{"id":"https://openalex.org/W7225651218","doi":"https://doi.org/10.7577/radopen.6721","title":"Management of Clinical Variability in Radiotherapy Delivery: Explicit Treatment-Delivery Judgment and a Three-Layer Framework.","display_name":"Management of Clinical Variability in Radiotherapy Delivery: Explicit Treatment-Delivery Judgment and a Three-Layer Framework.","publication_year":2026,"publication_date":"2026-11-09","ids":{"openalex":"https://openalex.org/W7225651218","doi":"https://doi.org/10.7577/radopen.6721"},"language":"en","primary_location":{"id":"doi:10.7577/radopen.6721","doi":"https://doi.org/10.7577/radopen.6721","is_oa":true,"landing_page_url":"https://doi.org/10.7577/radopen.6721","pdf_url":"https://journals.oslomet.no/radopen/article/download/6721/5591","source":{"id":"https://openalex.org/S4210208067","display_name":"Radiography Open","issn_l":"2387-3345","issn":["2387-3345"],"is_oa":true,"is_in_doaj":true,"is_core":false,"listed_in":["ddh","doaj","norway-1"],"host_organization":"https://openalex.org/P4310314092","host_organization_name":"Nordiskt Forum f\u00f6r Forskning och Utvecklingsarbete inom Utbildning i Sl\u00f6jd (NordFo)","host_organization_lineage":["https://openalex.org/P4310314092"],"host_organization_lineage_names":["Nordiskt Forum f\u00f6r Forskning och Utvecklingsarbete inom Utbildning i Sl\u00f6jd (NordFo)"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Radiography Open","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://journals.oslomet.no/radopen/article/download/6721/5591","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5127931389","display_name":"Seungwon Park","orcid":"https://orcid.org/0009-0006-0966-7831","observed_orcids":["https://orcid.org/0009-0006-0966-7831"]},"institutions":[{"id":"https://openalex.org/I4389425440","display_name":"Samsung Changwon Hospital","ror":"https://ror.org/04wdz4v71","country_code":"KR","type":"healthcare","lineage":["https://openalex.org/I2250650973","https://openalex.org/I2802194831","https://openalex.org/I4389425440"]},{"id":"https://openalex.org/I848706","display_name":"Sungkyunkwan University","ror":"https://ror.org/04q78tk20","country_code":"KR","type":"education","lineage":["https://openalex.org/I848706"]}],"countries":["KR"],"is_corresponding":true,"raw_author_name":"Seungwon Park","raw_affiliation_strings":["Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea"],"raw_orcid":"https://orcid.org/0009-0006-0966-7831","affiliations":[{"raw_affiliation_string":"Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea","institution_ids":["https://openalex.org/I4389425440","https://openalex.org/I848706"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5127931389"],"corresponding_institution_ids":["https://openalex.org/I4389425440","https://openalex.org/I848706"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"12","issue":"1","first_page":"37","last_page":"53"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10358","display_name":"Advanced Radiotherapy Techniques","score":0.9907000064849854,"subfield":{"id":"https://openalex.org/subfields/3108","display_name":"Radiation"},"field":{"id":"https://openalex.org/fields/31","display_name":"Physics and Astronomy"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T10358","display_name":"Advanced Radiotherapy Techniques","score":0.9907000064849854,"subfield":{"id":"https://openalex.org/subfields/3108","display_name":"Radiation"},"field":{"id":"https://openalex.org/fields/31","display_name":"Physics and Astronomy"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10844","display_name":"Radiation Dose and Imaging","score":0.0013000000035390258,"subfield":{"id":"https://openalex.org/subfields/2741","display_name":"Radiology, Nuclear Medicine and Imaging"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.0013000000035390258,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/radiotherapy-delivery","display_name":"radiotherapy delivery","score":0.902999997138977},{"id":"https://openalex.org/keywords/clinical-heterogeneity","display_name":"clinical heterogeneity","score":0.9909999966621399},{"id":"https://openalex.org/keywords/cone-beam-computed-tomography","display_name":"cone-beam computed tomography","score":0.8650000095367432},{"id":"https://openalex.org/keywords/protocol-adherence","display_name":"protocol adherence","score":0.6340000033378601},{"id":"https://openalex.org/keywords/three-layer-framework","display_name":"three-layer framework","score":0.8529999852180481},{"id":"https://openalex.org/keywords/organizational-learning","display_name":"organizational learning","score":0.6010000109672546},{"id":"https://openalex.org/keywords/standard-operating-procedures","display_name":"standard operating