{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:17:00Z","timestamp":1786976220620,"version":"build-2736575974"},"reference-count":52,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"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":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>It is challenging to achieve appropriate target coverage of the prostate with Image Guided Radiation Therapy (IGRT) while simultaneously constraining rectal doses within planned values when there is significant variability in rectal filling and shape. We investigated if rectum planning goals can be fulfilled using rigid CBCT\u2010based on\u2010board alignment to account for interfraction rectal deformations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Delivered rectal doses corresponding to prostate alignment (\u201cPR\u201d) and anterior rectum alignment (\u201cAR\u201d) for 239 daily treatments from 13 patients are reported. Rectal doses were estimated by rigidly mapping the planned dose on the daily CT derived from the daily CBCT according to respective alignment shifts. Rectum V95% (rV95%) was used for analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to \u201cPR\u201d, \u201cAR\u201d alignment increased rV95% for an average of 34.4% across all patients. rV95% (cc) averaged over all fractions was significant from planning values for 10\/13 patients for \u201cPR\u201d and for 9\/13 for \u201cAR\u201d. 3\/13 patients had reproducible anatomy. Of patients with non\u2010reproducible anatomy, three had dosimetrically more favorable, while seven had less favorable anatomies. Most shift differences (82.3%) between the \u201cPR\u201d and \u201cAR\u201d alignments larger than 2\u00a0mm resulted in rV95% changes larger than 2 cc. Most shift differences (82.2%) of 2\u00a0mm or less between the \u201cPR\u201d and \u201cAR\u201d alignments resulted in rV95% changes less than 2 cc. The average percentage of fractions among patients in which anterior or posterior shifts for \u201cAR\u201d and \u201cPR\u201d alignment was larger than the PTV margins was 9.1% (0.0%\u201337.5%) and 1.3% (0%\u201310%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rectal deformation and subsequent inconsistent interfraction separation between prostate and rectal wall translate into anatomical changes that cannot always be mitigated with rigid alignment. If systematic differences exist due to a non\u2010reproducible planning anatomy, attempts to restore the planned rectal doses through anterior rectum alignment produce rather small improvements and may result in unacceptable target underdosage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.14241","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T06:25:36Z","timestamp":1704781536000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Rectal deformation management with IGRT in prostate radiotherapy: Can it be managed with rigid alignment alone?"],"prefix":"10.1002","volume":"25","author":[{"given":"Mitchell","family":"Polizzi","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Virginia Commonwealth University  Richmond Virginia 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