{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:27:00Z","timestamp":1782289620553,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008769","name":"Julius-Maximilians-Universit\u00e4t W\u00fcrzburg","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008769","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Motivation<\/jats:title><jats:p>Online adaptive radiotherapy with Ethos is based on the anatomy determined from daily cone beam computed tomography (CBCT) images. Dose optimization and computation are performed on the density map of a synthetic CT (sCT), a deformable registration of the initial planning CT (pCT) onto the current CBCT. Large density changes as present in the lung region are challenging the system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Treatment plans for Ethos were created and delivered for 1, 2, and 3\u00a0cm diameter lung lesions in an anthropomorphic phantom, combining different insets in the pCT and during adaptive and non\u2010adaptive treatment sessions. Primary and secondary dose calculations as well as back\u2010projected dose from portal images were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Density changes due to changed insets were not considered in the sCTs. This resulted in errors in the dose; for example, \u201015.9% of the mean dose for a plan when changing from a 3\u00a0cm inset in the pCT to 1\u00a0cm at the time of treatment. Secondary dose calculation is based on the sCT and could therefore not reveal these dose errors. However, dose calculation on the CBCT, either as a recalculation in the treatment planning system or as pre\u2010treatment quality assurance (QA) before the treatment, indicated the differences. EPID in\u2010vivo QA also reported discrepancies between calculated and delivered dose distributions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An incorrect density distribution in the sCT has an impact on the dose calculation accuracy in the adaptive treatment workflow with the Ethos system. Additional quality checks of the sCT can detect such errors.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14311","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T20:50:26Z","timestamp":1708635026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Feasibility of Ethos adaptive treatments of lung tumors and associated quality assurance"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3024-7069","authenticated-orcid":false,"given":"Sonja","family":"Wegener","sequence":"first","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University of Wurzburg Wurzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Weick","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University of Wurzburg Wurzburg 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