{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:40:40Z","timestamp":1792402840707,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006775","name":"GE Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006775","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011699","name":"Siemens Healthineers","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011699","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pelvic external beam radiation therapy (EBRT), frequently exposes a substantial fraction of active bone marrow (ABM), leading to radiation\u2010induced marrow suppression and associated hematologic toxicity. Accurate delineation and quantitative assessment of ABM are therefore essential to enable marrow\u2010sparing radiotherapy strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To identify and quantify changes in ABM after EBRT using multi\u2010energy CT (MECT) and fat fraction MRI (FFMRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients with gynecological malignancies underwent MECT and FFMRI pre\u2010 and post\u2010radiation therapy. ABM was delineated on both imaging modalities using thresholding where ABM was defined as voxels with CT numbers above the mean in MECT\u2010derived virtual non\u2010calcium (VNCa) datasets and voxels with percent fat fraction (%FF) below the mean on the FFMRI. ABM volumes and mean HU\/%FF values were evaluated before and after treatment. A Wilcoxon\u2010signed rank test was computed to compare paired MECT versus FFMRI ABM volume percent changes. Changes in ABM as a function of dose were also evaluated. A paired t\u2010test was computed for each dose gradient (significant\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The average Dice Similarity Coefficient (DSC) between the MECT and FFMRI pre\u2010treatment ABM volumes was 0.57 (range: 0.50\u20130.68). The mean volumetric change in ABM volume between pre\u2010 and post\u2010treatment scans was \u221237%15% (range \u221257% to \u221212%) and \u221266%27% (range 8% to \u221294%) for MECT and FFMRI, respectively. All paired patients demonstrated greater ABM volume reduction with FFMRI than with MECT, and this difference was statistically significant (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0078). ABM changes were observed as a function of dose: A decrease in mean CT numbers and an increase in %FF corresponds to an increase in dose. CT number decreased significantly at doses \u226510\u00a0Gy (\n                      <jats:italic>p<\/jats:italic>\n                      \u2264 0.005), while %FF increased significantly across all dose gradients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2264 0.0017), with both metrics showing strong dose\u2011response behavior at higher doses (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a010\n                      <jats:sup>\u2212<\/jats:sup>\n                      <jats:sup>6<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This feasibility study demonstrates the utility of using MECT and FFMRI for delineating ABM in patients receiving pelvic EBRT. These imaging modalities showed good agreement in characterizing ABM volumes changes and radiation\u2010induced marrow suppression. These findings support further investigation of ABM segmentation into the RT\u2010planning workflow to facilitate marrow\u2010sparing strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70794","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:05:38Z","timestamp":1789697138000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of multi\u2010energy CT and fat fraction MRI for characterizing active bone marrow response to pelvic external beam radiation therapy"],"prefix":"10.1002","volume":"27","author":[{"given":"Carolyn","family":"Eckrich","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Hernando","sequence":"additional","affiliation":[{"name":"Department of Medical Physics University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jainil","family":"Shah","sequence":"additional","affiliation":[{"name":"Cancer Therapy Imaging Siemens Healthineers, Varian  Cary North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Wohlfahrt","sequence":"additional","affiliation":[{"name":"Cancer Therapy Imaging Siemens Healthineers, Varian  Forchheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lawless","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine University of Wisconsin\u2010Madison  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11547-020-01239-2"},{"key":"e_1_2_12_3_1","unstructured":"Ma\u0142kiewiczA DziedzicM Bone marrow reconversion\u2010imaging of physiological changes in bone marrow. 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