{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T23:13:34Z","timestamp":1773789214764,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"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":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study aimed to assess the dosimetric advantages of dual arc increments in head and neck volumetric\u2010modulated arc therapy (VMAT) in the Monaco treatment planning system (TPS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three VMAT plans were created for each of the 10 patients by prescribing 70\u00a0Gy in 35 fractions with arc increment combinations of 30\u00b0\/30\u00b0, 15\u00b0\/15\u00b0, and 30\u00b0\/15\u00b0 in the Monaco TPS. The dose to 0.03\u00a0cm<jats:sup>3<\/jats:sup> volume (D<jats:sub>0.03cc<\/jats:sub>), conformity number, and homogeneity and gradient indices was compared for the planning target volume (PTV), and the D<jats:sub>0.03cc<\/jats:sub> and mean dose (D<jats:sub>mean<\/jats:sub>) of the spinal cord, brain stem, parotid glands were compared. For plan complexity evaluation, the monitor unit and various related metrics were compared. Wilcoxon signed\u2010rank tests were performed across plans for the evaluated indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For PTV, plans with 30\u00b0\/15\u00b0 showed comparable D<jats:sub>0.03cc<\/jats:sub> and homogeneity and gradient indices to those of plans with 30\u00b0\/30\u00b0 and 15\u00b0\/15\u00b0 while exhibiting a better conformity number. The D<jats:sub>0.03cc<\/jats:sub> for spinal cord and brain stem for plans with 30\u00b0\/15\u00b0 were 26.0% and 20.8% less than those with 30\u00b0\/30\u00b0 and 16.8% and 19.0% less than those with 15\u00b0\/15\u00b0, respectively. The D<jats:sub>mean<\/jats:sub> for the left and right parotid glands under plans with 30\u00b0\/15\u00b0 were 17.4% and 13.2% less than those with 30\u00b0\/30\u00b0 and 14.0% and 9.8% less than those with 15\u00b0\/15\u00b0, respectively. The total monitor unit in plans with 30\u00b0\/15\u00b0 was less than that in other plans but with no significance. The plans with 30\u00b0\/15\u00b0 showed higher modulation complexity and plan\u2010averaged irregularity, while no significant differences observed in both plan\u2010averaged area and modulation compared with other plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In head and neck VMAT, a dual arc increment of 30\u00b0\/15\u00b0 seems advisable because it can substantially reduce doses to normal tissues with comparable delivery efficiency while maintaining target dose coverage.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14571","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T15:25:28Z","timestamp":1732893928000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Dosimetric advantages of dual arc increments for head and neck volumetric\u2010modulated arc therapy in the Monaco treatment planning 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Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minsoo","family":"Chun","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Chung\u2010Ang University Gwang Myeong Hospital  Gyeonggi\u2010do Republic of Korea"},{"name":"Institute of Radiation Medicine Seoul National University Medical Research Center  Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2010.01.004"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20201289"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2818738"},{"key":"e_1_2_10_5_1","unstructured":"ElektaAB.Hyperion VMAT Sequencer\u00ae Technical Reference (LRMMON0006).2016."},{"key":"e_1_2_10_6_1","unstructured":"ElektaAB.Monaco\u00ae Training Guide 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