{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:06Z","timestamp":1789700526530,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"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":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The accuracy of radiotherapy is limited by anatomical variations occurring over time scales ranging from sub\u2010seconds to days. Online Adaptive Radiotherapy (OART) addresses this by enabling daily plan adaptation based on real\u2010time imaging. While OART offers improved dose conformity, its dynamic, time\u2010constrained workflow introduces novel failure modes that challenge traditional quality assurance protocols.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aims to synthesize the existing literature on Failure Modes and Effects Analysis (FMEA) for OART to systematically catalog risks and identify mitigation strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature search was conducted to identify studies applying FMEA to OART workflows. Eleven studies were included, covering MR\u2010guided (ViewRay MRIdian, Elekta Unity), CBCT\u2010guided (Varian Ethos), and MR\u2010enhanced C\u2010arm linac systems. To address heterogeneity in risk scoring methodologies (e.g., TG\u2010100 10\u2010point scales vs. 5\u2010point rankings), extracted failure modes were harmonized into a standardized three\u2010tier risk classification system (Class I: Low, Class II: Intermediate, Class III: High).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 300 unique failure modes were identified, with 49.6 percent classified as high\u2010risk (Class III). Analysis revealed that the majority of high\u2010risk failures were concentrated in the online treatment delivery phase, specifically within human\u2010computer interactions and anatomical contouring steps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study supports the development of tailored, robust QA frameworks that prioritize human factors and process consistency to guide safe implementation in diverse clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70749","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:38:19Z","timestamp":1787636299000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Failure modes and effects analysis for clinical implementation of online adaptive radiotherapy: A systematic review"],"prefix":"10.1002","volume":"27","author":[{"given":"Deepikaa","family":"Balaji","sequence":"first","affiliation":[{"name":"Department of Radiotherapy The Netherlands Cancer Institute  Amsterdam Netherlands"},{"name":"Department of Radiotherapy Utrecht Medical Center  Utrecht Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3024-7069","authenticated-orcid":false,"given":"Sonja","family":"Wegener","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":"Kl\u00fcter","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara 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