{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T15:47:13Z","timestamp":1766159233452,"version":"3.41.2"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"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":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Comparing dose distributions is a routine task in radiotherapy, mainly in patient\u2010specific quality assurance (PSQA). Currently, the evaluation of the dose distributions is being performed mainly with statistical methods, which could underestimate the clinical importance of the spotted differences, as per the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This paper aims to provide proof\u2010of\u2010concept for a novel dose distribution comparison method based on the difference of the isodose surfaces. The new method connects acceptance tolerance to QA limitations (equipment capabilities) and integrates a clinical approach into the analysis procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The distance of dose points from the isocenter can be used as a function to define the shape of an isodose surface expressed as a histogram. Isodose surface differences (ISD) are defined as the normalized differences of reference and evaluated surface histograms plotted against their corresponding isodose. Acceptance tolerances originate from actual QA tolerances and are presented clinically intuitively. The ISD method was compared to the gamma index using intentionally erroneous VMAT and IMRT plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Results revealed that the ISD method is sensitive to all errors induced in the plans. Discrepancies are presented per isodose, enabling the evaluation of the plan in two regions representing PTV and Normal Tissue.\u00a0ISD manages to flag errors that would remain undetected under the gamma analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The ISD method is a meaningful, QA\u2010related, registration\u2010free, and clinically oriented technique of dose distribution evaluation. This method can be used either as a standalone or an auxiliary tool to the well\u2010established evaluation procedures, overcoming significant limitations reported in the literature.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14085","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T05:58:59Z","timestamp":1696485539000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Isodose surface differences: A novel tool for the comparison of dose distributions"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-8860","authenticated-orcid":false,"given":"Stefanos","family":"Diamantopoulos","sequence":"first","affiliation":[{"name":"2nd Department of Radiology University General Hospital \u201cAttikon\u201d 1 Rimini Street National and Kapodistrian University of Athens Chaidari Greece"},{"name":"Joint Department of Physics The Royal Marsden NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-7895","authenticated-orcid":false,"given":"Kalliopi","family":"Platoni","sequence":"additional","affiliation":[{"name":"2nd Department of Radiology University General Hospital \u201cAttikon\u201d 1 Rimini Street National and Kapodistrian University of Athens Chaidari Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pantelis","family":"Karaiskos","sequence":"additional","affiliation":[{"name":"Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vassilis","family":"Kouloulias","sequence":"additional","affiliation":[{"name":"2nd Department of Radiology University General Hospital \u201cAttikon\u201d 1 Rimini Street National and Kapodistrian University of Athens Chaidari Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efstathios","family":"Efstathopoulos","sequence":"additional","affiliation":[{"name":"2nd Department of Radiology University General Hospital \u201cAttikon\u201d 1 Rimini Street National and Kapodistrian University of Athens Chaidari Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598248"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12810"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2017.03.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3633904"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4826166"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2018.06.633"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2919075"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3659707"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2019.02.007"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2018.04.005"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4795757"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12285"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2019.10.029"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(03)00430-9"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(93)90206-B"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1145\/571647.571648"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.2307\/2683757"},{"key":"e_1_2_9_19_1","unstructured":"BrayJR CurtisJT.An Ordination of the Upland Forest Communities of Southern Wisconsin. 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