{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T08:51:56Z","timestamp":1782982316791,"version":"3.54.5"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"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":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>A workflow\/planning strategy delivering low\u2010dose radiation therapy (LDRT) (1\u00a0Gy) to all polymetastatic diseases using conventional planning\/delivery (Raystation\/Halcyon\u00a0=\u00a0\u201cconventional\u201d) and the AI\u2010based Ethos online adaptive RT (oART) platform is developed\/evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using retrospective data for ten polymetastatic non\u2010small cell lung cancer patients (5\u201052 lesions each) with PET\/CTs, gross tumor volumes (GTVs) were delineated using PET standardized\u2010uptake\u2010value (SUV) thresholding. A 1\u00a0cm uniform expansion of GTVs to account for setup\/contour uncertainty and organ motion\u2010generated planning target volumes (PTVs). Dose optimization\/calculation used the diagnostic CT from PET\/CT. Dosimetric objectives were: D<jats:sub>min,0.03cc<\/jats:sub> \u2265 95% (acceptable variation (\u0394) \u2265 90%), V<jats:sub>100%<\/jats:sub> \u2265 95% (\u0394 \u2265 90%), and D<jats:sub>0.03cc<\/jats:sub> \u2264 120% (\u0394 \u2264 125%). Additionally, online adaptation was simulated. When available, subsequent diagnostic CT was used to represent on\u2010treatment CBCT. Otherwise, the CT from PET\/CT used for initial planning was deformed to simulate clinically representative changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All initial plans generated, both for Raystation and Ethos, achieved clinical goals within acceptable variation. For all patients, D<jats:sub>min,0.03cc<\/jats:sub> \u2265 95%, V<jats:sub>100%<\/jats:sub> \u2265 95%, and D<jats:sub>0.03cc<\/jats:sub> \u2264 120% goals were achieved for 84.8%\/99.5%, 97.7%\/98.7%, 97.4%\/92.3%, in conventional\/Ethos plans, respectively. The ratio of 50% isodose volume to PTV volume (R<jats:sub>50%<\/jats:sub>), maximum dose at 2\u00a0cm from PTV (D<jats:sub>2cm<\/jats:sub>), and the ratio of the 100% isodose volume to PTV volume (conformity index) in Raystation\/Ethos plans were 7.9\/5.9; 102.3%\/88.44%; and 0.99\/1.01, respectively. In Ethos, online adapted plans maintained PTV coverage whereas scheduled plans often resulted in geographic misses due to changes in tumor size, patient position, and body habitus. The average total duration of the oART workflow was 26:15 (min:sec) ranging from 6:43 to 57:30. The duration of each oART workflow step as a function of a number of targets showed a low correlation coefficient for influencer generation and editing (<jats:italic>R<\/jats:italic><jats:sup>2\u00a0<\/jats:sup>=\u00a00.04 and 0.02, respectively) and high correlation coefficient for target generation, target editing and plan generation (<jats:italic>R<\/jats:italic><jats:sup>2\u00a0<\/jats:sup>=\u00a00.68, 0.63 and 0.69, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates feasibility of conventional planning\/treatment with Raystation\/Halcyon and highlights efficiency gains when utilizing semi\u2010automated planning\/online\u2010adaptive treatment with Ethos for immunostimulatory LDRT conformally delivered to all sites of polymetastatic disease.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14303","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T20:08:40Z","timestamp":1708459720000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Technical feasibility of novel immunostimulatory low\u2010dose radiation for polymetastatic disease with CBCT\u2010based online adaptive and conventional approaches"],"prefix":"10.1002","volume":"25","author":[{"given":"Nour","family":"Nasser","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Moffitt Cancer Center  Tampa Florida USA"},{"name":"Department of Physics University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradford A.","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Moffitt Cancer Center  Tampa Florida 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