{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:04Z","timestamp":1789700524947,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"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>Total skin electron therapy (TSET) is a standard treatment for cutaneous T\u2010cell lymphoma. Due to the complex patient positioning and irregular body contours, robust in\u2010vivo dosimetry (IVD) is essential to verify dose uniformity. While thermoluminescent dosimeters (TLDs) are traditional standard, their utility is hindered by labor\u2010intensive, manual processing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purposes<\/jats:title>\n                    <jats:p>This study evaluates the clinical implementation of a Gafchromic\u2122 EBT4 film\u2010based IVD system integrated with a bespoke, open\u2010source analysis platform for automated batch\u2010processing. To address the inherent orientation dependence and loss of film orientation frequently encountered when preparing small\u2010format IVD films with a manual paper cutter, we developed an orthogonal dual\u2010scan protocol. By averaging pixel values from two perpendicular scans for both calibration and clinical measurement, this protocol effectively mitigates orientation\u2010dependent uncertainties and ensures dosimetric robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The film\u2010based IVD system was clinically assessed in five TSET treatments and compared to six treatments utilizing TLD\u2010based IVD. Dosimetric accuracy was evaluated by comparing normalized fractional doses to the prescription. Statistical analysis was performed using the Mann\u2010Whitney U test with the Benjamini\u2010Hochberg procedure to control the false discovery rate across 20 anatomical sites. Workflow efficiency was quantified by the total time required for data readout and analysis per patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The EBT4 film\u2010based IVD demonstrated dosimetric accuracy comparable to the TLDs, with mean fractional doses of 102.7%\u00a0\u00b1\u00a09.6% and 100.4%\u00a0\u00b1\u00a09.7%, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.25). Clinical implementation of the film\u2010based approach significantly enhanced efficiency, reducing the total processing time from approximately 50 min to 15 min per treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The proposed EBT4 film\u2010based IVD system, supported by open\u2010source software and an orthogonal dual\u2010scan protocol, offers a robust, cost\u2010effective, and time\u2010efficient alternative to traditional TLDs. This approach streamlines the clinical workflow without compromising dosimetric accuracy, making it a viable solution for TSET and broader radiotherapy IVD applications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70774","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T04:30:45Z","timestamp":1787977845000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical in\u2010vivo dosimetry for total skin electron therapy using gafchromic\u2122 EBT4 film"],"prefix":"10.1002","volume":"27","author":[{"given":"Zhexuan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M. M","family":"Videtic","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherian","family":"Sheen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-10-184168"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.32.0630"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2016.11.008"},{"key":"e_1_2_10_5_1","volume-title":"StatPearls","author":"Vaidya T","year":"2025"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","unstructured":"KarzmarkCJ AndersonJ FS \u201cTotal Skin Electron Therapy: Technique and Dosimetry AAPM ReportNo.23 \u201d1987. doi:10.37206\/22","DOI":"10.37206\/22"},{"key":"e_1_2_10_7_1","volume-title":"Handbook of Treatment Planning in Radiation Oncology","author":"GMM V","year":"2020"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.01.008"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1498855"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.05.052"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1460396920000369"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2007.03.003"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4754797"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.4103\/jcrt.JCRT_1020_16"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/jmp.jmp_72_22"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2023.24.7.2505"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pro6.1204"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3442301"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13941"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14574"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.14497"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70774","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acm2.70774","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70774","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:06:32Z","timestamp":1789697192000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/acm2.70774"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70774","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"2026-03-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70774"}}