{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T09:34:27Z","timestamp":1789724067806,"version":"4.0.1"},"reference-count":51,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T00:00:00Z","timestamp":1780790400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"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":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Online adaptive radiotherapy (ART) relies on cone\u2010beam computed tomography (CBCT) imaging for daily treatment adaptation, but CBCT's physical limitations can compromise contour delineation and dose calculation accuracy. The relationship between image quality metrics and clinical ART workflow accuracy remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the clinical impact of CBCT image quality on ART workflow accuracy in breast cancer patients by comparing contour agreement and dose calculation accuracy between Halcyon and TrueBeam systems, establishing how quantitative image quality metrics affect contour agreement and dose calculation accuracy within the ART workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Forty breast cancer patients treated with VMAT were equally divided between Halcyon (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a020) and TrueBeam (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a020). Phantom\u2010based image quality assessment evaluated HU uniformity, contrast\u2010to\u2010noise ratio (CNR), signal\u2010to\u2010noise ratio (SNR), and modulation transfer function (MTF) using Catphan 504. Planning CT and first\u2010day CBCT images were aligned using deformable registration. AI auto\u2010segmentation generated contours for six structures, evaluated using Dice Similarity Coefficient (DSC) and other geometric metrics. VMAT plans were recalculated on CBCT images using system\u2010specific HU\u2010to\u2010electron density calibration curves for dose\u2010volume histogram, 3D gamma analysis, and dose difference analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Halcyon demonstrated 1.65\u2010fold higher CNR (22.21\u00a0vs. 13.42) and 1.78\u2010fold better HU uniformity (9\u00a0vs. 16 HU) compared to TrueBeam, despite comparable spatial resolution (MTF50: 0.36\u00a0lp\/mm). Contour agreement analysis showed Halcyon achieved higher accuracy (treated breast DSC: 0.92\u00a0\u00b1\u00a00.06\u00a0vs. 0.87\u00a0\u00b1\u00a00.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) with 3.5\u2010fold lower inter\u2010patient variability. Dosimetric analysis revealed paradoxical patterns: TrueBeam maintained better PTV coverage (D\n                      <jats:sub>95%<\/jats:sub>\n                      difference: 0.013\u00a0vs. 0.207\u00a0Gy) but showed significantly increased internal dose metrics (D\n                      <jats:sub>mean<\/jats:sub>\n                      difference: \u22120.320\u00a0vs. 0.046\u00a0Gy,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Although both systems achieved\u00a0&gt;\u00a099.8% gamma passing rates at 3%\/3\u00a0mm criteria, stringent 1%\/2\u00a0mm criteria revealed substantial performance differences (Halcyon: 97.66\u00a0\u00b1\u00a01.91%\u00a0vs. TrueBeam: 90.28\u00a0\u00b1\u00a06.51%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Quantitative CBCT image quality metrics, particularly CNR and HU uniformity, directly affect both contour agreement and dosimetric concordance in breast ART workflows. These findings provide quantitative evidence linking CBCT image quality metrics to both contour agreement and dose calculation accuracy within the ART workflow.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70648","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:01:16Z","timestamp":1780891276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Quantitative assessment of CBCT image quality metrics and their translation to clinical Art workflow performance in breast cancer patients"],"prefix":"10.1002","volume":"27","author":[{"given":"Sunhwa","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Medical Sciences College of Medicine The Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Kyu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of 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