Prescription Plan Research Articles

Planning and opportunism

The paper analyzes the occurrence of opportunistic behaviour opportunities in the planning processes. The following types of planning are distinguished: self-planning, collective planning, planning on behalf (or by contract), and directive (or prescriptive) planning. It is shown that any type of it excluding self-planning generates incentives to opportunistic behavior. Within this frame-work, two popular approaches in the planning theory are analyzed: participative planning and communicative one; it is shown that they are open to opportunism too. Basing on this analysis, the spheres of economy where government planning can be more efficient than market coordination mechanism are outlined.

A procedural approach for realizing prescriptive maintenance planning in manufacturing industries

Prescriptive maintenance planning is an essential enabler of smart and highly flexible production processes. Due to increasing complexity, traditional maintenance strategies lack in fulfilling present-day production requirements. This paper proposes a novel procedural approach for prescriptive maintenance planning in manufacturing companies. Multivariate data analysis and simulation tools are utilized to analyse historical data (product quality data, machine failure data and production program data). Based on identified data correlations and incoming real-time machine data, system failures are predicted and prescriptive maintenance measures are proposed. Results from real implementations in the automotive manufacturing industry are presented to demonstrate the effectiveness of the proposed approach.

Preserving cultural heritage by supporting landscape planning with quantitative predictions of soil consumption

Landscape preservation in Italy is a major issue in national cultural heritage conservation policies. Urban settlements growth is among the most threatening factors for the correct landscape preservation. Such phenomenon may result in corrupting the correct landscape-system functioning, particularly when the development occurs without precise planning prescriptions. Land-use/cover evolution dynamic is a subject widely and thoroughly investigated, especially concerning consumption of natural and other lands due to anthropogenic activities. This paper focuses on a region in southern Italy, where soil consumption is known to represent a urging matter of concern. However, although the negative impacts of soil consumption are well known, to our knowledge there are no case studies presenting a precise quantitative assessment of the intensity of such phenomenon for the region of interest. Furthermore, this study aims at forecasting the development of urban settlements through the application of the cellular automata model SLEUTH; the case study concerns the Municipality of Altamura (Apulia region, Italy). Results highlight how current landscape preservation instruments alone cannot ensure a reduction in soil consumption phenomenon and how urban areas expansion is incompatible with a correct landscape conservation in the study area.

Association of Medicare Part D Coverage and Low-Income Subsidies with Use of Novel Oral Agents in Multiple Myeloma

