{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:54:02Z","timestamp":1791986042817,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"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>Purpose<\/jats:title>\n                    <jats:p>We evaluated the feasibility of a magnetic resonance (MR)\u2010only simulation, planning, and treatment (MROSPT) workflow for prostate cancer patients using synthetic computed tomography (sCT) generated from magnetic resonance imaging (MRI) data. By validating sCT\u2010based dose calculations, we aimed to streamline radiotherapy workflows, eliminate the need for CT simulation, and enable reliable clinical implementation of MR\u2010based radiotherapy for MR\u2010linac (MRL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a comprehensive workflow encompassing the entire process from initial consultation to treatment delivery. After developing the workflow, a retrospective dosimetric validation study was performed on nine men with prostate cancer. They underwent CT and MRI simulations, and sCTs were generated from the MRI data. Contours and intensity\u2010modulated radiation therapy treatment plans were created on the reference simulation CT (rCT) and transferred to sCTs for dose\u2010calculation comparisons. Dosimetric accuracy was evaluated using gamma analysis (dose\/distance; 2%\/2mm). Bulk density sCTs (bCTs) were created by overriding organ density values with their mean (bulk) sCT\u2010determined densities. bCT based on sCT allows treatment planning directly on MRI for MRL workflow efficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Minimal non\u2010bone Hounsfield units (HU)\u2010value differences between rCT and sCT (5.5\u00a0\u00b1\u00a02.9 HU for prostate) demonstrated the reliability of the sCT generation process. Dosimetric comparisons between treatment plans (rCT vs. sCT, rCT vs. bCT) showed agreement within\u00a0\u00b1\u00a02% in gamma analysis, confirming robust accuracy. The gamma index pass rate for rCT versus sCT and rCT versus bCT were consistently\u00a0&gt;\u00a095% using 2%\/2 mm criteria. A dry run of the entire simulation\u2010to\u2010treatment workflow was successfully completed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The MROSPT workflow using sCT is clinically feasible and dosimetrically accurate for prostate cancer patients. Dose calculations based on sCT demonstrated high dosimetric agreement with simulation CT, with no statistically significant differences across all evaluated metrics. These findings support the adoption of sCT\u2011based planning for prostate cancer radiotherapy and suggest its potential applicability in other anatomical regions especially in the pelvis. Integration of robust quality\u2011assurance processes and treatment\u2011delivery flexibility will further enhance its clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70499","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T02:25:39Z","timestamp":1770690339000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and implementation of an MRI\u2010only simulation, planning, and treatment workflow for prostate radiotherapy using synthetic CT on MR\u2010linac"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1323-8942","authenticated-orcid":false,"given":"Reza","family":"Reiazi","sequence":"first","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarath","family":"Vijayan","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9254-4501","authenticated-orcid":false,"given":"Jinzhong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ergys","family":"Subashi","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belinda M.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunter L.","family":"Emory","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Therapy The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vi T.","family":"Dinh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Therapy The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg L.","family":"Swiedom","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Therapy The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2518-7989","authenticated-orcid":false,"given":"Jie","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mu\u2010Han","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Balter","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajat J.","family":"Kudchadker","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine E.","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungtaek","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Young","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3531-8054","authenticated-orcid":false,"given":"Surendra","family":"Prajapati","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010017\u20100778\u20107"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/aaa971"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4931947"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13490"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ab7737"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2018.00517"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphy.2022.897710"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.06.2234"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.06.2530"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010017\u20100854\u20104"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010022\u201002023\u20104"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2022.100561"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2023.08.003"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010023\u201002209\u20104"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2018.08.009"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100667"},{"key":"e_1_2_9_18_1","volume-title":"Syngo.via: MR\u2010based synthetic CT for radiation therapy planning","author":"Siemens Healthineers"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2023.100524"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598248"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7588"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.16556"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13244\u2010023\u201001603\u20106"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70499","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acm2.70499","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70499","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:41:59Z","timestamp":1791985319000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/acm2.70499"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70499","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-05-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70499"}}