{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:59:08Z","timestamp":1781863148188,"version":"3.54.5"},"reference-count":8,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"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":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Repeat images contribute to excess patient dose and workflow inefficiencies and can be analyzed to identify potential areas for improvement within a program. Although routinely used in diagnostic imaging, repeat image analysis is not widely used in radiation therapy imaging, despite the role of imaging in the delivery of precise radiation treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Repeat image analysis was performed for on\u2010board cone beam CT imagers and CT simulators within a radiation therapy department. Both the rate of repeat images and the reasons for the repeat images were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from nine conventional linear accelerators and three CT simulators were analyzed retrospectively over a 5\u2010month period. Repeated images that were not part of the standard of care were considered repeat images. The repeat rate was expressed as the number of repeat scans as percentage of the total number of scans performed. The reasons for the repeats were collected and classified as either patient preparation, patient setup, patient motion, or machine error. These reasons were further classified into sub\u2010categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall repeat rate across the linear accelerators was 3.3%, with a maximum of 5% on any single machine. The repeat rate for the three CT simulators was 1.5%. The most common reasons for repeat images were patient preparation (incorrect bladder or rectal filling) and patient setup or positioning. Greater positioning challenges led to higher repeat rates on units that treat a large number of breast patients, palliative patients, or pediatric patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Repeat image analysis can be applied within a radiation therapy department. Establishing baseline repeat rates and analyzing reasons for the repeat images can identify opportunities for improvements in terms of patient dose reduction and workflow efficiency for the program. Periodic repeat image analysis also permits monitoring the program for changes and for comparison against rates at other institutions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14019","type":"journal-article","created":{"date-parts":[[2023,5,5]],"date-time":"2023-05-05T05:17:03Z","timestamp":1683263823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Application of repeat image analysis to radiation therapy imaging modalities as a quality improvement tool for image guided radiotherapy"],"prefix":"10.1002","volume":"24","author":[{"given":"Daniella","family":"Chee","sequence":"first","affiliation":[{"name":"Radiation Therapy Department Princess Margaret Hospital Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Buckley","sequence":"additional","affiliation":[{"name":"Medical Physics Department The Ottawa Hospital Ottawa Ontario Canada"},{"name":"Department of Radiology, Radiation Oncology and Medical Physics University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4932623"},{"key":"e_1_2_9_3_1","unstructured":"United States Food and Drug Administration: Code of Federal Regulations. 21CFR900.2022."},{"key":"e_1_2_9_4_1","unstructured":"American College of Radiology ACR\u2010AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Radiographic Equipment. 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Accessed October 2 2022.https:\/\/www.canada.ca\/en\/health\u2010canada\/services\/environmental\u2010workplace\u2010health\/reports\u2010publications\/radiation\/safety\u2010code\u201035\u2010safety\u2010procedures\u2010installation\u2010use\u2010control\u2010equipment\u2010large\u2010medical\u2010radiological\u2010facilities\u2010safety\u2010code.html#m5"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.468"},{"key":"e_1_2_9_7_1","first-page":"60","article-title":"Quality assurance and optimization of radiation protection of patients in x\u2010ray radiographic examinations using the rejects film analysis","volume":"1","author":"Ahmed A","year":"2013","journal-title":"J Radiol Diagnostic Imaging"},{"issue":"4","key":"e_1_2_9_8_1","first-page":"1","article-title":"Image rejects in general direct radiography","volume":"10","author":"Hofmann B","year":"2015","journal-title":"Acta Radiologica Open"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12824"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.14019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T20:58:12Z","timestamp":1693861092000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.14019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,4]]},"references-count":8,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1002\/acm2.14019"],"URL":"https:\/\/doi.org\/10.1002\/acm2.14019","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,4]]},"assertion":[{"value":"2022-11-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14019"}}