Background: The introduction of novel parenteral (bortezomib) and oral (lenalidomide and thalidomide) agents in the mid-2000's radically improved the management and outcomes in multiple myeloma. The cost of these drugs typically exceeds $5000/month, posing a financial challenge for patients (pts), insurers and healthcare systems. Medicare beneficiaries in the United States have disparate coverage for parenteral and oral chemotherapy. Coverage for oral agents has been available since 2006 for those purchasing Part D prescription plans (PDP), but such plans impose substantial out-of-pocket expenses through the "donut hole" coverage gap and coinsurance required even in the "catastrophic" phase. Pts with low income can receive the Part D Low Income Subsidy (LIS) which largely eliminates this cost sharing. Our objective was to examine the association of Medicare part D and LIS policies with utilization of, and out-of-pocket burden for, the novel anti-myeloma agents.Methods: From the Surveillance, Epidemiology and End Results data base linked to Medicare claims (2000-2012), we selected pts ≥65 years old, diagnosed with myeloma in 2001-2011, and with fee-for-service Medicare insurance. Pts in the post-Part-D era (2006-2012) were classified according to their prescription coverage at diagnosis as those with: PDP without LIS, PDP with LIS, or no coverage. We identified first-line parenteral chemotherapy (using specific drug codes) and oral agents (assumed from generic follow-up codes for pts without PDP), as well as other relevant covariates: comorbidities, a claims-based performance status indicator, anemia, neuropathy, and use of health services. We then compared parenteral and oral chemotherapy use between pre-Part-D (2001-2005) and post-Part-D (2006-2011) eras, and use of lenalidomide/thalidomide among PDP pts with or without LIS, in multivariable robust Poisson models for relative risk (RR), reporting 95% confidence intervals (CI).Results: Among 19,434 pts (median age, 77 years; 46% women), 52% had a record of any chemotherapy within 1 year from myeloma diagnosis. This proportion increased from 42% in pre-Part-D era to 61% after Part D introduction (adjusted RR, 1.45; CI, 1.41-1.49; P<.0001), and bortezomib replaced other parenteral regimens. In the post-Part-D era, the proportion of pts receiving parenteral chemotherapy increased for those without prescription coverage (Fig. A, adjusted RR compared with pre-Part-D era, 1.30; CI, 1.23-1.38; P<.001), while it decreased, in favor of oral regimens, for those who acquired a PDP without LIS (RR, 0.90; CI, 0.85-0.95; P<.001), or PDP with LIS (RR, 0.85; CI, 0.78-0.92; P<.001). Among pts with no PDP coverage, 41% purchased it within 1 year from myeloma diagnosis.We then directly analyzed the upfront use of novel oral agents among treated pts with a PDP (and thus complete record of prescriptions, N=3,142). Lenalidomide largely replaced thalidomide between 2007 and 2011, but up to 40% of pts did not receive novel agents as part of their regimen (Fig. B). Pts with LIS had the same median age as those without LIS, but were more often female, non-white, with poor performance, or comorbidities (all P<.0001). Adjusting for clinical differences, recipients of LIS had a 17% higher probability of being treated with a novel oral agent (RR, 1.17; CI, 1.05-1.29; P=.0034). Median patient cost-sharing for the first prescription was $3 for pts with LIS and $3,120 without LIS. At the start of oral chemotherapy, 3% of pts were in the catastrophic phase of PDP coverage, while 79% reached it with the 2nd prescription. Median number of prescription fills was 6 (range, 1-27), and median gross cost of lenalidomide/thalidomide within the 1st year of therapy was $43,920.Conclusions: The proportion of Medicare beneficiaries actively treated with chemotherapy for myeloma increased after the introduction of Medicare Part D in 2006. Accounting for this, the availability of prescription coverage was associated with relatively increased use of oral regimens, and the use of novel agents was higher for those receiving Part D LIS which alleviates the out-of-pocket expenses. Our findings suggest concerning disparities in equitable access to novel, but expensive oral anti-myeloma agents based on insurance coverage for oral chemotherapy. Further research should determine if policies for oral chemotherapy coverage translate into disparities in survival or other outcomes. [Display omitted] DisclosuresOlszewski:TG Therapeutics: Research Funding; Genentech: Research Funding; Bristol-Myers Squibb: Consultancy.

A Comparison Study Between Spot Scanning Intensity Modulated Proton and Photon Grid Therapy

The purpose of this research was to compare grid therapy using photons to grid therapy using a novel, collimator-free, intensity modulated proton therapy (IMgPT) method. IMgPT plans were developed using robust optimization and compared to grid therapy plans developed using photons. Plans were evaluated and compared by spot size and separation distance, number of beams, peak-to-valley ratios (PVRs), dose to organs at risk, integral, and distal edge dose. The relative biological effectiveness (RBE) of the valley regions was simulated with the Monte Carlo Damage Simulation (MCDS) model of DSB damage implemented in the FLUKA Monte Carlo radiation transport code. A pediatric sarcoma case, located on the patient’s right hip, was selected as a basis for evaluating the IMgPT approach because of the size (13 cm) and location of the tumor (15-cm depth); according to the published literature for photon grid therapy, bulky tumors more than 7.6 cm across are usually considered to be good candidates for grid therapy. The full width at half-maximum (FHWM) of the proton beam spot size varied from 2 to 15 mm in air at 220 MeV. The calculated RBE values were increased by a maximum of 30% in the valley regions. Applying IMgPT with robustness revealed no dependence on beam direction. A constant spot separation of 1 cm produced similar PVR values (of approximately 3) to those reported for 3D photon grid therapy. The plan prescription was a single fraction of 2000 cGy, following the reported dose for photon grid therapy. The doses delivered to 95% (D95) of the clinical target volume and gross tumor volumes were 1399 and 1436 cGy, respectively. The dose to 1% (D1) was 3650 and 3505 cGy, for the respective volumes. The maximum dose to the bladder and ovaries was 1587 and 797 cGy, respectively. Planning with multiple beams resulted in a high dose to the overlapping beam areas, an approach that may improve skin sparing. The average integral dose was calculated to be 425 cGy for photon plans, 141 cGy for a single beam IMgPT plan, and 152 cGy for 2-beam IMgPT plans. The distal dose was 1543 cGy for photons and 388 cGy for a single proton beam, compared to 645 cGy for a 2-beam IMgPT plan and 952 cGy for an IMPT plan with robust optimization. IMgPT improves distal and integral dose compared to grid therapy using photons. An increased RBE was noted for valley regions. This finding supports bystander effects noted from prior reports and might be harnessed to increase local tumor control.

