{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T01:41:16Z","timestamp":1791423676802,"version":"4.3.3"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"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":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>LiF thermoluminescent dosimeters (TLDs) are commonly used in radiation therapy to verify the delivered dose. Examples include dose verification for complicated treatment setups or cardiovascular implantable electronic devices (CIEDs). TLDs may be present for both the pre\u2010treatment imaging kilovoltage (kV) beam and the megavoltage (MV) treatment beams. For low energy x\u2010ray beams, where the photoelectric effect dominates, TLDs respond differently than tissue or water. An overresponse of up to 40% has been previously reported for lower\u2010energy (kV) x\u2010rays when calibrated to higher\u2010energy (MV) beams. In this work, the response of TLDs to various cone beam computed tomography (CBCT) protocols with calibrations in clinical therapy beams (MV) is quantified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three Varian OBI (Head, Thorax, and Pelvis) and three Elekta XVI (Fast Head and Neck, Fast Chest, and Fast Pelvis) CBCT protocols were investigated. For each protocol, TLDs were positioned on a tissue equivalent phantom at various distances extending out from the center of the imaging field. The response was determined by calibrating TLDs to a 6\u00a0MV photon beam.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The maximum in\u2010field TLD response ranged from 0.82 to 4.80 and 0.06 to 2.69 cGy for Varian OBI and Elekta XVI protocols, respectively. The out\u2010of\u2010field CBCT response dropped exponentially from the field edge. Calculated uncertainties were generally less than 3% (<jats:italic>k<\/jats:italic>\u00a0=\u00a01), with exceptions along the edge of the CBCT field (6%) and at the most distal TLD positions (34%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Using the measured TLD responses to CBCT protocols with an MV calibration, the therapeutic dose can be isolated. The therapeutic dose can then be compared to predictions from the treatment planning system (TPS), allowing for more accurate dose verification for complex treatment setups and patients with CIEDs. The CBCT response can change the reported therapeutic dose by up to 2.5%.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.70103","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T01:49:00Z","timestamp":1745545740000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Accounting for TLD response to CBCT protocols in external beam radiotherapy dose monitoring"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0980-0157","authenticated-orcid":false,"given":"Andrew J.","family":"White","sequence":"first","affiliation":[{"name":"Department of Medical Physics School of Medicine and Public Health University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cliff G.","family":"Hammer","sequence":"additional","affiliation":[{"name":"Department of Medical Physics School of Medicine and Public Health University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Mercyhealth Javon Bea Hospital  Rockford Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry A.","family":"DeWerd","sequence":"additional","affiliation":[{"name":"Department of Medical Physics School of Medicine and Public Health University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt E.","family":"Stump","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Mission Cancer Center  Asheville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley S.","family":"Culberson","sequence":"additional","affiliation":[{"name":"Department of Medical Physics School of Medicine and Public 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