{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T19:14:31Z","timestamp":1771874071078,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"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":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study aimed to clarify the dosimetric impact of the respiratory motion of the liver on stereotactic body radiation therapy (SBRT) for spine metastasis and examine the utility of introducing beam avoidance (beam\u2010off at specific gantry angles).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 112 consecutive patients who underwent SBRT for spine metastasis between 2018 and 2024 were examined. Overall, 15 patients who had lesions near the liver dome were included in this study. Retrospective treatment plans were generated using computed tomography (CT) images acquired during inhalation and exhalation to evaluate the dosimetric impact of respiratory motion of the liver. The dose difference (<jats:italic>DD)<\/jats:italic> and relative value (<jats:italic>DD<\/jats:italic>%) were evaluated using the dose\u2010volume histogram (DVH) metrics, planning target volume <jats:italic>D<\/jats:italic><jats:sub>max<\/jats:sub>, <jats:italic>D<\/jats:italic><jats:sub>95%<\/jats:sub>, spinal cord <jats:italic>D<\/jats:italic><jats:sub>0.035 cc<\/jats:sub>, and esophagus <jats:italic>D<\/jats:italic><jats:sub>2.5 cc<\/jats:sub>. The magnitude of the liver movements was evaluated based on differences of liver size <jats:italic>L<\/jats:italic><jats:sub>ave<\/jats:sub> at the isocentric axial plane between the inspiratory and expiratory CT images.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The <jats:italic>DD<\/jats:italic> in almost all DVH metrics tended to increase when the liver moved away from the target during inhalation: For example, Mean  a standard deviation (SD) <jats:italic>DD<\/jats:italic> in PTV <jats:italic>D<\/jats:italic><jats:sub>95%<\/jats:sub> for the treatment plan incorporating beam avoidance and those without beam avoidance was 0.5  0.3 and 0.9  0.6\u00a0Gy, respectively. The spinal cord <jats:italic>D<\/jats:italic><jats:sub>0.035 cc<\/jats:sub> for those shows 0.4  0.2 and 0.7  0.7\u00a0Gy, respectively. The treatment plans without beam avoidance also showed moderate or strong correlations between <jats:italic>L<\/jats:italic><jats:sub>ave<\/jats:sub> and <jats:italic>DD<\/jats:italic> for almost all DVH metrics. No correlation was seen in the beam avoidance plan. The spinal cord <jats:italic>D<\/jats:italic><jats:sub>0.035 cc<\/jats:sub> revealed approximately 1\u00a0Gy or +4% in <jats:italic>DD<\/jats:italic> when <jats:italic>L<\/jats:italic><jats:sub>ave<\/jats:sub> was &lt; \u22124\u00a0cm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Respiratory motion of the liver dome can cause substantial dosimetric discrepancies in the dose delivered to the spinal cord, although the extent depends on patient variables. Dose assessment should be performed for determining the appropriate means of respiratory management, such as breath\u2010hold. Alternatively, beam avoidance effectively mitigates the impact.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14403","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T06:00:39Z","timestamp":1719900039000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Dosimetric impact of the respiratory motion of the liver dome in stereotactic body radiotherapy for spine metastasis: A planning study"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9491-787X","authenticated-orcid":false,"given":"Hiroyuki","family":"Okamoto","sequence":"first","affiliation":[{"name":"Radiation Safety and Quality Assurance Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Midori","family":"Nonaka","sequence":"additional","affiliation":[{"name":"Department of Radiological Technology National Cancer Center Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6550-9727","authenticated-orcid":false,"given":"Takahito","family":"Chiba","sequence":"additional","affiliation":[{"name":"Radiation Safety and Quality Assurance Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoya","family":"Kaneda","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology National Cancer Center Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Radiation Safety and Quality Assurance Division National Cancer Center Hospital  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Radiation Safety and Quality Assurance Division National Cancer Center 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