procedures","score":0.7760000228881836},{"id":"https://openalex.org/keywords/patient-safety","display_name":"patient safety","score":0.8180000185966492},{"id":"https://openalex.org/keywords/radiation-therapists","display_name":"radiation therapists","score":0.531000018119812},{"id":"https://openalex.org/keywords/quality-assurance","display_name":"quality assurance","score":0.4749999940395355}],"concepts":[{"id":"https://openalex.org/C177212765","wikidata":"https://www.wikidata.org/wiki/Q627335","display_name":"Workflow","level":2,"score":0.680899977684021},{"id":"https://openalex.org/C509974204","wikidata":"https://www.wikidata.org/wiki/Q180507","display_name":"Radiation therapy","level":2,"score":0.6401000022888184},{"id":"https://openalex.org/C106436119","wikidata":"https://www.wikidata.org/wiki/Q836575","display_name":"Quality assurance","level":3,"score":0.6352999806404114},{"id":"https://openalex.org/C2776007630","wikidata":"https://www.wikidata.org/wiki/Q2798912","display_name":"Accountability","level":2,"score":0.5806000232696533},{"id":"https://openalex.org/C2779328685","wikidata":"https://www.wikidata.org/wiki/Q1475557","display_name":"Patient safety","level":3,"score":0.5246000289916992},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.5072000026702881},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.4327999949455261},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.41290000081062317},{"id":"https://openalex.org/C2780791683","wikidata":"https://www.wikidata.org/wiki/Q846785","display_name":"Action (physics)","level":2,"score":0.3871999979019165},{"id":"https://openalex.org/C2909208188","wikidata":"https://www.wikidata.org/wiki/Q2046313","display_name":"Radiation Therapist","level":3,"score":0.3750999867916107},{"id":"https://openalex.org/C2780451532","wikidata":"https://www.wikidata.org/wiki/Q759676","display_name":"Task (project management)","level":2,"score":0.3707999885082245},{"id":"https://openalex.org/C2780385302","wikidata":"https://www.wikidata.org/wiki/Q367158","display_name":"Protocol (science)","level":3,"score":0.36559998989105225},{"id":"https://openalex.org/C112930515","wikidata":"https://www.wikidata.org/wiki/Q4389547","display_name":"Risk analysis (engineering)","level":1,"score":0.33059999346733093},{"id":"https://openalex.org/C71405471","wikidata":"https://www.wikidata.org/wiki/Q757012","display_name":"Quality management","level":3,"score":0.3239000141620636},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.32199999690055847},{"id":"https://openalex.org/C195094911","wikidata":"https://www.wikidata.org/wiki/Q14167904","display_name":"Process management","level":1,"score":0.30570000410079956},{"id":"https://openalex.org/C175154964","wikidata":"https://www.wikidata.org/wiki/Q380077","display_name":"Task analysis","level":3,"score":0.3052000105381012},{"id":"https://openalex.org/C31601959","wikidata":"https://www.wikidata.org/wiki/Q931309","display_name":"Medical imaging","level":2,"score":0.3041999936103821},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.288100004196167},{"id":"https://openalex.org/C21547014","wikidata":"https://www.wikidata.org/wiki/Q1423657","display_name":"Operations management","level":1,"score":0.28220000863075256},{"id":"https://openalex.org/C544519230","wikidata":"https://www.wikidata.org/wiki/Q32566","display_name":"Computed tomography","level":2,"score":0.27469998598098755},{"id":"https://openalex.org/C2779951463","wikidata":"https://www.wikidata.org/wiki/Q7268788","display_name":"Quality of life (healthcare)","level":2,"score":0.2703000009059906},{"id":"https://openalex.org/C2987700449","wikidata":"https://www.wikidata.org/wiki/Q186161","display_name":"Radiation dose","level":2,"score":0.2549999952316284},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.2538999915122986}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.7577/radopen.6721","doi":"https://doi.org/10.7577/radopen.6721","is_oa":true,"landing_page_url":"https://doi.org/10.7577/radopen.6721","pdf_url":"https://journals.oslomet.no/radopen/article/download/6721/5591","source":{"id":"https://openalex.org/S4210208067","display_name":"Radiography Open","issn_l":"2387-3345","issn":["2387-3345"],"is_oa":true,"is_in_doaj":true,"is_core":false,"listed_in":["ddh","doaj","norway-1"],"host_organization":"https://openalex.org/P4310314092","host_organization_name":"Nordiskt Forum f\u00f6r Forskning och Utvecklingsarbete inom Utbildning i Sl\u00f6jd (NordFo)","host_organization_lineage":["https://openalex.org/P4310314092"],"host_organization_lineage_names":["Nordiskt Forum f\u00f6r Forskning och Utvecklingsarbete inom Utbildning i Sl\u00f6jd (NordFo)"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Radiography