{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:16:58Z","timestamp":1767179818470,"version":"3.48.0"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"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":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Purpose<\/jats:title>\n                    <jats:p>The RefleXion X1 (RefleXion Medical, Inc., Hayward, CA) is a unique radiotherapy platform integrating kVCT and PET as on\u2010board imaging guidance. This study aims to evaluate the feasibility and treatment planning quality of RefleXion X1 treatment planning system (TPS) for spinal stereotactic body radiation therapy (SBRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study analyzed treatment plans of 10 different patient cases, including five single\u2010dose level SBRT cases and five simultaneously integrated boost (SIB) SBRT cases. All plans were created using the X1 TPS with a 10\u00a0mm jaw size and evaluated against institutional planning guidelines to ensure clinical acceptability. To assess planning quality, the X1\u2010generated plans were compared to clinically treated plans. Key metrics such as planning target volume (PTV) coverage, maximum point dose (measured as maximal dose to any volume of 0.035cc), conformity index (CI), and organs\u2010at\u2010risk (OARs) constraints were evaluated. Statistical analysis was performed using the Wilcoxon signed\u2010rank test, with significance defined as\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All RefleXion X1 plans met our institutional planning guidelines for spinal SBRT and were deemed clinically acceptable. No statistically significant differences were observed in all PTV metrics, including  (),  (), and  (). Meanwhile, X1 plans demonstrated slightly higher average maximum cauda equina doses (X1: \u00a0Gy, clinically treated: \u00a0Gy, ), while maintaining comparable dose sparing for other OARs. The average CI values for X1 plans and clinically treated plans were  and , respectively (), demonstrating similar dose conformity. Additionally, homogeneity index (HI) and gradient index (GI) values also showed no significant differences, further supporting the comparable performance of X1 plans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The RefleXion X1 system can generate clinically acceptable treatment plans for complex spinal SBRT, with plan quality comparable to that of clinically treated plans at our institution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70307","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T03:34:58Z","timestamp":1764473698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of treatment planning feasibility of a positron emission tomography (PET)\u2013Linac system for spine stereotactic body radiotherapy (SBRT)"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0666-5404","authenticated-orcid":false,"given":"Haozhao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Medical Artificial Intelligence and Automation Laboratory The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5694-8130","authenticated-orcid":false,"given":"Shunyu","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Medical Artificial Intelligence and Automation Laboratory The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Medical Artificial Intelligence and Automation Laboratory The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4786-6891","authenticated-orcid":false,"given":"Thomas","family":"Banks","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rameshwar","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang Kyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Medical Artificial Intelligence and Automation Laboratory The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Godley","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"},{"name":"Medical Artificial Intelligence and Automation Laboratory The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas 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