional","affiliation":[{"name":"Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Ho","family":"Hua","sequence":"additional","affiliation":[{"name":"St. Jude Children's Research Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.09.002"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2014.03.014"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12824"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28629"},{"key":"e_1_2_13_6_1","unstructured":"F. 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