{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:12Z","timestamp":1789700532342,"version":"4.0.1"},"reference-count":8,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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>State regulatory inspections of radiation\u2010producing treatment equipment combine a review of quality assurance and regulatory records with direct verification of facility and safety systems. When these activities are performed entirely on\u2010site across multiple facilities, real\u2010time document retrieval can prolong visits and divert clinical staff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To develop and evaluate a centralized hybrid framework that separates advance document review from focused on\u2010site verification during state\u2010mandated annual inspections of photon linear accelerators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The framework was implemented across five photon treatment sites comprising 10 linear accelerators using an institutionally deployed cloud\u2010based quality assurance platform (TotalQA, Image Owl Inc., Greenwich, NY). Site physicists uploaded machine\u2010 and site\u2010specific records directly. A dedicated guest account allowed the inspector to review documents approximately 14 days before each visit. Document\u2010verifiable items and photographs of required postings were reviewed remotely; audio\/video monitoring systems, linac\u2010on warning lights, staff access to applicable state regulatory requirements and personnel dosimetry records, written operating and emergency procedures, direct questions, and unresolved items remained on\u2010site. A system\u2010wide clinical deviation logbook containing protected health information was reviewed once in person at a central location. Operational outcomes included on\u2010site duration, daily throughput, physicist support, schedule adherence, treatment impact, and inspection findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Historical inspections required approximately 120\u00a0min of on\u2010site time per facility, based on calendar records, prior schedules, and staff recollection. During the hybrid implementation, on\u2010site inspection time was approximately 30 minutes per facility based on records documented at the time of each inspection, representing an estimated 75% reduction. Daily throughput increased from approximately three sites per day to four sites per day. The inspector estimated that advance review required 1 to 2\u00a0h per site, generally closer to 2\u00a0h during the first cycle. All visits remained within scheduled blocks, no inspection\u2010related treatment delays or interruptions occurred, and no documentation\u2010related citations were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A centralized hybrid model was feasible for state\u2010mandated annual inspections of linear accelerators in a multi\u2010site radiation oncology system. Advance review reduced on\u2010site document\u2010navigation demands while preserving direct verification of physical and safety\u2010related elements. Because remote\u2010review time was estimated retrospectively, the findings support reduced on\u2010site duration rather than reduced total inspector effort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70791","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:40:39Z","timestamp":1789026039000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A centralized hybrid model for regulatory inspection readiness in a multi\u2010site radiation oncology system"],"prefix":"10.1002","volume":"27","author":[{"given":"Chaitanya","family":"Kalavagunta","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin","family":"Simonson","sequence":"additional","affiliation":[{"name":"Frederick Health Radiation Medicine  Frederick Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598691"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4947547"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3190392"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14160"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2024.101469"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2022.03.003"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6498\/ac31c2"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2021.10.003"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70791","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acm2.70791","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70791","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:07:15Z","timestamp":1789697235000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70791"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":8,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/acm2.70791"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70791","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-05-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70791"}}