{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:50:46Z","timestamp":1792104646101,"version":"4.4.0"},"reference-count":42,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","physicamedica.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Physica Medica"],"published-print":{"date-parts":[[2026,8]]},"DOI":"10.1016\/j.ejmp.2026.105863","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T09:29:11Z","timestamp":1782206951000},"page":"105863","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["Reducing patient-specific QA workload through statistical process control and complexity metrics"],"prefix":"10.1016","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6946-5478","authenticated-orcid":false,"given":"Laurent","family":"Bartolucci","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6390-5849","authenticated-orcid":false,"given":"Anthony","family":"Richert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halima El","family":"Azhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphine","family":"Jarnet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudine","family":"Niederst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Arbor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Dehaynin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4505-4737","authenticated-orcid":false,"given":"Philippe","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ejmp.2026.105863_b0005","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1002\/acm2.13294","article-title":"Survey of patient-specific quality assurance practice for IMRT and VMAT","volume":"22","author":"Chan","year":"2021","journal-title":"J Appl Clin Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0010","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1002\/mp.12810","article-title":"AAPM TG 218 - Tolerance limits and methodologies for IMRT measurement-based verification QA","volume":"45","author":"Miften","year":"2018","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0015","unstructured":"Alber, Welleweerd. Booklet 9: Guidelines for the verification of IMRT. 2008."},{"key":"10.1016\/j.ejmp.2026.105863_b0020","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/mp.17468","article-title":"Which failures do patient-specific quality assurance systems need to catch?","volume":"52","author":"O\u2019Daniel","year":"2025","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0025","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1120\/jacmp.v15i5.4935","article-title":"A six\u2010year review of more than 13,000 patient\u2010specific IMRT QA results from 13 different treatment sites","volume":"15","author":"Pulliam","year":"2014","journal-title":"J Appl Clin Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0030","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1118\/1.3514120","article-title":"Dosimetry tools and techniques for IMRT","volume":"38","author":"Low","year":"2011","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0035","doi-asserted-by":"crossref","DOI":"10.1177\/15330338221114499","article-title":"Sensitivity of three patient-specific quality assurance systems to MLC aperture errors with volumetric modulated arc therapy","volume":"21","author":"Hu","year":"2022","journal-title":"Technol Cancer Res Treat"},{"key":"10.1016\/j.ejmp.2026.105863_b0040","doi-asserted-by":"crossref","first-page":"897","DOI":"10.3390\/bioengineering12080897","article-title":"A time-series approach for machine learning-based patient-specific quality assurance of radiosurgery plans","volume":"12","author":"Buzzi","year":"2025","journal-title":"Bioengineering"},{"key":"10.1016\/j.ejmp.2026.105863_b0045","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejmp.2023.102548","article-title":"An effective and optimized patient-specific QA workload reduction for VMAT plans after MLC-modelling optimization","volume":"107","author":"Marsac","year":"2023","journal-title":"Phys Med"},{"key":"10.1016\/j.ejmp.2026.105863_b0050","article-title":"Virtual patient-specific quality assurance of IMRT using UNet++: classification, gamma passing rates prediction, and dose difference prediction","volume":"11","author":"Huang","year":"2021","journal-title":"Front Oncol"},{"key":"10.1016\/j.ejmp.2026.105863_b0055","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ejmp.2019.05.024","article-title":"Use of metrics to quantify IMRT and VMAT treatment plan complexity: a systematic review and perspectives","volume":"64","author":"Antoine","year":"2019","journal-title":"Phys Med"},{"key":"10.1016\/j.ejmp.2026.105863_b0060","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s13246-014-0274-9","article-title":"Treatment plan complexity metrics for predicting IMRT pre-treatment quality assurance results","volume":"37","author":"Crowe","year":"2014","journal-title":"Australas Phys Eng Sci Med"},{"key":"10.1016\/j.ejmp.2026.105863_b0065","doi-asserted-by":"crossref","DOI":"10.1118\/1.4810969","article-title":"Impact of plan parameters on the dosimetric accuracy of volumetric modulated