{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:08:10Z","timestamp":1790208490135,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"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":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ExacTrac Dynamic (ETD) is a novel patient positioning and motion management system for radiation therapy that combines surface guidance, thermal imaging, and stereoscopic x\u2010rays for image guidance. This combination of technology enables both intrafraction monitoring and surface\u2010based breath hold gating capabilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to use the American Association of Physicists in Medicine (AAPM) TG\u2010302 framework to commission two independent ETD systems for performing breath hold gated lung radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A series of static and dynamic tests were performed using an anthropomorphic thorax phantom placed on a dynamic motion platform. Static tests included localization accuracy and reproducibility, and the impact of reference surface selection on localization. Spatial drift was evaluated during system warmup, during typical treatment session duration, and with changing temperature. Dynamic tests assessed localization accuracy and reproducibility, as well as gating latency. Finally, end\u2010to\u2010end testing of a simulated breath hold lung stereotactic body radiation therapy (SBRT) treatment was performed, with both gated and ungated dose measurements being acquired.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Static and dynamic localization accuracy averaged less than 1\u00a0mm, with reproducibility within 0.4\u00a0mm. An optimal Hounsfield Unit (HU) threshold of\u2010700 for the reference surface contour was demonstrated to have the best localization accuracy. The maximum observed spatial drift for all tests was less than 1\u00a0mm. Congruence between surface guidance, x\u2010ray imaging, and CBCT were all within 1\u00a0mm. Mean beam on and off latency averaged 1023 and 527.1\u00a0ms, respectively. End\u2010to\u2010end testing demonstrated less than 1% dose difference between gated and non\u2010gated treatment delivery. The independent ETD systems demonstrated consistent performance across all commissioning tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>All commissioning tests were within acceptable tolerances published in the AAPM TG\u2010302 report. This study demonstrated that the ETD system is suitable for performing surface\u2010guided breath hold gated lung SBRT treatments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70283","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:39:36Z","timestamp":1763465976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Commissioning of a combined stereoscopic x\u2010ray and surface guided radiotherapy system for performing breath hold gated lung radiotherapy"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3967-1026","authenticated-orcid":false,"given":"Garrett C.","family":"Baltz","sequence":"first","affiliation":[{"name":"Scripps Cancer Center  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Kirsner","sequence":"additional","affiliation":[{"name":"Scripps Cancer Center  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13810"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13754"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.573279"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.07.1468"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13346"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3190392"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15532"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.05.026"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13567"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/jmp.jmp_67_22"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13246\u2010023\u201001291\u2010y"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598691"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2021.12.012"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ab205a"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010020\u201001611\u20106"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:13:20Z","timestamp":1767179600000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":15,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/acm2.70283"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70283","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]},"assertion":[{"value":"2025-02-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70283"}}