{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:13:33Z","timestamp":1787238813040,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical evidence has demonstrated that proton therapy can achieve comparable tumor control probabilities compared to conventional photon therapy but with the added benefit of sparing healthy tissues. However, proton therapy is sensitive to inter\u2010fractional anatomy changes. Online pre\u2010fraction evaluation can effectively verify proton dose before delivery to patients, but\u00a0there is a lack of guidelines for implementing this workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study is to develop a cone\u2010beam CT\u2010based (CBCT) online evaluation framework for proton therapy that enables knowledge transparency and evaluates the efficiency and accuracy of each essential component.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty\u2010three patients with various lesion sites were included to conduct a retrospective study of implementing the proposed CBCT evaluation framework for the clinic. The framework was implemented on the RayStation 11B Research platform. Two synthetic CT (sCT) methods, corrected CBCT (cCBCT), and virtual CT (vCT), were used, and the ground truth images were acquired from the same\u2010day deformed quality assurance CT (dQACT) for the comparisons. The evaluation metrics for the framework include time efficiency, dose\u2010difference distributions (gamma passing rates), and water equivalent thickness (WET) distributions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean online CBCT evaluation times were 1.6\u00a0\u00b1\u00a00.3\u00a0min and 1.9\u00a0\u00b1\u00a00.4\u00a0min using cCBCT and vCT, respectively. The dose calculation and deformable image registration dominated the evaluation efficiency, and accounted for 33% and 30% of the total evaluation time, respectively. The sCT generation took another 19% of the total time. Gamma passing rates were greater than 91% and 97% using 1%\/1\u00a0mm and 2%\/2\u00a0mm criteria, respectively. When the appropriate sCT was chosen, the target mean WET difference from the reference were less than 0.5\u00a0mm. The appropriate sCT method choice determined the uncertainty for the framework, with the cCBCT being superior for head\u2010and\u2010neck patient evaluation and vCT being better for lung patient evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An online CBCT evaluation framework was proposed to identify the use of the optimal sCT algorithm regarding efficiency and dosimetry accuracy. The framework is extendable to adopt advanced imaging methods and has the potential to support online adaptive radiotherapy to enhance patient benefits.\u00a0It could be implemented into clinical use in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.16625","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T11:35:31Z","timestamp":1689334531000},"page":"5375-5386","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["An optimized framework for cone\u2010beam computed tomography\u2010based online evaluation for proton therapy"],"prefix":"10.1002","volume":"50","author":[{"given":"Chih\u2010Wei","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology and Winship Cancer Institute Emory University Atlanta Georgia 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