Review Reports

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

Thank you very much for the opportunity to review the revised manuscript. The authors made substantial changes according to the recommendations and the manuscript is now suitable for publication. 

Author Response

Thank you for your review. 

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

This new version of the paper has been improved in several parts. There is now consistency between the abstract and the main body of the paper, although some imperfections in the writing remain. Mixed reality has now been added; however, the paper does not consider any specific details regarding this topic.

Methods – “...and Scopus databases to capture the landscape of virtual reality (VR), augmented reality (AR), and mixed reality (MR). The...” The acronyms VR and AR are already defined in the Introduction, so it is not necessary to repeat them here. MR is also introduced , but the paper mainly focuses on VR and AR, without providing any examples of MR. In addition, the last sentence of the Introduction refers only to VR and AR, not to MR. How do you justify this?

Methods – “...we conducted an additional search of the ClinicalTrials.gov registry in August 2025.” Why August 2025? I suggest including more recent trials, as the paper is being written in 2026.

Results – Subchapter 3.1.1 is not necessary, as section “3.1. Virtual and Augmented Reality in Radiation Oncology” does not appear to have any other subchapters.

Why is “3.1. Virtual and Augmented Reality in Radiation Oncology” written in italics while the other sections are in capital letters? Please use consistent formatting throughout.

Results – Table 2 - Why is Table 2 presented before Table 1? Please consider renumbering the tables to follow the logical flow of the paper.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report (Previous Reviewer 3)

Comments and Suggestions for Authors

The authors have worked to address and resolve the proposed comments. However, despite these efforts, several issues still need to be resolved before the manuscript can be considered for publication. I outline them below:

1. Systematic character of the review. The authors added several elements to the manuscript’s methodology, including PubMed and Scopus, a Boolean search string, the 2010–2026 time range, inclusion/exclusion criteria, and a PRISMA-like diagram on page 4. This clearly improves the manuscript. However, key elements are still missing, including the exact search date for PubMed/Scopus, a clear description of the screening process (who performed the screening, whether it was done independently, and how discrepancies were resolved), and any assessment of quality/risk of bias. In addition, the abstract still states that the review was conducted using four “keywords,” which does not accurately reflect the more developed methodology described later. Therefore, I do not consider this point to be fully resolved. Please correct it.
2. Although the authors used expressions such as “pilot randomized trial,” “phantom-based evaluation,” “clinical evidence remains preliminary,” and acknowledged that a standardized positioning system is not yet ready for widespread use, the wording remains overly optimistic in several parts of the manuscript, especially in the abstract (“transformative tools,” “hold considerable promise”) and in the conclusion, where the tone is still more affirmative than the available evidence allows. Please work on correcting this inconsistency.
3. Regarding the qualitative component, the authors added that they used thematic analysis and created a subsection for qualitative results, which does improve the reporting. However, it is still not clearly stated how many interviews were conducted, how participants were selected, whether interviews were recorded/transcribed, how the data were coded, whether more than one analyst was involved, whether saturation was considered, or whether verbatim quotations were included. Please include this information.

In addition, there is an inconsistency in the point-by-point response: the authors state that three themes emerged, whereas the revised manuscript reports four themes. Please clarify this.

4. Regarding confidentiality/patient data access, it is true that the authors moved this issue to the discussion and now present it more as a theoretical opportunity, with caveats regarding security, regulation, and integration with EHRs. However, the underlying problem remains. The manuscript still retains “Confidential Data Access” as a formal application in Table 2, with benefits framed in a rather assertive way, and it also includes an AI-generated figure of a physician using VR/AR on an airplane, which reinforces precisely the sense of futuristic speculation that the reviewer criticized. Even more concerning, the text mentions “preliminary firsthand observations,” that is, an unpublished basis. Please resolve this and ensure harmony throughout the manuscript.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

none

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you very much for allowing me to review this interesting manuscript. This report focuses on a very relevant and timely topic of current uses and future applications of augmented and virtual reality in radiation oncology. The manuscript is very informative. However, the methods, structure and the flow of the manuscript are incoherent and confusing. The abstract describes methods used in this study as 1) a systematic search of pubmed; 2) online survey of radiation oncologists and residents; and 3) semistructured interviews of physicians, residents, therapists and a staff psychologist at a tertiary cancer centre. However, neither the abstract, nor the body of the manuscript specify sources of their results and the body of the manuscript does not include Methods section at all. The flow diagram of the identified, included and excluded studies is missing. The results include description of included studies summarized by specific uses of AR and VR in radiation oncology but the results of the online survey is in the discussion section and not in the results section. The results of the semistructured interviews are not mentioned at all (at least not explicitly stating their original qualitative results versus the sources of their data being literature review). Is this review perhaps a part of a larger more comprehensive study that is not reported on here fully? If so, the authors need to explain this. This manuscript has a good potential but the issues I listed above need to be addressed before I would recommend this manuscript for publication. 

