{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T02:32:48Z","timestamp":1768271568356,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T00:00:00Z","timestamp":1665705600000},"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":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Treatment planning for head\u2010and\u2010neck (H&amp;N) cancer, in particular oropharynx, nasopharynx, and paranasal sinus cases, at our center requires noncoplanar proton beams due to the complexity of the anatomy and target location. Targeting accuracy for all beams is carefully evaluated by using image guidance before delivering proton beam therapy (PBT). In this study, we analyzed couch shifts to evaluate whether imaging is required before delivering each field with different couch angles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>After the Institutional Review Board approval, a retrospective analysis was performed on data from 28 H&amp;N patients treated with PBT. Each plan was made with two\u2010to\u2010three noncoplanar and two\u2010to\u2010three coplanar fields. Cone\u2010beam computed tomography and orthogonal kilovoltage (kV) images were acquired for setup and before delivering each field, respectively. The Cartesian (longitudinal, vertical, and lateral) and angular (pitch and roll) shifts for each field were recorded from the treatment summary on the first two fractions and every subsequent fifth fraction. A net magnitude of the three\u2010dimensional (3D) shift in Cartesian coordinates was calculated, and a 3D vector was created from the 6 degrees of freedom coordinates for transforming couch shifts in the system coordinate to the beam's\u2010eye view.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 3219 Cartesian and 2146 angular shift values were recorded for 28 patients. Of the Cartesian shifts, 2069 were zero (64.3%), and 1150 (35.7%) were nonzero (range, \u22127 to 11\u00a0mm). Of the angular shifts, 1034 (48.2%) were zero, and 1112 (51.8%) were nonzero (range, \u22123.0\u00b0 to 3.2\u00b0). For 17 patients, the couch shifts increased toward the end of the treatment course. We also found that patients with higher body mass index (BMI) presented increased net couch shifts (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). With BMI\u00a0&lt;\u00a027, all overall net shift averages were &lt;2\u00a0mm, and overall maximum net shifts were &lt;6\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These results confirm the need for orthogonal kV imaging before delivering each field of H&amp;N PBT at our center, where a couch rotation is involved.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.13795","type":"journal-article","created":{"date-parts":[[2022,10,14]],"date-time":"2022-10-14T10:58:52Z","timestamp":1665745132000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Evaluation of intrafraction couch shifts for proton treatment delivery in head\u2010and\u2010neck cancer patients: Toward optimal imaging frequency"],"prefix":"10.1002","volume":"23","author":[{"given":"Nrusingh C.","family":"Biswal","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario B.","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiguang","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason K.","family":"Molitoris","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew E.","family":"Witek","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shifeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,14]]},"reference":[{"issue":"4","key":"e_1_2_10_2_1","first-page":"255","article-title":"Proton therapy for head and neck cancer: current applications and future directions","volume":"1","author":"Lin A","year":"2012","journal-title":"Transl Cancer 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patient setup error in prostate image guided radiation therapy with fiducial\u2010based kilovoltage onboard imaging and cone\u2010beam computed tomography","volume":"5","author":"Ye JC","year":"2015","journal-title":"Quant Imaging Med Surg"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13641"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12820"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aab231"},{"key":"e_1_2_10_18_1","first-page":"123","article-title":"Targeting accuracy at couch kick for a frameless image guided radiosurgery system","volume":"5","author":"Huang Y","year":"2018","journal-title":"J Radiosurg SBRT"}],"container-title":["Journal of Applied Clinical Medical 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