{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:07:12Z","timestamp":1787695632402,"version":"build-2784847793"},"reference-count":18,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T00:00:00Z","timestamp":1718668800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007210","name":"Varian Medical Systems","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007210","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":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Novel on\u2010board CBCT allows for improved image quality and Hounsfield unit accuracy. When coupled with online adaptive tools, this may have potential to allow for simulation and treatment to be completed in a single on\u2010table session.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To study the feasibility of a high\u2010efficiency radiotherapy treatment workflow without the use of a separate session for simulation imaging. The dosimetric accuracy, overall efficiency, and technical feasibility were used to evaluate the clinical potential of CT simulation\u2010free adaptive radiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Varian's Ethos adaptive radiotherapy treatment platform was upgraded with a novel CBCT system, HyperSight which reports image quality and Hounsfield unit accuracy specifications comparable to standard fan\u2010beam CT. Using in\u2010house developed MATLAB software, CBCT images were imported into the system and used for planning. Two test cases were completed on anthropomorphic phantoms equipped with small volume ion chambers (cross\u2010calibrated to an ADCL traceable dose standard) to evaluate the feasibility and accuracy of the workflows. A simulated palliative spine treatment was planned with 8\u00a0Gy in one fraction, and an intact prostate treatment was planned with 60\u00a0Gy in 20 fractions. The CBCTs were acquired using HyperSight with default thorax and pelvis imaging protocols and reconstructed using an iterative algorithm with scatter removal, iCBCT Acuros. CBCTs were used for contouring and planning, and treatment was delivered via an online adaptive workflow. In addition, an external dosimetry audit was completed using only on\u2010board CBCT imaging in an end\u2010to\u2010end head and neck phantom irradiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>An extended\u2010field CBCT acquisition can be acquired in 12\u00a0s, in addition to the time for longitudinal table shifts, and reconstructed in approximately 1\u00a0min. The superior\u2010inferior extent for the CBCT planning images was 38.2\u00a0cm, which captured the full extent of relevant anatomy. The contouring and treatment planning for the spine and prostate were completed in 30 and 18\u00a0min, respectively. The dosimetric agreement between ion chamber measurements and the treatment plan was within a range of \u22121.4 to 1.6%, and a mean and standard deviation of 0.41\u00a0\u00b1\u00a01.16%. All metrics used in the external audit met the passing criteria, and the dosimetric comparison between fan\u2010beam and CBCT techniques had a gamma passing rate of 99.0% with a criteria of 2%\/2\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using an in\u2010house workflow, CT simulation\u2010free radiation therapy was shown to be feasible with acceptable workflow efficiency and dosimetric accuracy. This approach may be particularly applicable for urgent palliative treatments. With the availability of software to enable this workflow, and the continued advancement of on\u2010treatment adaptation, single\u2010visit radiation therapy may replace current practice for some clinical indications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14438","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T18:58:12Z","timestamp":1718737092000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["The feasibility of CT simulation\u2010free adaptive radiation therapy"],"prefix":"10.1002","volume":"25","author":[{"given":"R. Lee","family":"MacDonald","sequence":"first","affiliation":[{"name":"Department of Physics and Atmospheric Science Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Medical Physics Nova Scotia Health Queen Elizabeth II Health Sciences Centre  Halifax Nova Scotia Canada"},{"name":"Department of Radiation Oncology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Fallone","sequence":"additional","affiliation":[{"name":"Department of Physics and Atmospheric Science Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Medical Physics Nova Scotia Health Queen Elizabeth II Health Sciences Centre  Halifax Nova Scotia Canada"},{"name":"Department of Radiation Oncology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Chytyk\u2010Praznik","sequence":"additional","affiliation":[{"name":"Department of Physics and Atmospheric Science Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Medical Physics Nova Scotia Health Queen Elizabeth II Health Sciences Centre  Halifax Nova Scotia Canada"},{"name":"Department of Radiation Oncology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Robar","sequence":"additional","affiliation":[{"name":"Department of Physics and Atmospheric Science Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Medical Physics Nova Scotia Health Queen Elizabeth II Health Sciences Centre  Halifax Nova Scotia Canada"},{"name":"Department of Radiation Oncology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Cherpak","sequence":"additional","affiliation":[{"name":"Department of Physics and Atmospheric Science Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Medical Physics Nova Scotia Health Queen Elizabeth II Health Sciences Centre  Halifax Nova Scotia Canada"},{"name":"Department of Radiation Oncology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.10.021"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010023\u201002340\u20102"},{"key":"e_1_2_9_4_1","volume-title":"Evaluation of Ethos HyperSight imaging performance compared to standard CBCT and FBCT","author":"Fallone A","year":"2023"},{"key":"e_1_2_9_5_1","volume-title":"Treatment plan dose calculation using the novel HyperSight CBCT","author":"Cherpak A","year":"2023"},{"key":"e_1_2_9_6_1","volume-title":"Characterization of a Novel High Performance kV CBCT System on a Ring\u2010Gantry Linac","author":"Salerno M","year":"2023"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2023.10.014"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100566"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.11.017"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radphyschem.2023.111338"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2022.10.012"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2023.100491"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2023.101258"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2023.100490"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13841"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109538"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2022.100561"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.06.2157"},{"key":"e_1_2_9_19_1","unstructured":"Head and Neck IMRT phantom. 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