{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T03:17:10Z","timestamp":1783048630552,"version":"3.54.6"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1 KL2 TR001856"],"award-info":[{"award-number":["1 KL2 TR001856"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Radiation\u2010induced fibrosis is a common, often debilitating late effect of head and neck cancer (HNC) treatment. An updated systematic review is needed to evaluate the reliability, validity, and clinical utility of fibrosis measurement tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Cochrane Library, Medline,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/embase.com\">Embase.com<\/jats:ext-link>\n                      , and Web of Science were systematically searched. Articles were independently screened by two reviewers using COSMIN checklists for risk of bias assessment, following PRISMA guidelines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 4678 articles, 17 studies describing 13 tools met inclusion: six studies assessed four patient\u2010reported outcome measures, two assessed two clinician\u2010reported tools, and nine assessed seven imaging modalities. The Neck Fibrosis Scale, HN\u2010LEF Symptom Inventory, and LENT\u2010SOMA demonstrated validity and reliability. Young's modulus was the only imaging tool demonstrating both. Imaging studies had a higher risk of bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Several subjective tools are reliable and valid for radiation\u2010induced fibrosis assessment in HNC. Young's modulus is the only objective imaging\u2010based tool that provides evidence of both validity and reliability, though methodological limitations remain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70380","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T02:37:44Z","timestamp":1783046264000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Measurement Tools for Radiation\u2010Induced Fibrosis in Head and Neck Cancer: A Systematic Review"],"prefix":"10.1002","author":[{"given":"Vanessa","family":"Helou","sequence":"first","affiliation":[{"name":"Department of Otolaryngology University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja D.","family":"Reddy","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania 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