{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T11:11:55Z","timestamp":1777547515994,"version":"3.51.4"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,8,20]],"date-time":"2017-08-20T00:00:00Z","timestamp":1503187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To explore the feasibility of multi\u2010isocentric 4<jats:italic>\u03c0<\/jats:italic> volumetric\u2010modulated arc therapy (<jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>4<jats:italic>\u03c0<\/jats:italic>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content>) for the complex targets of head and neck cancers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010five previously treated patients of <jats:styled-content style=\"fixed-case\">HNC<\/jats:styled-content> underwent re\u2010planning to improve the dose distributions with either coplanar <jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> technique (<jats:styled-content style=\"fixed-case\">CP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content>) or noncoplanar <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>4<jats:italic>\u03c0<\/jats:italic>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> plans. The latter, involving 3\u20136 noncoplanar arcs and 2\u20133 isocenters were re\u2010optimized using the same priorities and objectives. Dosimetric comparison on standard metrics from dose\u2010volume histograms was performed to appraise relative merits of the two techniques. Pretreatment quality assurance was performed with <jats:styled-content style=\"fixed-case\">IMRT<\/jats:styled-content> phantoms to assess deliverability and accuracy of the <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>4<jats:italic>\u03c0<\/jats:italic>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> plans. The gamma agreement index (<jats:styled-content style=\"fixed-case\">GAI<\/jats:styled-content>) analysis with criteria of 3 mm distance to agreement (<jats:styled-content style=\"fixed-case\">DTA<\/jats:styled-content>) and 3% dose difference (<jats:styled-content style=\"fixed-case\">DD<\/jats:styled-content>) was applied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">CP<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>4<jats:italic>\u03c0<\/jats:italic>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> plans achieved the same degree of coverage for all target volumes related to near\u2010to\u2010minimum and near\u2010to\u2010maximum doses. <jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>4<jats:italic>\u03c0<\/jats:italic>\u2010V\u039c\u0391\u03a4 plans resulted in an improved sparing of organs at risk. The average mean dose reduction to the parotids, larynx, oral cavity, and pharyngeal muscles were 3 Gy, 4 Gy, 5 Gy, and 4.3 Gy, respectively. The average maximum dose reduction to the brain stem, spinal cord, and oral cavity was 6.0 Gy, 3.8 Gy, and 2.4 Gy. Pretreatment <jats:styled-content style=\"fixed-case\">QA<\/jats:styled-content> results showed that plans can be reliably delivered with mean gamma agreement index of 97.0 \u00b1 1.1%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">MI<\/jats:styled-content>4<jats:italic>\u03c0<\/jats:italic>\u2010<jats:styled-content style=\"fixed-case\">VMAT<\/jats:styled-content> plans allowed to decrease the dose\u2010volume\u2010metrics for relevant <jats:styled-content style=\"fixed-case\">OAR<\/jats:styled-content> and results are reliable from a dosimetric standpoint. Early clinical experience has begun and future studies will report treatment outcome.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.12164","type":"journal-article","created":{"date-parts":[[2017,8,21]],"date-time":"2017-08-21T04:36:37Z","timestamp":1503290197000},"page":"293-300","source":"Crossref","is-referenced-by-count":10,"title":["Multi\u2010isocentric 4<i>\u03c0<\/i> volumetric\u2010modulated arc therapy approach for head and neck cancer"],"prefix":"10.1002","volume":"18","author":[{"given":"Vallinayagam Shanmuga","family":"Subramanian","sequence":"first","affiliation":[{"name":"Yashoda Super Specialty hospital Department of Radiation Oncology Hyderabad India"},{"name":"Research and Development Centre Bharathiar University Coimbatore India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vellaiyan","family":"Subramani","sequence":"additional","affiliation":[{"name":"Research and Development Centre Bharathiar University Coimbatore India"},{"name":"Department of 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