{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T08:42:04Z","timestamp":1775983324142,"version":"3.50.1"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007219","name":"Natural Science Foundation of Shanghai Municipality","doi-asserted-by":"publisher","award":["23ZR1460200"],"award-info":[{"award-number":["23ZR1460200"]}],"id":[{"id":"10.13039\/100007219","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2025,11]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Carbon\u2010ion radiotherapy employs distinct relative biological effectiveness (RBE) models\u2014the local effect model (LEM) and the microdosimetric kinetic model (MKM)\u2014which differ in their dependencies on dose\u2010averaged linear energy transfer (\n LETd<\/jats:italic>\n ) and absorbed dose. Conversion factors (CFs) between these models are essential for translating clinical outcomes across institutions; however, previous studies have neglected\n LETd\u2010<\/jats:italic>\n driven spatial heterogeneity.\n <\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n \n This study aimed to quantify the impact of\n LETd<\/jats:italic>\n on CFs by establishing a voxel\u2010level framework for iso\u2010effective dose conversion and validating its clinical applicability.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n RayStation\u2010optimized plans included cubic and spherical targets, as well as clinical cases of prostate and lung cancer. CFs were derived by comparing LEM\u2010 and MKM\u2010based RBE\u2010weighted doses. A conversion model correlating\n LETd<\/jats:italic>\n with MKM\/LEM parameters (, ) was developed using cubic plans (1\u201312\u00a0cm modulation depths) and validated against RayStation calculations. Spatial CF variations were analyzed across dose levels (\u226410\u00a0Gy[RBE]) and\n LETd<\/jats:italic>\n values (\u2264210.4\u00a0keV\/\u00b5m).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n CFs showed primary dependence on dose and\n LETd<\/jats:italic>\n . Smaller targets (2\u2010cm cubic) demonstrated higher\n LETd<\/jats:italic>\n (83.0\u00a0keV\/\u00b5m) compared with larger targets (12\u2010cm cubic, 38.4\u00a0keV\/\u00b5m) and lower CFs (1.03\u00a0vs 1.13 at 4\u00a0Gy [RBE]). In cube plan targets (e.g., a 6\u2010cm cube at 7\u00a0cm depth), the model predicted voxel\u2010level doses with <2% error.\n LETd<\/jats:italic>\n variations (36\u2013100\u00a0keV\/\u00b5m) introduced approximately 5% CF uncertainty. Clinical validations showed \u22640.5% dose discrepancies in targets but revealed\n LETd<\/jats:italic>\n \u2010driven heterogeneity in Bragg peaks.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n LETd<\/jats:italic>\n \u2010induced spatial CF variability necessitates voxel\u2010level analysis for precise dose conversion. The proposed framework supports\n LETd<\/jats:italic>\n \u2010aware treatment planning and cross\u2010model interoperability, although clinical adoption will require tumor\u2010specific CFs and validation in complex anatomies.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/mp.70111","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:05:36Z","timestamp":1761894336000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Voxel\u2010level linear energy transfer\u2010driven dose conversion factors between LEM\u2010 and MKM\u2010based treatment plans in carbon\u2010ion radiotherapy"],"prefix":"10.1002","volume":"52","author":[{"given":"Weiwei","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Medical Physics Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy Shanghai China"},{"name":"Institute of Modern Physics Applied Ion Beam Physics Laboratory Fudan University Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Shanghai Proton and Heavy Ion Center Shanghai Key Laboratory of Radiation Oncology Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinxiangzi","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingfang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai Key Laboratory of Radiation Oncology Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"issue":"1","key":"e_1_2_9_2_1","first-page":"1","article-title":"Prescribing, recording, and 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