arc therapy: Plan parameters and VMAT dosimetric accuracy","volume":"40","author":"Masi","year":"2013","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0070","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1118\/1.3276775","article-title":"A new metric for assessing IMRT modulation complexity and plan deliverability: New metric for assessing IMRT complexity and deliverability","volume":"37","author":"McNiven","year":"2010","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0075","doi-asserted-by":"crossref","first-page":"7315","DOI":"10.1088\/0031-9155\/59\/23\/7315","article-title":"Modulation indices for volumetric modulated arc therapy","volume":"59","author":"Park","year":"2014","journal-title":"Phys Med Biol"},{"key":"10.1016\/j.ejmp.2026.105863_b0080","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.1088\/0031-9155\/48\/14\/301","article-title":"Use of a quantitative index of beam modulation to characterize dose conformality: illustration by a comparison of full beamlet IMRT, few-segment IMRT (fsIMRT) and conformal unmodulated radiotherapy","volume":"48","author":"Webb","year":"2003","journal-title":"Phys Med Biol"},{"key":"10.1016\/j.ejmp.2026.105863_b0085","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1120\/jacmp.v17i4.6241","article-title":"Predicting deliverability of volumetric-modulated arc therapy (VMAT) plans using aperture complexity analysis","volume":"17","author":"Younge","year":"2016","journal-title":"J Appl Clin Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0090","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20190270","article-title":"Complexity metrics for IMRT and VMAT plans: a review of current literature and applications","volume":"92","author":"Chiavassa","year":"2019","journal-title":"BJR"},{"key":"10.1016\/j.ejmp.2026.105863_b0095","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.ijrobp.2022.04.040","article-title":"Prospective clinical validation of virtual patient-specific quality assurance of volumetric modulated arc therapy radiation therapy plans","volume":"113","author":"Wall","year":"2022","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0100","article-title":"Prediction models as decision-support tools for virtual patient-specific quality assurance of helical tomotherapy plans","volume":"26","author":"Cavinato","year":"2023","journal-title":"Phys Imaging Radiat Oncol"},{"key":"10.1016\/j.ejmp.2026.105863_b0105","article-title":"Multi-institutional generalizability of a plan complexity machine learning model for predicting pre-treatment quality assurance results in radiotherapy","volume":"29","author":"Claessens","year":"2024","journal-title":"Phys Imaging Radiat Oncol"},{"key":"10.1016\/j.ejmp.2026.105863_b0110","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.radonc.2020.09.038","article-title":"What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans","volume":"153","author":"Hernandez","year":"2020","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ejmp.2026.105863_b0115","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.radonc.2022.06.005","article-title":"Plan quality assessment in clinical practice: results of the 2020 ESTRO survey on plan complexity and robustness","volume":"173","author":"Kaplan","year":"2022","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ejmp.2026.105863_b0120","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejmp.2025.105026","article-title":"Exploring plan quality: using plan complexity to quantitatively analyse the tradeoff between clinical suitability and dosimetric accuracy","volume":"136","author":"Cavinato","year":"2025","journal-title":"Phys Med"},{"key":"10.1016\/j.ejmp.2026.105863_b0125","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1136\/qshc.2006.018093","article-title":"Walter a Shewhart, 1924, and the Hawthorne factory","volume":"15","author":"Best","year":"2006","journal-title":"Qual Saf Health Care"},{"key":"10.1016\/j.ejmp.2026.105863_b0130","doi-asserted-by":"crossref","first-page":"3961","DOI":"10.1002\/mp.17081","article-title":"Incorporating plan complexity into the statistical process control of volumetric modulated arc therapy pre\u2010treatment verifications","volume":"51","author":"Russo","year":"2024","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0135","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1120\/jacmp.v14i6.4286","article-title":"Optimized Varian aSi portal dosimetry: development of datasets for collective use","volume":"14","author":"Esch","year":"2013","journal-title":"J Appl Clin Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0140","unstructured":"ANSM. D\u00e9cision du 28\/02\/2023 fixant les modalit\u00e9s du contr\u00f4le de qualit\u00e9 des installations de radioth\u00e9rapie externe et de radiochirurgie 2023."