{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:59:32Z","timestamp":1791381572660,"version":"4.3.3"},"reference-count":15,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T00:00:00Z","timestamp":1754611200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"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":["Medical Physics"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Converging lens radiotherapy (CLRT) is a novel radiotherapy modality employing a lens which produces a nearly monoenergetic x\u2010ray beam at 60\u00a0keV to focus radiation on deep\u2010seated tumors, enabling highly precise dose\u00a0delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study represents the first comparison of CLRT treatment plan quality to conventional intensity\u2010modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). The goal is to provide a proof\u2010of\u2010concept of CLRT treatment planning and to evaluate whether CLRT could potentially offer improved organ\u2010at\u2010risk (OAR) sparing and target\u00a0coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The physical CLRT prototype system was developed by Convergent Radiotherapy and Radiosurgery Ltd. (CRnR) in Haifa, Israel, under the product name\n                      <jats:italic>AngelCure<\/jats:italic>\n                      . We initially characterized the CLRT beam model using Monte Carlo simulations, validating it with film dosimetry of the physical beam. Subsequently, we developed a 3D dose computation algorithm and novel inverse, non\u2010coplanar treatment planning for CLRT inside the open\u2010source radiation treatment planning platform\n                      <jats:italic>matRad<\/jats:italic>\n                      . Two prototype lenses with different focal spot sizes (A \u00a0mm and B \u00a0mm) were employed. Using these tools, we performed CLRT treatment plan optimization for selected treatment sites and compared our results retrospectively to conventional IMRT\/VMAT patient plans from the Dana\u2010Farber Brigham Cancer Center clinical database, which were generated in\n                      <jats:italic>Eclipse<\/jats:italic>\n                      (Varian Medical Systems, Palo Alto, CA, USA). Here, we present three cases from the central nervous system (CNS), thoracic, and genitourinary (GU) sites. We utilized conformity index (CI), target coverage index (TCI), conformal number (CN), and gradient index (GI) as plan quality metrics, together with dose\u2010volume histogram points to compare OAR\u00a0sparing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CLRT demonstrated variable OAR dose sparing. In the CNS case, both lenses showed better hypothalamus sparing, with 0% of the volume receiving 400\u00a0cGy or more compared to 91% for Linac. For the Thoracic case, Lens A achieved 0% of esophagus volume receiving more than 1000\u00a0cGy, versus 11% for Linac. In the GU case, Lens A delivered at least 400\u00a0cGy to 0% of rectum volume, compared to 17% with Linac. CLRT demonstrated potentially better or comparable plan quality metrics, with Lens A showing perfect conformity (CI\u00a0=\u00a01.00) in the CNS case and Lens B demonstrating the steepest dose gradient (GI\u00a0=\u00a0240%\/cm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study serves as a first proof\u2010of\u2010concept of the treatment capabilities of a novel CLRT x\u2010ray system. The system demonstrated, in this limited set of plans, better OAR dose sparing compared to conventional Linac\u2010based plans across 3 different anatomical sites, accompanied by similar, and possibly better, plan quality metrics (CI, TCI, CN, GI), while maintaining comparable target\u00a0coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.18007","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T06:00:30Z","timestamp":1754719230000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Converging lens radiotherapy (CLRT) employing kilovoltage x\u2010ray source: Treatment planning study"],"prefix":"10.1002","volume":"52","author":[{"given":"Marvin","family":"Kinz","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Brigham and Women's Hospital, Dana\u2010Farber Cancer Institute Harvard Medical School Boston Massachusetts USA"},{"name":"Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty Mannheim Heidelberg University Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi","family":"Alfassi","sequence":"additional","affiliation":[{"name":"Convergent Radiotherapy and Radiosurgery Ltd. Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Gebert","sequence":"additional","affiliation":[{"name":"Convergent Radiotherapy and Radiosurgery Ltd. Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dror","family":"Alezra","sequence":"additional","affiliation":[{"name":"Convergent Radiotherapy and Radiosurgery Ltd. Haifa Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Hesser","sequence":"additional","affiliation":[{"name":"Mannheim Institute for Intelligent Systems in Medicine (MIISM), Medical Faculty Mannheim Heidelberg University Mannheim Germany"},{"name":"Interdisciplinary Center for Scientific Computing (IWR) Heidelberg University Heidelberg Germany"},{"name":"Central Institute for Computer Engineering (ZITI) Heidelberg University Heidelberg Germany"},{"name":"CZS Heidelberg Center for Model\u2010Based AI Heidelberg University Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Zygmanski","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Brigham and Women's Hospital, Dana\u2010Farber Cancer Institute Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2017.08.002"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-98888-8"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ac5c8f"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2020.11.001"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/ad111a"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13153"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4866224"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1088\/2057-1976\/ab36c1"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12251"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpor.2020.03.002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.78.1492"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3438081"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.10.042"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2017.09.007"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.11.214"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.18007","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mp.18007","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.18007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:38:25Z","timestamp":1791380305000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.18007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":15,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1002\/mp.18007"],"URL":"https:\/\/doi.org\/10.1002\/mp.18007","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-01-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e18007"}}