Scaling up health knowledge at European level requires sharing integrated data: an approach for collection of database specification.

Computerized health care databases have been widely described as an excellent opportunity for research. The availability of “big data” has brought about a wave of innovation in projects when conducting health services research. Most of the available secondary data sources are restricted to the geographical scope of a given country and present heterogeneous structure and content. Under the umbrella of the European Innovation Partnership on Active and Healthy Ageing, collaborative work conducted by the partners of the group on “adherence to prescription and medical plans” identified the use of observational and large-population databases to monitor medication-taking behavior in the elderly. This article describes the methodology used to gather the information from available databases among the Adherence Action Group partners with the aim of improving data sharing on a European level. A total of six databases belonging to three different European countries (Spain, Republic of Ireland, and Italy) were included in the analysis. Preliminary results suggest that there are some similarities. However, these results should be applied in different contexts and European countries, supporting the idea that large European studies should be designed in order to get the most of already available databases.

Doses to Pelvic Bone Marrow from Intracavitary Brachytherapy in Carcinoma Cervix: A Dosimetric Study

Doses to Pelvic Bone Marrow from Intracavitary Brachytherapy in Carcinoma Cervix: A Dosimetric Study

PO-0857: GTV-based prescription and Monte Carlo treatment planning in Cyberknife treatments for lung lesions

PO-0857: GTV-based prescription and Monte Carlo treatment planning in Cyberknife treatments for lung lesions

Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa.

Sparse research informs how caloric prescriptions should be advanced during nutritional rehabilitation of inpatients with anorexia nervosa (AN). This study compared the impact of a standardized caloric increase approach, in which increases occurred on a predetermined schedule, to an individualized approach, in which increases occurred only following insufficient weight gain, on rate, pattern, and cumulative amount of weight gain and other weight restoration outcomes. This study followed a natural experiment design comparing AN inpatients consecutively admitted before (n = 35) and after (n = 35) an institutional change from individualized to standardized caloric prescriptions. Authors examined the impact of prescription plan on weekly weight gain in the first treatment month using multilevel modeling. Within a subsample remaining inpatient through weight restoration (n = 40), multiple regressions examined the impact of caloric prescription plan on time to weight restoration, length of hospitalization, maximum caloric prescription, discharge BMI, and incidence of activity restriction and edema. There were significant interactions between prescription plan and quadratic time on average weekly weight gain (p = .03) and linear time on cumulative weekly weight gain (p < .001). Under the standardized plan, patients gained in an accelerated curvilinear pattern (p = .04) and, therefore, gained cumulatively greater amounts of weight over time (p < .001). Additionally, 30% fewer patients required activity restriction under the standardized plan. Standardized caloric prescriptions may confer advantage by facilitating accelerated early weight gain and lower incidence of bedrest without increasing the incidence of refeeding syndrome.

Prescriptivism as a nation-building tool in the Upper Amazon: the case of Shiwiar

ABSTRACTThe Shiwiar are an indigenous nation of Ecuador and Peru, and they are one of five ethnic groups collectively known as the Jivaroan people. In stark contrast to the other Jivaroan groups, the Shiwiar have largely been overlooked by local governments until recently and are still popularly considered to be an offshoot of their closely related neighbours, the Achuar. This has led to a strong desire within the Shiwiar community to be recognised as an independent group. In order to achieve this, the Shiwiar leaders have made use of linguistic prescriptivism as a tool to emphasise the distinction between the Shiwiar language and the other Jivaroan languages. A slightly modified orthography was advocated and the use of particular lexical items was encouraged. However, this strategy has proved to be unsuccessful. Instead of generating a sense of union and independence among the Shiwiar nation, it has resulted in uncertainty and confusion regarding language use and identity. It is argued here that although prescriptive language planning has been successful in nation-building initiatives around the world, the sociolinguistic situation of Shiwiar does not allow for the necessary conditions for a prescriptive campaign to be effective.

Exercise and diabetes mellitus: optimizing performance in patients who have type 1 diabetes.

