{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T07:31:41Z","timestamp":1753860701271,"version":"3.41.2"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T00:00:00Z","timestamp":1739318400000},"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":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The unique design of the MR\u2010linac may restrict the use of effective immobilization devices, resulting in significant patient setup variations (PSVs). The purpose of this study is to analyze the PSVs on the Elekta Unity system and investigate their impact on adaptive planning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The PSVs for 10 brain, 10 pancreas, five prostate, and five rectum patients previously treated on Elekta Unity were analyzed. The five prostate and five pancreas plans were selected to investigate the impact of PSVs on adaptive planning. The reference scans were shifted by 1, 2, and 3\u00a0cm in the left\u2013right (LR) and superior\u2013inferior (SI) directions to simulate PSVs. Both the adaptive\u2010to\u2010position (ATP) and adaptive\u2010to\u2010shape (ATS) workflows were executed. The adaptive planning time, number of monitor units (MUs), and dosimetric metrics quantifying target coverage and organ\u2010at\u2010risks (OARs) sparing were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For brain treatments, the average\/maximum PSVs were \u22120.2\u00a0\u00b1\u00a00.3\u00a0cm\/0.8\u00a0cm (LR), 0.3\u00a0\u00b1\u00a00.7\u00a0cm\/1.8\u00a0cm (SI), and 0.8\u00a0\u00b1\u00a00.7\u00a0cm\/1.8\u00a0cm in the anterior\u2013posterior (AP) direction. For pancreas treatments, the PSVs are \u22120.1\u00a0\u00b1\u00a01.0\u00a0cm\/3.8\u00a0cm (LR), \u22120.1\u00a0\u00b1\u00a00.8\u00a0cm\/3.5\u00a0cm (SI), and 0.3\u00a0\u00b1\u00a00.3\u00a0cm\/1.3\u00a0cm (AP). Pelvis treatments had similar PSVs as pancreas treatments. The ATS workflow took two to three times longer than the ATP workflow. The only trend observed was that the plan MUs increased slightly (&lt;\u00a010%) with PSVs in the ATP workflow for prostate patients. Both workflows effectively reproduced target coverage and OAR sparing, regardless of the magnitude of the PSVs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Significant PSVs were observed on Elekta Unity due to suboptimal patient immobilization. Using prostate and pancreas treatments as examples, we demonstrated that adaptive planning can effectively accommodate such PSVs. Nevertheless, efforts should be made to minimize PSVs\u2014particularly rotations\u2014to mitigate intra\u2010fraction motion and reduce treatment time.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.70016","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T05:48:46Z","timestamp":1739425726000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient setup variation on Elekta Unity and its impact on adaptive planning"],"prefix":"10.1002","volume":"26","author":[{"given":"Maggie","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Computer Information and Science Engineering University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erika","family":"Kollitz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng\u2010Hsuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Hitchcock","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"De Leo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luke","family":"Maloney","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chihray","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guanghua","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3438081"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12771"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-021-01910-6"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14162"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tipsro.2021.11.002"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2019.04.001"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.01.024"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11061662"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/54\/12\/N01"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2020.12.001"}],"container-title":["Journal 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