{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:33:34Z","timestamp":1768437214945,"version":"3.49.0"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T00:00:00Z","timestamp":1585872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Due to multiple beamlets in the delivery of highly modulated volumetric arc therapy (VMAT) plans, dose delivery uncertainties associated with small\u2010field dosimetry and interplay effects can be concerns in the treatment of mobile lung lesions using a single\u2010dose of stereotactic body radiotherapy (SBRT). Herein, we describe and compare a simple, yet clinically useful, hybrid 3D\u2010dynamic conformal arc (h\u2010DCA) planning technique using flattening filter\u2010free (FFF) beams to minimize these effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Fifteen consecutive solitary early\u2010stage I\u2010II non\u2010small\u2010cell lung cancer (NSCLC) patients who underwent a single\u2010dose of 30\u00a0Gy using 3\u20136 non\u2010coplanar VMAT arcs with 6X\u2010FFF beams in our clinic. These patients\u2019 plans were re\u2010planned using a non\u2010coplanar hybrid technique with 2\u20133 differentially\u2010weighted partial dynamic conformal arcs (DCA) plus 4\u20136 static beams. About 60\u201370% of the total beam weight was given to the DCA and the rest was distributed among the static beams to maximize the tumor coverage and spare the organs\u2010at\u2010risk (OAR). The clinical VMAT and h\u2010DCA plans were compared via RTOG\u20100915 protocol for conformity and dose to OAR. Additionally, delivery efficiency, accuracy, and overall h\u2010DCA planning time were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All plans met RTOG\u20100915 requirements. Comparison with clinical VMAT plans h\u2010DAC gave better target coverage with a higher dose to the tumor and exhibited statistically insignificance differences in gradient index, D<jats:sub>2cm<\/jats:sub>, gradient distance and OAR doses with the exception of maximal dose to skin (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.015). For h\u2010DCA plans, higher values of tumor heterogeneity and tumor maximum, minimum and mean doses were observed and were 10%, 2.8, 1.0, and 2.0\u00a0Gy, on average, respectively, compared to the clinical VMAT plans. Average beam on time was reduced by a factor of 1.51. Overall treatment planning time for h\u2010DCA was about an hour.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Due to no beam modulation through the target, h\u2010DCA plans avoid small\u2010field dosimetry and MLC interplay effects and resulting in enhanced target coverage by improving tumor dose (characteristic of FFF\u2010beam). The h\u2010DCA simplifies treatment planning and beam on time significantly compared to clinical VMAT plans. Additionally, h\u2010DCA allows for the real time target verification and eliminates patient\u2010specific VMAT quality assurance; potentially offering cost\u2010effective, same or next day SBRT treatments. Moreover, this technique can be easily adopted to other disease sites and small clinics with less extensive physics or machine support.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.12868","type":"journal-article","created":{"date-parts":[[2020,4,3]],"date-time":"2020-04-03T16:22:53Z","timestamp":1585930973000},"page":"83-92","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A simple, yet novel hybrid\u2010dynamic conformal arc therapy planning via flattening filter\u2010free beam for lung stereotactic body radiotherapy"],"prefix":"10.1002","volume":"21","author":[{"given":"Damodar","family":"Pokhrel","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine Medical Physics Graduate Program University of Kentucky Lexington KY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Halfman","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine 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