Those who have type 1 diabetes mellitus should include regular sports or recreational activities in their overall healthcare programs. Essential responsibilities of physicians who treat these patients include preparticipation clearance, education about blood glucose self-monitoring, exercise prescription, aggressive dietary and insulin management plans, identification of risk factors and potential complications, and ongoing education. Exercise has risks and benefits that must be understood so that participation yields a safe, enjoyable outcome that meshes with the patient's culture, activity goals, and lifestyle.

CBCT-based dosimetric verification and alternate planning techniques to reduce the normal tissue dose in SBRT of lung patients

Purpose: Confirmation of treatment delivery accuracy in stereotactic body radiotherapy (SBRT) of lung tumors suggests the possibility of treatment margin, or aperture reduction. In this investigation, the dose delivery to lung tumors using SBRT techniques was verified, and the feasibility of normal tissue sparing via aperture reduction or altered prescription isodose line was assessed. Methods: Planned and delivered doses to the gross tumor volume (GTV) and planning target volume (PTV) were compared for 10 patients using planning CT and conebeam CT image. Potential for reduction in normal tissue dose were assessed using 2 alternate treatment plans – reduced PTVs and alternate prescription techniques. Plans were assessed using conformity index, homogeneity index and the ratio of 50% / 100% isodose volumes (R 50% ). Results: The planned and delivered mean doses were consistent to within 4%. However, the mean dose delivered to the GTV exceeded the prescription dose (Rx) by 19% and is consistent with our planning technique of prescribing to the 80% isodose line. When reducing treatment margins and retaining a constant dose-volume constraint, block margins had to be increased which produced a constant effective field aperture outside of the GTV. Prescription to a lower isodose line using stereotactic-like planning techniques yielded the only method by which the volume of the prescription isodose could be affected, although this yielded increases in normal tissue dose due to the increased monitor units required. Conversely, conventional prescription techniques using wider field apertures were effective in reducing absolute values of normal tissue dose. Although dose conformity was similar across different prescription isodose lines, homogeneity index and R 50% values were significantly different in the 60%-70% prescription isodose line plans than the 80%, 90% prescription plans. Conclusion: Traditional margin reduction techniques did not affect a reduction in the volume of normal tissue irradiated to the prescribed dose. Prescribing to low isodose lines yields reduced volumes of the prescribed dose, but at the expense of normal tissue dose.

PIH48 - Switching In Part D Prescription Plan: Plan Switching Versus Brand Name Drug Switching

There is a dearth of evidence on factors influencing prescription plan switching versus switching from brand name drug to generic one. However, either of this switching decision could significantly impact health and wellbeing of Medicare beneficiaries. The objective of the present study was to better understand the relative impacts of individual versus prescription plan level characteristics on both of these switching decisions. Medicare beneficiaries participated in the 2007 HRS prescription drug survey and 2009 HRS well-being survey and enrolled in Medicare part D (stand-alone), HMO, fee-for service or Advantage plans. The study sample includes 1298 individuals responded both years surveys. . Random intercept multinomial logistic regression model was estimated. Only 5% of sample members switched into different prescription plans in both 2007 and 2009, while about 24% individuals switched from brand name drugs to generic product to save prescription drug costs. An outcome variable of interest includes 4 categories: switched into different part D plan, switch from brand to generic drug, thought about switching but did not actually switch and didn’t do anything. The main covariates of interest include individual and plan level characteristics. Compared to “didn’t do anything” Individuals were more likely to switch to different prescription plan (13%) or switched into generic drug from brand name (25%) if they were using higher number of prescription medications (p<0.04). Individuals having plans with good customer service was 54% less likely to switch into different part-D plan. Compared to “didn’t do anything” individuals were 123% more likely to stay on the same plan being not satisfied with the current plan if they experience “inertia” in the plan choice decision. Unobserved plan level characteristics matter in part-D plan switching or drug switching decisions. Consumer inertia and plan’s customer service quality appear to be important factors influencing these switching decisions.

