{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T11:09:03Z","timestamp":1768734543755,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T00:00:00Z","timestamp":1535500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Adaptive radiation therapy (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) \u201cflags,\u201d such as change in external body contour or relative weight loss, are widely used to identify which head and neck cancer (<jats:styled-content style=\"fixed-case\">HNC<\/jats:styled-content>) patients may benefit from replanned treatment. Despite the popularity of <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>, few published quantitative approaches verify the accuracy of replan candidate identification, especially with regards to the simple flagging approaches that are considered current standard of practice. We propose a quantitative evaluation framework, demonstrated through the assessment of a single institution's clinical <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> flag: change in body contour exceeding 1.5\u00a0cm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ground truth replan criteria were established by surveying <jats:styled-content style=\"fixed-case\">HNC<\/jats:styled-content> radiation oncologists. Patient\u2010specific dose deviations were approximated by using weekly acquired <jats:styled-content style=\"fixed-case\">CBCT<\/jats:styled-content> images to deform copies of the <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> simulation, yielding during treatment \u201csynthetic <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>s.\u201d The original plan reapplied to the synthetic <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>s estimated interfractional dose deposition and truth table analysis compared ground truth flagging with the clinical <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> metric. This process was demonstrated by assessing flagged fractions for 15 <jats:styled-content style=\"fixed-case\">HNC<\/jats:styled-content> patients whose body contour changed by &gt;1.5\u00a0cm at some point in their treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Survey results indicated that geometric shifts of high\u2010dose volumes relative to image\u2010guided radiation therapy alignment of bony anatomy were of most interest to <jats:styled-content style=\"fixed-case\">HNC<\/jats:styled-content> physicians. This evaluation framework successfully identified a fundamental discrepancy between the \u201ctruth\u201d criteria and the body contour flagging protocol selected to identify changes in central axis dose. The body contour flag had poor sensitivity to survey\u2010derived major violation criteria (0%\u201328%). The sensitivity of a random sample for comparable violation\/flagging frequencies was 27%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These results indicate that centers should establish ground truth replan criteria to assess current standard of practice <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> protocols. In addition, more effective replan flags may be tested and identified according to the proposed framework. Such improvements in <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> flagging may contribute to better clinical resource allocation and patient outcome.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.12437","type":"journal-article","created":{"date-parts":[[2018,8,30]],"date-time":"2018-08-30T10:51:33Z","timestamp":1535626293000},"page":"26-34","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Framework for the quantitative assessment of adaptive radiation therapy protocols"],"prefix":"10.1002","volume":"19","author":[{"given":"Sarah","family":"Weppler","sequence":"first","affiliation":[{"name":"Department of Physics and Astronomy University of Calgary Calgary AB Canada"},{"name":"Department of Medical Physics Tom Baker Cancer Centre Calgary AB Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harvey","family":"Quon","sequence":"additional","affiliation":[{"name":"Department 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