Journal of Clinical Medicine

Journal Browser

► Journal Browser

Optimizing Radiotherapy in Clinical Practice: Innovation and Outcomes

Share This Special Issue

Special Issue Editors

Dr. Sarah Han-Oh

E-Mail Website
Guest Editor

Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
Interests: radiotherapy safety and quality; respiratory-induced tumor motion management for radiotherapy; AI-assisted radiotherapy; radiation therapy accreditation; microwave imaging for radiotherapy

Dr. Senthamizhchelvan Srinivasan

E-Mail Website
Guest Editor

Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Interests: molecular imaging; theranostics; radiopharmaceutical therapy dosimetry; spatially fractionated radiotherapy; IORT

Dr. Joseph Moore

E-Mail Website
Guest Editor

Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
Interests: radiation oncology; radiotherapy

Special Issue Information

Dear Colleagues,

Radiation oncology is one of the most technologically dynamic fields in medicine, with innovations rapidly developed and adopted to improve cancer treatment outcomes while preserving patients’ quality of life. This Special Issue will highlight emerging state-of-the-art technologies that have the potential to transform clinical practice and deliver superior patient outcomes. We invite original research articles on clinical applications and innovations in areas such as AI-assisted radiotherapy, personalized radiopharmaceutical therapy, and online adaptive radiotherapy, where these innovations can advance radiotherapy more accurate, safer, and efficient (timely provision), ultimately leading to improved patient care.

Dr. Sarah Han-Oh
Dr. Senthamizhchelvan Srinivasan
Dr. Joseph Moore
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

AI-assisted automated contouring and planning
AI-assisted quality assurance
AI-assisted safety and quality improvement
radiotherapy automation
radiomics
radiotherapy error detection
personalized radiopharmaceutical therapy
theranostics
online adaptive radiotherapy
real-time treatment adaptation
image-guided radiotherapy (IGRT)
AI-assisted online adaptation
personalized radiotherapy
cone-beam CT adaptation

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.

Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.

Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.

External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.

Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (1 paper)

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

16 pages, 2276 KB

Open AccessArticle

Diagnostic and Economic Evaluation of [¹⁸F]FDG PET/CT Versus MRI for Lymph Node Staging in Nasopharyngeal Carcinoma: Implications for Individualized Upper-Neck-Only Irradiation

by Ya-Nan Zhao, Xiao-Wen Lan, Yun He, Xiao-Hui Wang, Chun-Yan Chen, Xu Zhang, Pu-Yun Ouyang and Fang-Yun Xie

J. Clin. Med. 2026, 15(5), 1849; https://doi.org/10.3390/jcm15051849 - 28 Feb 2026

Viewed by 525

Abstract

Background/Objectives: To compare diagnostic performance and cost-effectiveness of [¹⁸F]FDG PET/CT versus MRI for cervical lymph node assessment in nasopharyngeal carcinoma (NPC) and to evaluate their impact on N-staging and upper-neck-only irradiation planning. Materials and Methods: We retrospectively identified treatment-naïve NPC patients who underwent both MRI and FDG PET/CT within 14 days prior to ultrasound-guided biopsy of specific cervical lymph nodes with rigorous one-to-one multimodal matching. Using histopathology as the reference standard (Cohort A, node level), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were compared between PET/CT and MRI. In a staging cohort (Cohort B, patient level), we compared imaging-based N-staging accuracy and the pathology-concordant classification of treatment recommendations assuming upper-neck-only irradiation for N0 to N1 disease. In discordant cases (Cohort C), three experienced radiation oncologists designed dose prescriptions and neck irradiation volumes, first using MRI alone and then after reviewing PET/CT to quantify decision impact. A decision tree/Markov model (10-year horizon) evaluated cost-effectiveness of MRI- versus PET/CT-initiated strategies. Results: In total, 694 biopsy-verified lymph nodes from 649 patients were analyzed. PET/CT demonstrated higher sensitivity (96.0% vs. 92.6%, p = 0.001) and NPV (80.2% vs. 66.7%, p < 0.001) than MRI, with comparable specificity (64.0% vs. 59.0%, p = 0.317) and PPV (91.4% vs. 90.0%, p = 0.203); AUCs were 0.864 and 0.841, respectively (p = 0.298). In Cohort B (N = 503), PET/CT provided accurate N-staging for a significantly higher proportion of patients compared to MRI (8.0% vs. 4.2%, p = 0.021) and yielded more accurate recommendations for upper-neck-only irradiation when restricted to N0 to N1 disease (93.8% vs. 88.9%, p = 0.003). In discordant cases (Cohort C, N = 62), PET/CT substantially improved accuracy compared with MRI and prompted clinically meaningful plan adjustments, including dose escalation for metastatic nodes (up to 16.7%) and expansion from upper-neck-only to whole-neck irradiation with rates of 6.4%, 8.0%, and 11.3% for the three radiation oncologists, respectively. In the base case economic analysis, PET/CT achieved higher effectiveness (5.329 vs. 5.305 quality-adjusted life years [QALYs]) at higher cost (US$27,228 vs. US$25,596), with an incremental cost–effectiveness ratio (ICER) of approximately US$68,000 per QALY, remaining below a willingness-to-pay threshold of US$100,000 per QALY; probabilistic sensitivity analysis favored PET/CT in 79.6% of iterations. Conclusions: FDG PET/CT provided superior sensitivity and negative predictive value versus MRI for detecting nodal metastases in NPC, improving pathology-adjudicated N-staging and the accuracy of upper-neck-only irradiation recommendations. PET/CT was cost-effective in the modeled setting, although treatment de-escalation for benign nodes remained conservative in clinical decision-making. Full article

(This article belongs to the Special Issue Optimizing Radiotherapy in Clinical Practice: Innovation and Outcomes)

► Show Figures

Journal Menu

Journal Browser

Optimizing Radiotherapy in Clinical Practice: Innovation and Outcomes

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (1 paper)

Research

Further Information

Guidelines

MDPI Initiatives

Follow MDPI