},{"key":"10.1016\/j.ejmp.2026.105863_b0145","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1118\/1.598248","article-title":"A technique for the quantitative evaluation of dose distributions","volume":"25","author":"Low","year":"1998","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0150","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1118\/1.1598711","article-title":"Evaluation of the gamma dose distribution comparison method","volume":"30","author":"Low","year":"2003","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0155","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ejmp.2017.03.001","article-title":"Challenges in calculation of the gamma index in radiotherapy \u2013 Towards good practice","volume":"36","author":"Hussein","year":"2017","journal-title":"Phys Med"},{"key":"10.1016\/j.ejmp.2026.105863_b0160","doi-asserted-by":"crossref","DOI":"10.1118\/1.4789580","article-title":"On the sensitivity of common gamma-index evaluation methods to MLC misalignments in Rapidarc quality assurance: on the sensitivity of common Gamma-index evaluation to MLC misalignments","volume":"40","author":"Heilemann","year":"2013","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0165","doi-asserted-by":"crossref","DOI":"10.1002\/acm2.14318","article-title":"A radiotherapy community data-driven approach to determine which complexity metrics best predict the impact of atypical TPS beam modeling on clinical dose calculation accuracy","volume":"25","author":"Brooks","year":"2024","journal-title":"J Appl Clin Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0170","doi-asserted-by":"crossref","DOI":"10.1002\/mp.70144","article-title":"Quantification of the aperture modulation in radiotherapy treatment plans","volume":"52","author":"Hernandez","year":"2025","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0175","first-page":"69","article-title":"A guide to appropriate use of correlation coefficient in medical research","volume":"24","author":"Mukaka","year":"2012","journal-title":"Malawi Med J"},{"key":"10.1016\/j.ejmp.2026.105863_b0180","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1002\/mp.15346","article-title":"A robust approach to establish tolerance limits for the gamma passing rate-based patient-specific quality assurance using the heuristic control charts","volume":"49","author":"Xiao","year":"2022","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0185","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.zemedi.2023.02.003","article-title":"Reduction of patient specific quality assurance through plan complexity metrics for VMAT plans with an open-source TPS script","volume":"34","author":"Uher","year":"2024","journal-title":"Zeitschrift F\u00fcr Medizinische Physik"},{"key":"10.1016\/j.ejmp.2026.105863_b0190","doi-asserted-by":"crossref","DOI":"10.1088\/1361-6560\/acf43a","article-title":"Patient specific quality assurance in SBRT: a systematic review of measurement-based methods","volume":"68","author":"Malatesta","year":"2023","journal-title":"Phys Med Biol"},{"key":"10.1016\/j.ejmp.2026.105863_b0195","doi-asserted-by":"crossref","first-page":"5408","DOI":"10.1002\/mp.14472","article-title":"A Bayesian control chart based on the beta distribution for monitoring the two\u2010dimensional gamma index pass rate in the context of patient\u2010specific quality assurance","volume":"47","author":"Tiplica","year":"2020","journal-title":"Med Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0200","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejmp.2024.103208","article-title":"A TPS integrated machine learning tool for predicting patient-specific quality assurance outcomes in volumetric-modulated arc therapy","volume":"118","author":"Noblet","year":"2024","journal-title":"Phys Med"},{"key":"10.1016\/j.ejmp.2026.105863_b0205","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.ijrobp.2019.07.049","article-title":"Machine learning for patient-specific quality assurance of VMAT: prediction and classification accuracy","volume":"105","author":"Li","year":"2019","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ejmp.2026.105863_b0210","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.ijrobp.2019.09.003","article-title":"Complexity in radiation therapy: it\u2019s complicated","volume":"106","author":"Kamperis","year":"2020","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Physica Medica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S112017972600150X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S112017972600150X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T22:43:19Z","timestamp":1792104199000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S112017972600150X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":42,"alternative-id":["S112017972600150X"],"URL":"https:\/\/doi.org\/10.1016\/j.ejmp.2026.105863","relation":{},"ISSN":["1120-1797"],"issn-type":[{"value":"1120-1797","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Reducing patient-specific QA workload through statistical process control and complexity metrics","name":"articletitle","label":"Article Title"},{"value":"Physica Medica","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ejmp.2026.105863","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"105863"}}