{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T20:27:21Z","timestamp":1789331241520,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"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":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare the effect of two linacs designs on fetal dose sparing on a pregnant patient, including estimation of the fetal dose, and the effect of a lead apron.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A patient with a high\u2010grade sarcoma located in the right knee\/lower thigh was prescribed 51\u00a0Gy (1.7\u00a0Gy\/Fx) with a simultaneous\u2010integrated\u2010boost (SIB) of 60\u00a0Gy to a smaller volume, starting in the 26th\u00a0gestational week. Volumetric modulated radiation therapy (VMAT) plans with 6MV\u2010FFF were developed using identical dosimetric constraints on a Varian Truebeam Edge with HD\u2010MLC and a Varian Halcyon with double\u2010stacked MLC. Based on patient dimension measurements, an anthropomorphic phantom was constructed using a Rando phantom and saline bags in the patient's Vac\u2010Lok bag. Phantom measurements were performed using OSLDs and TLDs placed at three different planes, corresponding to the pubis, the umbilicus, and the fundus based on patient measurements and projected gestational age, to estimate the fetal dose. Three experimental scenarios were measured, each with CBCT\u2010based image guidance for an accurate, reproducible setup: Edge, Halcyon, and Halcyon with a tri\u2010folded lead apron (0.5\u00a0mm\u00a0\u00d7\u00a03\u00a0=\u00a01.5\u00a0mm\u00a0Pb) over the phantom abdomen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Plan quality and total MUs are comparable between the Edge and Halcyon plans. The OSLD\u2010measured whole\u2010course dose to the pubis, umbilicus, and fundus were 18.8, 13.1, and 11.7 cGy, respectively, on Halcyon, on average 27.8% lower than Edge. The repeatability within either dosimeter was good, although TLD showed systematically lower doses. Importantly, both dosimetry systems showed a lower measured fetal dose for the Halcyon plan compared with the Edge plan. Adding a tri\u2010folded lead apron over the abdomen did not meaningfully lower the measured dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this case study, Halcyon demonstrated a better sparing of out\u2010of\u2010field fetal dose compared to TrueBeam Edge. It was shown that lead aprons do not provide additional fetal dose sparing.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14556","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T18:43:44Z","timestamp":1730745824000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative analysis of fetal dose sparing between a C\u2010arm linac and an O\u2010ring linac in a SIB\u2010VMAT sarcoma treatment for a pregnant patient: A technical note and case report"],"prefix":"10.1002","volume":"26","author":[{"given":"Wesley","family":"Rivais","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Constine","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Rochester Medical Center  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