Abstract 12: Variation in the Use of Guideline-directed Medications Prior to Cardiac Defibrillator Implantation

Objective: Guideline-directed medical therapy (GDMT) is recommended prior to implantation of a primary prevention cardioverter-defibrillator (ICD). We examined GDMT use prior to primary prevention ICD implantation among Medicare beneficiaries. Methods: Using the National Cardiovascular Data Registry ICD Registry from 2007-2011, we identified recipients of a primary prevention ICD for the indication of heart failure with an ejection fraction &lt;40%. We then selected the subset of these patients enrolled in a fee-for-service Medicare prescription plan in the 120 days immediately preceding ICD implant. GDMT was defined as filling one or more prescriptions for a renin-angiotensin inhibitor (RAI) and a heart-failure approved beta blocker (HFBB). We identified patients with any fills and with optimal prescription supply (at least 80% of days covered) in the 90 days prior to ICD implant. We determined the proportion of patients receiving GDMT overall and for each U.S. hospital referral region (HRR). We used logistic regression to identify patient characteristics associated with receipt of optimal GDMT and to model the association between GDMT receipt and 1 year mortality. Results: Among 433,882 patients in the ICD registry who were enrolled in Medicare, we identified 25,473 that met Medicare prescription benefit enrollment criteria. Just 60% of these patients filled one or more prescription for both GDMTs (HFBB 76%, RAI 73%). Of those with some GDMT fills, just 38% received sufficient supplies to cover 80% of days. The HRR-level proportion of patients filling any GDMT ranged from 44%-78%. Patients were significantly less likely to receive GDMT if they were male, did not receive a low-income prescription benefit subsidy, had NYHA class 4 symptoms, renal failure, a history of ventricular tachycardia, or their most recent ejection fraction assessment within 1 month prior to implant. Ejection fraction was not associated with receipt of GDMT. Those filling GDMT were significantly less likely to die within 1 year (odds ratio 0.69 adjusted for age (95% CI 0.64, 0.75)). Conclusion: Prior to primary prevention ICD implantation, GDMT use appears inadequate overall and varies widely by region. Greater GDMT use should improve heart failure outcomes and may decrease the number of patients meeting an indication for ICD implantation. Understanding drivers of high and low use would inform policies aimed at optimizing this care.

Discussing Cities and Regencies in the Context of Regional Rating System. Promoting Communication, Reaching Sustainable Growth

This paper discusses how important to describe cities and regencies (kotadankabupaten) by using official statistical data in such a way to understand their position in the context of regional rating system within regional autonomy policy in Indonesia. Regional rating system can be seen as a creative method towards sustainable growth by accelerating or decelerating down the growth in the regional context. The global competitiveness index is adapted as a method to formulate regional rating system. Furthermore, the simplification is made to facilitate probable planning prescription with the category to accelerate, continue, or decelerate by modifying particular variables which are presented by related statistical data. In terms of performing planning prescription, it is important to understand the existing and future role of cities and regencies especially in performing development equity, reducing the dominant role of large size cities, facilitating medium sized cities, and envisioning small sized cities. Note that rating system method in terms of planning prescriptions formulation can be seen as a progress of communicative city concept, by sharing information, promoting communication, providing option, and promotingparticipation.

Integer programming techniques for solving non-linear workforce planning models with learning

Abstract In humans, the relationship between experience and productivity, also known as learning (possibly also including forgetting), is non-linear. As a result, prescriptive planning models that seek to manage workforce development through task assignment are difficult to solve. To overcome this challenge we adapt a reformulation technique from non-convex optimization to model non-linear functions with a discrete domain with sets of binary and continuous variables and linear constraints. Further, whereas the original applications of this technique yielded approximations, we show that in our context the resulting mixed integer program is equivalent to the original non-linear problem. As a second contribution, we introduce a capacity scaling algorithm that exploits the structure of the reformulation model and reduces computation time. We demonstrate the effectiveness of the techniques on task assignment models wherein employee learning is a function of task repetition.

Planning for Adaptation to Climate Change: Lessons from the US National Wildlife Refuge System

US national wildlife refuges have recent, detailed management plans illustrating the state of planning for climate-change adaptation in protected areas. Discussion of and prescriptions for addressing climate change increased in refuge plans between 2005 and 2010 but decreased in 2011. The plans respond to some climate-change impacts on biodiversity and call for monitoring but with little clarity regarding how to act on monitoring results and scant attention to future changes in phenology and community composition. The threats posed by sea-level rise generated the best-developed plan prescriptions. Examples of excellent prescriptions provide models for future planning. Some decision-support tools, such as vulnerability assessments, will improve future planning as they become more available. However, research better targeted at management information gaps is also needed. Region-level coordination, such as through landscape conservation design, offers opportunities for enlarging conservation footprints and improving information generation and sharing.

