{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T11:32:50Z","timestamp":1758281570211,"version":"3.44.0"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,16]],"date-time":"2025-03-16T00:00:00Z","timestamp":1742083200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005090","name":"Beijing Nova Program","doi-asserted-by":"publisher","award":["Z201100006820058"],"award-info":[{"award-number":["Z201100006820058"]}],"id":[{"id":"10.13039\/501100005090","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":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>A new workflow was investigated for Elekta Unity MR\u2010Linac by removing the computed tomography (CT)\u2010simulation step and using diagnostic CT (DCT) for reference plan generation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Ten patients with ultra\u2010hypofractionated prostate cancer treated with magnetic resonance imaging (MRI)\u2010guided adaptive radiotherapy were retrospectively enrolled. Targets and organs at risk (OARs) were recontoured on DCT, and Hounsfield unit conversions to relative electron density were calibrated for DCT. Reference plans were reoptimized and recalculated using DCT for Unity. Subsequent adaptive plans were designed through an adapt\u2010to\u2010shape workflow to edit targets and OARs via daily MRI to generate a new treatment plan. Bulk electron density information for Unity adaptive plan was compared between planning CT (PCT) and DCT for volumes of interest. Dosimetric parameters were evaluated between PCT\u2010 and DCT\u2010based reference and adaptive plans for target coverage and OAR dose constraints.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Bulk relative electron density differences between PCT and DCT were within\u00a0\u00b11% for targets and OARs, excepting the rectum. PCT and DCT\u2010based reference plans did not significantly differ in mean target coverages or for OARs in dosimetric difference except for <jats:italic>V<\/jats:italic><jats:sub>36\u00a0Gy<\/jats:sub> of the rectum. PCT\u2010 and DCT\u2010based adaptive plans did not significantly differ for most dosimetric parameters of targets and OARs except for <jats:italic>V<\/jats:italic><jats:sub>29\u00a0Gy<\/jats:sub> and <jats:italic>V<\/jats:italic><jats:sub>36\u00a0Gy<\/jats:sub> of the rectum, <jats:italic>V<\/jats:italic><jats:sub>18.1\u00a0Gy<\/jats:sub> of the bladder, and <jats:italic>D<\/jats:italic><jats:sub>50%<\/jats:sub> of the urethra.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>By removing the CT simulation step, it is feasible to use DCT for designing reference and adaptive plans in the Unity ATS workflow. The workflow increased adaptive radiotherapy efficiency and decreased patient waiting time and additional radiation dose.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.70075","type":"journal-article","created":{"date-parts":[[2025,3,16]],"date-time":"2025-03-16T12:10:06Z","timestamp":1742127006000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic image\u2010based treatment planning for online adaptive ultra\u2010hypofractionated prostate cancer radiotherapy with MR\u2010Linac"],"prefix":"10.1002","volume":"26","author":[{"given":"Yuan","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College  Beijing 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