{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:44:55Z","timestamp":1787244295886,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T00:00:00Z","timestamp":1697241600000},"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":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Uncertainties in radiotherapy cause deviation from the planned dose distribution and may result in delivering a treatment that fails to meet clinical objectives. The impact of uncertainties is unique to the patient anatomy and the needle locations in HDR prostate brachytherapy. Evaluating this impact during treatment planning is not common practice, relying on margins around the target or organs\u2010at\u2010risk to account for uncertainties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>A robust evaluation framework for HDR prostate brachytherapy treatment plans was evaluated on 49 patient plans, measuring the range of possible dosimetric outcomes to the patient due to 14 major uncertainties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patient plans were evaluated for their robustness to uncertainties by simulating probable uncertainty scenarios. Five\u2010thousand probabilistic and 1943 worst\u2010case scenarios per patient were simulated by changing the position and size of structures and length of dwell times from their nominal values. For each uncertainty scenario, the prostate D\n                      <jats:sub>90<\/jats:sub>\n                      and maximum doses to the urethra, D\n                      <jats:sub>0.01cc<\/jats:sub>\n                      , and rectum, D\n                      <jats:sub>0.1cc<\/jats:sub>\n                      , were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The D\n                      <jats:sub>90<\/jats:sub>\n                      was an average 1.16\u00a0\u00b1\u00a00.51% (mean\u00a0\u00b1\u00a0SD) below nominal values for the probabilistic scenarios; the D\n                      <jats:sub>0.01cc<\/jats:sub>\n                      metric was 2.24\u00a0\u00b1\u00a00.90% higher; and D\n                      <jats:sub>0.1cc<\/jats:sub>\n                      was greater by 0.48\u00a0\u00b1\u00a00.30%. The D\n                      <jats:sub>0.01cc<\/jats:sub>\n                      and D\n                      <jats:sub>90<\/jats:sub>\n                      metrics were more sensitive to uncertainties than D\n                      <jats:sub>0.1cc<\/jats:sub>\n                      , with a median of 79.0% and 84.9% of probabilistic scenarios passing the constraints, compared to 96.5%. The median pass\u2010rate for scenarios that passed all three metrics simultaneously was 63.4%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Assessing treatment plan robustness improves plan quality assurance, is achievable in less than 1\u2010min, and identifies treatment plans with poor robustness, allowing re\u2010optimization before delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.14182","type":"journal-article","created":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T14:38:31Z","timestamp":1697294311000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A robust evaluation of 49 high\u2010dose\u2010rate prostate brachytherapy treatment plans including all major uncertainties"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3053-6052","authenticated-orcid":false,"given":"Andrew Christopher","family":"Kennedy","sequence":"first","affiliation":[{"name":"School of Physical Sciences University of Adelaide  Adelaide SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael John James","family":"Douglass","sequence":"additional","affiliation":[{"name":"School of Physical Sciences University of Adelaide  Adelaide SA Australia"},{"name":"Department of Radiation Oncology Royal Adelaide Hospital  Adelaide SA Australia"},{"name":"Australian Bragg Centre for Proton Therapy and Research  Adelaide SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Manuel Cara\u00e7a","family":"Santos","sequence":"additional","affiliation":[{"name":"School of Physical Sciences University of Adelaide  Adelaide SA Australia"},{"name":"Department of Radiation Oncology Royal Adelaide Hospital  Adelaide SA Australia"},{"name":"Australian Bragg Centre for Proton Therapy and Research  Adelaide SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,14]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"ICRU Report 62: Prescribing, Recording, and Reporting Photon Beam Therapy (Supplement to ICRU Report 50)","author":"International Commission on Radiation Units and Measurements","year":"1999"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360\u20103016(00)01463\u20102"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2010.08.021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2012.29370"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.09.038"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2018.12.002"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.08.005"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/52\/10\/009"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/aae659"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1287\/ijoc.2018.0815"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/abe04e"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2016.60499"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15658"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.11.002"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13246\u2010023\u201001279\u20108"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.1646040"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.597458"},{"key":"e_1_2_11_19_1","unstructured":"Python Language Reference. 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