An assessment of land use sources of barriers and the community-based housing model in the UK

Purpose – The aim of this study is to define land use policy sources of barriers to community-based housing options in practice. Design/methodology/approach – The paper accentuated the need to tackle land use sources of barrier to Community Land Trust (CLT) performance, through text analysis of semi-structured interview responses from key stakeholders. Findings – This study found out that there is a need to ameliorate stakeholder approach to community-based housing (CBH), which is hampered by restrictive land use sources of barriers that occur in an urban and rural context. These barriers were found to include both planning inadequacies and a systemic inefficient network of knowledge transfer practices between stakeholders. Recommendations include the need for drastic policy intervention through the political willingness to address Section 106 shortcomings in the choice of affordable housing supply models, and the inaccessibility of land below market rate in an endogenous prescriptive planning system. Practical implications – This paper highlights the subjective limitations of the CLT model in regards to grey areas between setting boundaries to what is an acceptable level of concessions to CBH and the socio-economic impact or benefits of a completely deregulated social housing system. These boundaries do vary from system to system, hence the need for UK housing institutions to address identified inherent barrier sources and their reconciliation with international best practices. Therefore, greater roles can be accorded to the CLT model in the UK affordable housing dynamics based on its confirmed strengths and merits. Originality/value – This paper adds to literature through the practical identification and interpretation of various key stakeholder perspectives on sources of CLT barriers and an idealised strategy to tackling them accordingly. This contributes to the housing affordability debate on the viability of CBH options, and how it could be invariably hampered by direct and indirect effects of planning and restrictive land use policies in practice.

Detection of varying influenza circulation within England in 2012/13: informing antiviral prescription and public health response.

Subnational variation of 2009 pandemic influenza activity in England has been reported; however, little work has been published on this topic for seasonal influenza. If variation is present, this knowledge may assist with both identifying the onset of influenza epidemics, informing community antiviral prescription and local health planning. An end-of-season analysis of influenza surveillance systems (acute respiratory outbreaks, primary care consultations, virological testing, influenza-confirmed secondary care admissions and excess all-cause mortality) was undertaken at national and subnational levels for 2012/13 when influenza B and A(H3N2) dominated. National community antiviral prescription was recommended in Week 51 following national threshold exceedance. However, this was preceded up to 2 weeks by subnational influenza activity in 2/9 regions in England. Regional variation in circulation of influenza subtypes was observed and severe influenza surveillance data sources were able to monitor the subnational impact. Evidence of virological activity in two or more regions above a threshold indicated the onset of the 2012/13 season. Subnational thresholds should be determined and evaluated in order to improve timeliness of the national antiviral alert. During the season, outputs should be reported at levels that can inform local public health responses and variation considered when retrospectively evaluating the impact of interventions.

SU-E-T-167: Evaluation of Mobius Dose Calculation Engine Using Out of the Box Preconfigured Beam Data

Purpose: Determine the dose calculation accuracy of a preconfigured Mobius server for use in secondary checks of a treatment planning system. Methods: 10 plans were created for irradiation on two of the IROC (formerly RPC) accreditation phantoms: 4 for the head and neck phantom and 6 for the lung phantom. The plans each were created using one of four different photon energies (6FFF, 10 FFF, 6X, and 15X) and were varied in treatment type including VMAT, step and shoot IMRT, dynamic MLC IMRT (DMLC), and conformal RT (CRT). The TLDs in the phantoms were contoured, and each plan was sent for calculation to Mobius software (Mobius Medical Systems, Houston, TX) with a default configuration. Each plan was then irradiated on the planned phantom 3 times to create an average reading across 56 TLDs. These readings were then compared against the corresponding Mobius calculation at each TLD location. Results: The mean difference (MD) normalized to the plan prescription dose between each TLD and Mobius calculation for all measurements was 0.5 ± 3.3%, with a maximum difference of 8.4%. The MD was 0.6 ± 3.8%, − 2.0 ± 1.9%, 1.7 ± 3.7%, and 1.9 ± 1.2% across the 6FFF, 10FFF, 6X and 15X energies respectively. The MD was −1.2 ± 2.3% for lung plans and 1.8 ± 3.5% for head/neck plans. Across treatment types, the MD ranged from − 1.8 ± 1.7% for CRT to 4.3 ± 2.4 % for DMLC. Conclusion: Out of the box and preconfigured, Mobius provides accurate dose calculations with respect to beam energy, treatment type, and treatment site.