Open","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.7577/radopen.6721","doi":"https://doi.org/10.7577/radopen.6721","is_oa":true,"landing_page_url":"https://doi.org/10.7577/radopen.6721","pdf_url":"https://journals.oslomet.no/radopen/article/download/6721/5591","source":{"id":"https://openalex.org/S4210208067","display_name":"Radiography Open","issn_l":"2387-3345","issn":["2387-3345"],"is_oa":true,"is_in_doaj":true,"is_core":false,"listed_in":["ddh","doaj","norway-1"],"host_organization":"https://openalex.org/P4310314092","host_organization_name":"Nordiskt Forum f\u00f6r Forskning och Utvecklingsarbete inom Utbildning i Sl\u00f6jd (NordFo)","host_organization_lineage":["https://openalex.org/P4310314092"],"host_organization_lineage_names":["Nordiskt Forum f\u00f6r Forskning och Utvecklingsarbete inom Utbildning i Sl\u00f6jd (NordFo)"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Radiography Open","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.6240000128746033,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225651218.pdf","grobid_xml":"https://content.openalex.org/works/W7225651218.grobid-xml"},"referenced_works_count":21,"referenced_works":["https://openalex.org/W1971530208","https://openalex.org/W1985349470","https://openalex.org/W2106970583","https://openalex.org/W2126077852","https://openalex.org/W2171985063","https://openalex.org/W2431505808","https://openalex.org/W2605239868","https://openalex.org/W2748063510","https://openalex.org/W2793027295","https://openalex.org/W2895502606","https://openalex.org/W2921377786","https://openalex.org/W2922577842","https://openalex.org/W2932221521","https://openalex.org/W2940466532","https://openalex.org/W3123353923","https://openalex.org/W3137875358","https://openalex.org/W3162898339","https://openalex.org/W4200274468","https://openalex.org/W4229443642","https://openalex.org/W4294653386","https://openalex.org/W4379779378"],"related_works":["https://openalex.org/W7063896521","https://openalex.org/W3095417915","https://openalex.org/W2002216832","https://openalex.org/W2945521800","https://openalex.org/W2060659715","https://openalex.org/W1982192365","https://openalex.org/W2153873918","https://openalex.org/W4410548005","https://openalex.org/W2946317748","https://openalex.org/W2376144394"],"abstract_inverted_index":{"Radiotherapy":[0],"delivery":[1,80],"is":[2,111],"founded":[3],"on":[4],"standardization,":[5],"protocol":[6],"adherence,":[7],"and":[8,15,34,51,81,91,102,131,151,166],"quality":[9],"assurance":[10],"to":[11,113,141],"ensure":[12],"precision,":[13],"reproducibility,":[14],"patient":[16,24,162],"safety.":[17],"However,":[18],"clinical":[19,76],"variability":[20,77],"remains":[21],"unavoidable":[22],"because":[23],"anatomy,":[25],"organ":[26],"filling,":[27],"immobilization":[28],"conditions,":[29],"physiological":[30],"status,":[31],"image":[32],"quality,":[33],"workflow":[35],"constraints":[36],"can":[37],"change":[38],"across":[39,156],"treatment":[40],"fractions.":[41],"During":[42],"daily":[43],"cone-beam":[44],"computed":[45],"tomography":[46],"(CBCT)-based":[47],"verification,":[48],"predefined":[49],"protocols":[50],"tolerance":[52],"thresholds":[53],"provide":[54],"essential":[55],"safety":[56,96],"boundaries":[57,153],"but":[58],"do":[59],"not":[60],"always":[61],"determine":[62],"the":[63],"most":[64],"appropriate":[65],"action":[66],"in":[67,78],"complex":[68],"or":[69],"borderline":[70],"situations.":[71],"This":[72],"discussion":[73],"paper":[74,134],"examines":[75],"radiotherapy":[79,143],"proposes":[82],"a":[83,94,98,103],"three-layer":[84],"framework":[85,139],"for":[86],"making":[87],"treatment-delivery":[88],"judgment":[89,116],"explicit":[90,119],"governable,":[92],"distinguishing":[93],"protocol-based":[95],"baseline,":[97],"guideline-based":[99],"consensus":[100],"domain,":[101],"bounded":[104],"judgment-based":[105],"domain.":[106],"An":[107],"organizational":[108],"learning":[109],"loop":[110],"proposed":[112],"convert":[114],"recurrent":[115],"scenarios":[117],"into":[118],"institutional":[120,150],"standards":[121],"through":[122],"documentation,":[123],"peer":[124],"discussion,":[125],"interdisciplinary":[126],"review,":[127],"standard-operating-procedure":[128],"refinement,":[129],"audit,":[130],"education.":[132],"The":[133,158],"also":[135],"considers":[136],"how":[137],"this":[138],"relates":[140],"current":[142],"practice,":[144],"where":[145],"radiation":[146],"therapists":[147],"operate":[148],"within":[149],"regulatory":[152],"that":[154],"differ":[155],"settings.":[157],"approach":[159],"supports":[160],"governance,":[161],"safety,":[163],"professional":[164],"education,":[165],"accountability":[167],"without":[168],"redefining":[169],"medical":[170],"decision-making":[171],"authority.":[172]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-11-10T00:00:00"}