Reviewer 2 Report

Comments and Suggestions for Authors

General considerations

The aim of this work is “The Contemporary Role of Virtual and Augmented Reality in Radiation Oncology: A Review.”

The topic is potentially interesting; however, several issues need to be clarified.

The abstract is organized into the following sections: Purpose, Methods, Results, and Conclusion. Why does the main manuscript not follow the same structure?

In the body of the paper, methods, results, and discussion are intermixed and lack a clear organization.

Additionally, several parts included in the “Discussion” section do not constitute a true discussion. Instead, they present results or methodological details and should be moved to appropriate Methods or Materials sections (which are currently missing).

I recommend revising the manuscript to ensure a clearer and more rigorous scientific structure.

Details:

1. page 6, lines 242-244. “One such system superimposes virtual data onto the…” What system? please specify.

 

2. page 6, lines 252-256 “Similarly, 252 other investigations have confirmed that AR guidance can significantly reduce alignment 253 errors by enhancing the spatial awareness...”. Please add here results.

 

3. page 6, lines 272-273 “AR-enabled smart glasses can display sensitive patient information privately, enabling 272 charting, treatment planning, and real-time decision-making (Figure 1).” It is not clear if this sentence refers to reality or fiction, please specify in detail.

 

4. pages 7-8, lines 309-330 This paragraph is a result not a discussion, please, move it in a proper part.

 

5. page 8, lines 336-345. This paragraph is not a discussion, please, move it in a proper part.

 

6. Table 1 and 2 should be not into discussion. Table 2 summarize key benefits and limitations and barriers. In the paper limitations and barriers should be analysed and commented.

Reviewer 3 Report

Comments and Suggestions for Authors

The submitted manuscript, “The Contemporary Role of Virtual and Augmented Reality in Radiation Oncology: A Review,” although potentially interesting, is presented in an erroneous manner and conflates different research designs. It lacks the methodological rigor required for publication. Below, I provide an analysis of the most important concerns.

-The manuscript does not have a clearly defined study design.
The abstract presents it as a review with a “systematic” PubMed search, but it also adds an online survey and semistructured interviews. In practice, this turns it into a hybrid manuscript (review + survey + qualitative component), yet none of these three components is reported with sufficient rigor. Moreover, the abstract states that the survey targeted “radiation oncologists and residents,” whereas the discussion describes it as a survey of “practicing radiation oncologists” with 34 responses out of approximately 330 contacted. This conceptual inconsistency substantially weakens the manuscript’s methodological credibility.

-The review component is far too insufficiently reported to be called systematic.
The manuscript only mentions a PubMed search using four general terms. It does not report the search date, the full search strategy, Boolean operators, inclusion/exclusion criteria, screening process, number of included studies, data extraction procedures, or any assessment of study quality or risk of bias. At this level of reporting, the use of the term “systematic” is methodologically overstated. In a serious journal, this would likely be identified immediately.

The synthesis is predominantly descriptive rather than genuinely critical.
The manuscript lists applications and benefits, but it rarely appraises or hierarchizes the evidence. Pilot studies, phantom studies, case reports, one systematic review, institutional experiences, and opinion-based contributions are all discussed at nearly the same level. As a result, the reader cannot distinguish which findings are promising but preliminary, which are reproducible, and which remain merely feasible. Table 2 summarizes benefits and barriers, but it does not provide evidence grading, study design, magnitude of effect, or level of certainty. This substantially limits the academic value of the paper.

-There are overstatements in relation to an empirical base that remains small and heterogeneous.
The abstract presents concrete figures—for example, anxiety reduction of 26–56%, segmentation time reduction of 41–58%, and the feasibility of AR-based positioning—that sound robust, but the manuscript does not adequately contextualize the heterogeneity of those studies, their sample sizes, their limitations, or their transferability to real clinical practice. In several sections, the tone is closer to technological promotion than to prudent scientific evaluation.

-The national survey adds little value because of how it is presented.
The manuscript states that it obtained only 34 responses, with a response rate of 10.3%, and it acknowledges possible non-response bias. With this level of participation, the survey may serve as an exploratory signal, but not as strong support for national-level conclusions. In addition, the instrument, validation process, domains, response scale, recruitment strategy, analysis, and participant profile are not described. Therefore, this component appears to have been added more as narrative reinforcement than as a robust methodological contribution.

-The qualitative component is virtually unreported.
The abstract announces semistructured interviews with physicians, residents, therapists, and a psychologist, but the manuscript does not subsequently develop qualitative results in terms of method, saturation, analytical framework, quotations, themes, or subthemes. In other words, it declares a qualitative component that never truly materializes as such. This creates the impression of an incomplete study design.

-The confidentiality/patient data access section is the weakest and least convincing part of the manuscript.
It is poorly anchored in evidence specific to radiation oncology, relies on a very general reference about AR in healthcare, and the visual example of a physician reviewing confidential data on an airplane through VR/AR interfaces feels more futuristic and speculative than scientifically useful. In a clinical review, this section may be perceived as tangential and may even detract from the seriousness of the article.