{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T07:32:12Z","timestamp":1753860732815,"version":"3.41.2"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"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":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The role of biliary stents in image\u2010guided localization for pancreatic cancer has been inconclusive. To date, stent accuracy has been largely evaluated against implanted fiducials on cone beam computed tomography. We aim to use magnetic resonance (MR) soft tissue as a direct reference to examine the geometric and dosimetric impacts of stent\u2010based localization on the newly available MR linear accelerator.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty pancreatic cancer patients (132 fractions) treated on our MR linear accelerator were identified to have a biliary stent. In our standard adaptive workflow, patients were set up to the target using soft tissue for image registration and structures were re\u2010contoured on daily MR images. The original plan was then projected on treatment anatomy and dose predicted, followed by plan re\u2010optimization and treatment delivery. These online predicted plans were soft tissue\u2010based and served as reference plans. Retrospective image registration to the stent was performed offline to simulate stent\u2010based localization and the magnitude of shifts was taken as the geometric accuracy of stent localization. New predicted plans were generated based on stent\u2010alignment for dosimetric comparison.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Shifts were within 3\u00a0mm for 90% of the cases (mean\u00a0=\u00a01.5\u00a0mm); however, larger shifts up to 7.2\u00a0mm were observed. Average PTV coverage dropped by 1.1% with a maximum drop of 26.8%. The mean increase in V35Gy was 0.15, 0.05, 0.02, and 0.02 cc for duodenum, stomach, small bowel and large bowel, respectively. Stent alignment was significantly worse for all metrics except for small bowel (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.07).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall discrepancy between stent\u2010 and soft tissue\u2010alignment was modest; however, large discrepancies were observed for select cases. While PTV coverage loss may be compensated for by using a larger margin, the increase in dose to gastrointestinal organs at risk may limit the role of biliary stents in image\u2010guided localization.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.13965","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T08:54:56Z","timestamp":1678956896000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of MR\u2010soft tissue based versus biliary stent based alignment for image guidance in pancreatic SBRT"],"prefix":"10.1002","volume":"24","author":[{"given":"Zhaohui","family":"Han","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts 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H.","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai Anh","family":"Huynh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ritchell R.","family":"van Dams","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam","family":"Tanguturi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veena","family":"Venkatachalam","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph D.","family":"Mancias","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harvey J.","family":"Mamon","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil E.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda B.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan E.","family":"Leeman","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Brigham and Women's Hospital and Dana\u2010Farber Cancer Institute Harvard Medical School  Boston Massachusetts 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