{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:53Z","timestamp":1789740113383,"version":"4.0.1"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"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":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The current standard radiotherapy treatment planning workflow typically requires several hours to days, during which patients must wait before treatment can be initiated. In certain oncological situations, however, treatment should commence as soon as possible. This is particularly critical in oncological emergencies to prevent further complications, as well as in palliative treatment indications where rapid symptom relief is essential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In this study, we report our initial clinical experience with the online simulation\u2010free CBCT\u2010based adaptive radiotherapy (OSCAR) workflow, focusing on feasibility, workflow timing, and dosimetric plan quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seven anatomical regions were predefined for rapid treatment initiation using standardized RT\u00a0intent templates in Ethos (Varian Medical Systems) with HyperSight CBCT. The OSCAR workflow was implemented including institutional safety strategies and alternative workflows where necessary. For the first patients treated with OSCAR, workflow timing was assessed, post\u2010adaptive treatment strategies were documented, and Ethos on\u2010couch IMRT plans were compared dosimetrically to corresponding IGRT VMAT plans generated in Eclipse on the HyperSight CBCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The OSCAR workflow was successfully established for the first 11\u00a0patients requiring rapid initiation of radiotherapy. The average total time required to initiate treatment was approximately 1\u00a0h and 50\u00a0min, while the adaptive treatment fraction (including patient setup, online adaptation, and irradiation) required approximately 20\u00a0min. The dosimetric comparison between static gantry IMRT and VMAT plans demonstrated that both techniques met clinical acceptance criteria for target coverage and OAR sparing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The OSCAR workflow presented here enables rapid and clinically feasible treatment initiation without the need for a dedicated planning CT by combining standardized RT\u00a0intent templates with HyperSight\u2010CBCT\u2010based online adaptation. While evaluated in a limited initial cohort and heterogeneous indications, the workflow demonstrated practicability and clinically acceptable plan quality. Future studies should evaluate scalability to additional disease sites and fractionation schemes, including ultra\u2010hypofractionated regimens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70727","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:43:53Z","timestamp":1785815033000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial experience of clinical implementation of an Online Simulation\u2010free CBCT\u2010based Adaptive Radiotherapy (OSCAR) workflow for palliative and urgent treatment indications"],"prefix":"10.1002","volume":"27","author":[{"given":"Robert","family":"Schindhelm","sequence":"first","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Kleine","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6995-3956","authenticated-orcid":false,"given":"J\u00f6rg","family":"Tamihardja","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Lewitzki","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fclent","family":"Polat","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick","family":"Mantel","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"He\u00df","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingulf","family":"Lawrenz","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"K\u00fcnzig","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Schilling","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Wittig\u2010Sauerwein","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-972X","authenticated-orcid":false,"given":"Gary","family":"Razinskas","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology University Hospital W\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminoncol.2011.03.015"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109538"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.03.005"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2022.101091"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2020.10.010"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14337"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110458"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.70338"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.11832"},{"key":"e_1_2_9_11_1","unstructured":"Varian Medical Systems I.Halcyon and Ethos Radiotherapy System Instructions for Use.2022. P1039628\u2010001\u2010A. July 2022."},{"key":"e_1_2_9_12_1","unstructured":"VarianMedicalAffairs. Accessed 29 December2025.https:\/\/medicalaffairs.varian.com\/othertotalbodyirradiation\u2010tbi\u2010vmat2"},{"key":"e_1_2_9_13_1","unstructured":"Varian Medical Systems I.Ethos Algorithms Reference Guide.2023. P1050581\u2010001\u2010A. May 2023."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13539"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13950"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.70147"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100611"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2026.101145"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.70306"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tipsro.2023.100216"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.70244"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/22373346"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2025.02.045"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.37549\/ARO\u2010D\u201024\u201000021"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.zemedi.2024.05.001"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.zemedi.2022.11.004"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20102512\u20109269"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70727","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acm2.70727","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T13:07:27Z","timestamp":1789736847000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70727"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/acm2.70727"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70727","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-02-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70727"}}