{"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":1789700524816,"version":"4.0.1"},"reference-count":46,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":13,"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"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}],"id":[{"id":"10.13039\/100000054","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":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Online adaptive radiotherapy (OART) modifies treatment plans using anatomy\u2010of\u2010the\u2010day imaging, but successful clinical implementation depends on automated planning strategies that can generate high\u2010quality plans within the constraints of an online workflow. This narrative review compares the automated planning architectures of the Varian Ethos and Elekta Unity\/Monaco systems using a targeted literature search through July 2026. Ethos generates a daily adapted plan through goal\u2010prioritized supervisory optimization governed by an unchanged clinical directive. Unity\/Monaco provides Adapt\u2010to\u2010Position (ATP) and Adapt\u2010to\u2010Shape (ATS) pathways, with methods ranging from reference\u2010segment recalculation and refinement to full online replanning with newly optimized fluence and segments. Rather than representing opposing planning paradigms, these systems differ in how ordered clinical goals or reference\u2010plan information guide a selected adaptation method and in the degrees of freedom available within that method. Representative workflow and implementation studies are reviewed to provide clinical context, but they do not support direct comparisons of platform performance or superiority. MRIdian is acknowledged as another established MR\u2010guided adaptive platform, although its planning architecture is beyond the scope of this focused review. Accordingly, the comparison is best understood by asking what guides the selected adaptation method and which degrees of freedom that method permits, rather than as a binary distinction between flexible and reference\u2010based planning. This framework provides a conceptual basis for interpreting current commercial OART systems and may help guide the future development and evaluation of automated adaptive planning technologies.<\/jats:p>","DOI":"10.1002\/acm2.70797","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:09:59Z","timestamp":1789452599000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Automated planning architectures for online adaptive radiotherapy: A narrative review of the Ethos and Unity\/Monaco platforms"],"prefix":"10.1002","volume":"27","author":[{"given":"Songye","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Medical Physics Memorial Sloan Kettering Cancer Center  New York New York USA"},{"name":"Department of Radiation Oncology, Wilmot Cancer Institute University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria F.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Wilmot Cancer Institute University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16061206"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.10.021"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/42\/1\/008"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1201\/b10517"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/accdb2"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1088\/978-0-7503-6119-4"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/15330338261449016"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13526"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.01.012"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2335486"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aae24c"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aae24f"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1533033819873922"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/53\/3\/011"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2022.06.004"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2020.07.003"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tipsro.2024.100239"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20190594"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12194-024-00828-4"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053\u20104296(99)80052\u20106"},{"issue":"2","key":"e_1_2_15_22_1","first-page":"77","article-title":"Making on\u2010line adaptive radiotherapy possible using artificial intelligence and machine learning for efficient daily re\u2010planning","volume":"8","author":"Archambault Y","year":"2020","journal-title":"Med Phys Int"},{"key":"e_1_2_15_23_1","unstructured":"Systems Varian Medical.Ethos algorithms reference guide. 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