{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:33:07Z","timestamp":1789187587676,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272941"],"award-info":[{"award-number":["82272941"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272735"],"award-info":[{"award-number":["82272735"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Patient setup errors have been a primary concern impacting the dose delivery accuracy in radiation therapy. A robust treatment plan might mitigate the effects of patient setup errors. In this reported study, we aimed to evaluate the impact of translational and rotational errors on the robustness of linac\u2010based, single\u2010isocenter, coplanar, and non\u2010coplanar volumetric modulated arc therapy treatment plans for multiple brain metastases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifteen patients were retrospectively selected for this study with a combined total of 49 gross tumor volumes (GTVs). Single\u2010isocenter coplanar and non\u2010coplanar plans were generated first with a prescribed dose of 40\u00a0Gy in 5 fractions or 42\u00a0Gy in 7 fractions to cover 95% of planning target volume (PTV). Next, four setup errors (+1\u00a0 and +2\u00a0mm translation, and +1\u00b0 and +2\u00b0 rotation) were applied individually to generate modified plans. Different plan quality evaluation metrics were compared between coplanar and non\u2010coplanar plans. 3D gamma analysis (3%\/2\u00a0mm) was performed to compare the modified plans (+2\u00a0mm and +2\u00b0 only) and the original plans. Paired <jats:italic>t<\/jats:italic>\u2010test was conducted for statistical analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After applying setup errors, variations of all plan evaluation metrics were similar (<jats:italic>p<\/jats:italic>\u00a0&gt;\u00a00.05). The worst case for V100% to GTV was 92.07%\u00a0\u00b1\u00a06.13% in the case of +2\u00a0mm translational error. 3D gamma pass rates were\u00a0&gt;\u00a090% for both coplanar (+2\u00a0mm and +2\u00b0) and the +2\u00a0mm non\u2010coplanar groups but was 87.40%\u00a0\u00b1\u00a06.89% for the +2\u00b0 non\u2010coplanar group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Translational errors have a greater impact on PTV and GTV dose coverage for both planning methods. Rotational errors have a greater negative impact on gamma pass rates of non\u2010coplanar plans. Plan evaluation metrics after applying setup errors showed that both coplanar and non\u2010coplanar plans were robust and clinically acceptable.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14317","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T06:46:35Z","timestamp":1709621195000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of setup errors on the robustness of linac\u2010based single\u2010isocenter coplanar and non\u2010coplanar VMAT plans for multiple brain metastases"],"prefix":"10.1002","volume":"25","author":[{"given":"Xiaohuan","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Xijing Hospital, Air Force Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fada","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Therapeutic Radiology Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghui","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Equipment Xijing Hospital, Air Force Medical University  Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Townsville University Hospital  Douglas Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Biggs","sequence":"additional","affiliation":[{"name":"Radiotherapy AI Pty Ltd  Wagga Wagga Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9584-2678","authenticated-orcid":false,"given":"Zhongfei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Xijing Hospital, Air Force Medical University  Xi'an 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