{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:40:45Z","timestamp":1792402845504,"version":"4.4.0"},"reference-count":33,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"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":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The knowledge of the dosimetric impact of systematic source position uncertainty and the use of a methodology for robust treatment planning against such uncertainty can help improve the quality of treatment plans, during MR\u2010only cervical brachytherapy treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess the dosimetric impact of systematic source position uncertainty along the source path and evaluate strategies to minimize it during MRI\u2010only cervical high\u2010dose\u2010rate (HDR) brachytherapy treatment planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Treatment plans from 22 cervical cancer patients (FIGO stages IB2\u2013IVA; 11 intracavitary brachytherapy (ICBT), 11 interstitial brachytherapy (ISBT)) were retrospectively analyzed. Positional uncertainty was modeled by systematically shifting the source position (\u00b1\u00a01 to\u00a0\u00b1\u00a05\u00a0mm with 0\u00a0mm as the reference position) within applicators along the source path in the original plans. Dosimetric parameters, HRCTV_D90 and D\n                      <jats:sub>2cc<\/jats:sub>\n                      for organs at risk (OARs), were computed for each source position. Statistical significance was assessed via paired t\u2010test and Wilcoxon signed\u2010rank test. Targeted plans exceeding dosimetric limits for OARs were re\u2010optimized by modifying dwell times or gradients within 1\u00a0cm of the targeted OAR to improve the variability and overall OAR dosimetry.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant dosimetric changes were observed for bladder, sigmoid (all shift positions;\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      \u2264\u00a00.001) and rectum (1 to 5\u00a0mm;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0\u2264\u00a00.04) in ICBT, and for all OARs (all shift positions;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0\u2264\u00a00.003) in ISBT. HRCTV_D90 was significantly affected in ICBT from \u20102 to \u20105\u00a0mm (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0\u2264\u00a00.042) and at all shifts (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0\u2264\u00a00.033) except at \u20101 and\u00a0\u20102\u00a0mm in ISBT. Within\u00a0\u00b1\u00a05\u00a0mm shift range, the mean (maximum) drop in HRCTV_D90 and increase in OARs (bladder, bowel, rectum and sigmoid) D\n                      <jats:sub>2cc<\/jats:sub>\n                      were up to\u00a0\u22122.0\u00a0\u00b1\u00a01.9(\u22125.4)% and (6.0\u00a0\u00b1\u00a03.4(13.6)%, 0.5\u00a0\u00b1\u00a02.5(5.5)%, 2.2\u00a0\u00b1\u00a02.7(7.4)% and 1.8\u00a0\u00b1\u00a01.2(4.2)%) for ICBT, and\u00a0\u20106.2\u00a0\u00b1\u00a01.4(\u201011.9)% and (5.2\u00a0\u00b1\u00a04.6(17.2)%, 1.3\u00a0\u00b1\u00a00.9(3.0)%, 4.6\u00a0\u00b1\u00a02.5(7.6)% and 6.6\u00a0\u00b1\u00a03.6(13.8)%) for ISBT, respectively. Re\u2010optimized plans showed improved robustness of dosimetry against source positional uncertainty for the targeted OAR with the same or better dosimetry for other OARs and HRCTV. The strategies to obtain this robustness were patient and applicator\u2010type dependent.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Systematic source position uncertainty significantly influences dosimetry in MRI\u2010only cervical HDR brachytherapy. Adjusting dwell times and gradients near the targeted OAR could minimize this effect.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70810","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:21:53Z","timestamp":1790158913000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dosimetric evaluation of systematic source position uncertainty along the source path and robust planning during MRI\u2010only cervical HDR brachytherapy"],"prefix":"10.1002","volume":"27","author":[{"given":"Amritpal","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Physics Toronto Metropolitan University  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffi","family":"Karshafian","sequence":"additional","affiliation":[{"name":"Department of Physics Toronto Metropolitan University  Toronto Ontario Canada"},{"name":"Institute for Biomedical Engineering, Science and Technology (IBEST)  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananth","family":"Ravi","sequence":"additional","affiliation":[{"name":"Department of Physics Toronto Metropolitan University  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-1704","authenticated-orcid":false,"given":"Moti Raj","family":"Paudel","sequence":"additional","affiliation":[{"name":"Department of Physics Toronto Metropolitan University  Toronto Ontario Canada"},{"name":"Department of Medical Physics Sunnybrook Health Science Centre  Toronto Ontario Canada"},{"name":"Department of Radiation Oncology University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24247"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.22034\/APJCP.2018.19.10.2745"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.05.033"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.07.017"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20101673.2008.02025.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2011.08.007"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2012.09.005"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2016.01.005"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2020.06.007"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2011.12.024"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2010.06.004"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2018.73755"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2009.05.003"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2023.132697"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/15330338211041201"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2013.39453"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167\u20108140(01)00300\u20100"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971\u20106203.83491"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2009.07.002"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/52\/17\/N03"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v12i1.3355"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3181539"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v12i4.3447"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2020.98119"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.07.1541"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2008.09.002"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2009.10.015"},{"key":"e_1_2_11_29_1","unstructured":"TanderupK P\u00f6tterR LindegaardJ et\u00a0al.Image guided intensity modulated external beam radiochemotherapy and MRI based adaptive brachytherapy in locally advanced Cervical cancer.EMBRACE II study Protoc v10. 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