{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:53:20Z","timestamp":1790247200891,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T00:00:00Z","timestamp":1721347200000},"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>To evaluate the dosimetric impact on spatially fractionated radiation therapy (SFRT) plan quality due to intrafraction patient motion via multi\u2010field MLC\u2010based method for treating large and bulky (\u22658\u00a0cm) unresectable tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>For large tumors, a cone beam CT\u2010guided 3D conformal MLC\u2010based SFRT method was utilized with 15\u00a0Gy prescription. An MLC GTV\u2010fitting algorithm provided 1\u00a0cm diameter apertures with a 2\u00a0cm center\u2010to\u2010center distance at the isocenter. This generated a highly heterogeneous sieve\u2010like dose distribution within an hour, enabling same\u2010day SFRT treatment. Fifteen previously treated SFRT patients were analyzed (5 head &amp; neck [H&amp;N], 5 chest and lungs, and 5 abdominal and pelvis masses). For each plan, intrafraction motion errors were simulated by incrementally shifting original isocenters of each field in different x\u2010, y\u2010, and z\u2010directions from 1 to 5\u00a0mm. The dosimetric metrics analyzed were: peak\u2010to\u2010valley\u2010dose\u2010ratio (PVDR), percentage of GTV receiving 7.5\u00a0Gy, GTV mean dose, and maximum dose to organs\u2010at\u2010risk (OARs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For\u00a0\u00b11,\u00a0\u00b12,\u00a0\u00b13,\u00a0\u00b14, and\u00a0\u00b15\u00a0mm isocenter shifts: PVDR dropped by 3.9%, 3.8%, 4.0%, 4.1%, and 5.5% on average respectively. The GTV(V7.5) remained within 0.2%, and the GTV mean dose remained within 3.3% on average, compared to the original plans. The average PVDR drop for 5\u00a0mm shifts was 4.2% for H&amp;N cases, 10% for chest and lung, and 2.2% for abdominal and pelvis cases. OAR doses also increased. The maximum dose to the spinal cord increased by up to 17 cGy in H&amp;N plans, mean lung dose (MLD) changed was small for chest\/lung, but the bowel dose varied up to 100 cGy for abdominal and pelvis cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Due to tumor size, location, and characteristics of MLC\u2010based SFRT, isocenter shifts of up to\u00a0\u00b15\u00a0mm in different directions had moderate effects on PVDR for H&amp;N and pelvic tumors and a larger effect on chest tumors. The dosimetric impact on OAR doses depended on the treatment site. Site\u2010specific patient masks, Vac\u2010Lok bags, and proper immobilization devices similar to SBRT\/SRT setups should be used to minimize these effects.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14469","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T23:49:03Z","timestamp":1721432943000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Dosimetric impact of intrafraction patient motion on MLC\u2010based 3D\u2010conformal spatially fractionated radiation therapy treatment of large and bulky tumors"],"prefix":"10.1002","volume":"25","author":[{"given":"Josh","family":"Misa","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine Medical Physics Graduate Program University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Volk","sequence":"additional","affiliation":[{"name":"Department of 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