{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:05:12Z","timestamp":1790697912270,"version":"4.1.0"},"reference-count":69,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"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":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>The AAPM TG\u201043 formalism has long served as the clinical standard for brachytherapy dose calculation but assumes a homogeneous water equivalent medium, overlooking limited scattering conditions and tissue heterogeneities. Model\u2010based dose\u2010calculation algorithms (MBDCAs), including Monte Carlo (MC) simulations overcome these limitations by accounting for real tissue composition, scatter, and applicator attenuation. This systematic review evaluates TG\u201043, MBDCAs\/MC methods in terms of dosimetric accuracy, validation strategies, computational feasibility, clinical implementation barriers, and emerging innovations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA\u2010guided literature search was conducted using the Scopus database, identifying 284 records, of which 42 full\u2010text studies met inclusion criteria. Eligible studies compared at least two of the three dose\u2010calculation approaches (TG\u201043, MBDCAs and MCs) in pelvic, breast, or head\u2010and\u2010neck brachytherapy. Extracted data encompassed dosimetric discrepancies, validation approaches, computational performance, workflow integration, and enabling technologies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across anatomical sites, TG\u201143 showed no consistent bias. Its differences from heterogeneity\u2011aware models depended on tissue composition, scatter conditions, and source geometry. In soft\u2011tissue regions with minimal heterogeneity, TG\u201143 generally overestimated target coverage by about 0.5%\u20135%. Near low\u2011density interfaces or in reduced\u2011scatter configurations, TG\u201143 could instead yield lower doses than Monte Carlo or MBDCAs. For OARs, discrepancies were site\u2011specific: skin dose was often overestimated, while other organs showed smaller or opposite variations. Overall, MBDCAs and Monte Carlo agreed with experimental or benchmark data within roughly 3% and produced more reliable biological metrics. GPU\u2011accelerated and deep\u2011learning engines reduced computation times from hours to seconds, shifting remaining challenges toward standardization, commissioning, and QA. Successful clinical adoption relied on TG\u2011186\u2013aligned validation, staff training, and integrated automated workflows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evidence from the systematic review supports a clinical transition toward TG\u2010186\u2013compliant, heterogeneity\u2010aware dose\u2010calculation frameworks. MBDCAs\/MC algorithms provide superior dosimetric and radiobiological accuracy and are increasingly compatible with adaptive and biologically guided planning. Broad implementation is now supported by established QA standards and benchmarking datasets, which connects dosimetric precision with patient outcomes. The transition beyond TG\u201043 marks a pivotal step toward precision, safety, and personalization in modern brachytherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70627","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:28:03Z","timestamp":1779272883000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Beyond TG\u201143: A PRISMA\u2010based systematic review on model\u2010based dose\u2010calculation algorithms in brachytherapy"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6249-3689","authenticated-orcid":false,"given":"Dat","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Physics University of Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-8105","authenticated-orcid":false,"given":"Thanh\u2010Tai","family":"Duong","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Faculty of Medicine Nguyen Tat Thanh University  Ho Chi Minh City Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7328-2553","authenticated-orcid":false,"given":"Shada","family":"Wadi\u2010Ramahi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology UPMC Hillman Cancer Center University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-5242","authenticated-orcid":false,"given":"David","family":"Bradley","sequence":"additional","affiliation":[{"name":"Centre for Applied Physics and Radiation Technologies Sunway University  Bandar Sunway Malaysia"},{"name":"School of Mathematics and Physics University of Surrey  Guildford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4202-4855","authenticated-orcid":false,"given":"James C. 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