{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:53:59Z","timestamp":1791986039693,"version":"4.4.0"},"reference-count":64,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Using a constant relative biological effectiveness (RBE\u00a0=\u00a01.1) in proton therapy may underestimate the RBE\u2010weighted dose in high linear energy transfer (LET) regions at the distal end of the beam, thereby limiting the ability to accurately predict clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To commission and validate a Monte Carlo (MC) model incorporating variable RBE for breast cancer proton therapy, enabling improved RBE\u2010weighted dose calculation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A FLUKA\u2010based MC model of a raster scanning proton beamline was commissioned and benchmarked against the clinically employed treatment planning system (TPS) (Siemens Syngo) and physical measurements. Dose\u2010averaged LET (LET\n                      <jats:sub>d<\/jats:sub>\n                      ) and variable RBE\u2010weighted dose distributions were computed using McMahon (McM), McNamara (McN), and Wedenberg (Wed) models. Treatment plans for four representative breast cancer cases were recalculated to compare TPS and MC results using dose\u2010volume histograms (DVH) and three\u2010dimensional gamma (\u03b3) analysis. LET\n                      <jats:sub>d<\/jats:sub>\n                      \u2010volume histograms (LVH) and variable RBE\u2010weighted dose distributions were analyzed to compare cases without adverse effects versus those presenting rib fractures or radiation pneumonitis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The FLUKA\u2010MC model showed good agreement with both the TPS results and the measured data, exhibiting proton range deviations within \u00b10.1\u00a0mm. The \u03b3 pass rates for the four patients are 94.0%, 92.2%, 92.6%, and 86.7%, respectively. LET\n                      <jats:sub>d<\/jats:sub>\n                      analysis of 0.5 cm\n                      <jats:sup>3<\/jats:sup>\n                      volumes of rib revealed numerical differences (fracture cases: 11.1 and 10.8\u00a0keV\/\u00b5m; non\u2010fracture: 9.2 and 10.0\u00a0keV\/\u00b5m). The RBE\u2010weighted dose to 0.5 cm\n                      <jats:sup>3<\/jats:sup>\n                      of the ribs was consistently elevated in fracture cases across all models (RBE\u00a0=\u00a01.1: 46.2\u201349.0 Gy; McM: 54.6\u201356.5 Gy; McN: 51.0\u201353.3 Gy; Wed: 50.6\u201352.5 Gy) versus non\u2010fracture cases (RBE\u00a0=\u00a01.1: 44.0\u201345.3 Gy; McM: 52.2\u201353.8 Gy; McN: 48.6\u201350.1 Gy; Wed: 48.3\u201349.8 Gy). The estimated RBE values in the rib region were 1.60 (McM), 1.38 (McN), and 1.44 (Wed), which were derived from the mean LET\n                      <jats:sub>d<\/jats:sub>\n                      within 0.5 cm\n                      <jats:sup>3<\/jats:sup>\n                      rib volumes. The RBE\u2010weighted lung V20 was elevated in pneumonitis patients across all models. All variable RBE models predicted elevated RBE\u2010weighted doses in distal proton beam regions across cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The commissioned MC framework demonstrated the feasibility of integrating multiple variable RBE models for RBE\u2010weighted dose estimation in proton therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70477","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:07:24Z","timestamp":1769515644000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Commissioning of a Monte Carlo\u2010based scanning proton beam for breast cancer: Incorporating LETd calculations and variable RBE models"],"prefix":"10.1002","volume":"27","author":[{"given":"Zhen","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy  Shanghai People's Republic of China"},{"name":"Department of Radiotherapy The Third Affiliated Hospital of Naval Medical University  Shanghai People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy  Shanghai People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingfang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital Shanghai Key Laboratory of Radiation Oncology, Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy  Shanghai People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.23838\/pfm.2019.00058"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13390"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.02.018"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.14338\/IJPT\u201017\u201000031.1"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.08.015"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.12.031"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.03.012"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2017.1348625"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.02366"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.14338\/IJPT\u201022\u201000034.1"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.05.015"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14535"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjro.20230012"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16040780"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/aad9db"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/aae8a5"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/60\/21\/8399"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2012.705892"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14014"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ad0281"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2020.1834141"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/abd230"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13527"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.08.038"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.3109\/02841868809090331"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2012.718094"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010016\u20100642\u20106"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2023.10.009"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110579"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ab5e97"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphy.2021.738112"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2016.00116"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ab02cb"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1088\/2057\u20101976\/ac9b5d"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1080\/09553002.2020.1812758"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598116"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/45\/2\/314"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2401042"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/60\/7\/2645"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2021.1992007"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/41\/1\/009"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13622"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/abda98"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ad3329"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010022\u201002143\u2010x"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15174268"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100691"},{"key":"e_1_2_9_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.10.031"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/57\/13\/4223"},{"key":"e_1_2_9_52_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/aa8663"},{"key":"e_1_2_9_53_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/abc12d"},{"key":"e_1_2_9_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2018.08.020"},{"key":"e_1_2_9_55_1","doi-asserted-by":"publisher","DOI":"10.21037\/tlcr.2018.04.0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