{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T21:09:32Z","timestamp":1787087372050,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["24ck0106924h0001"],"award-info":[{"award-number":["24ck0106924h0001"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>OXRAY, a state\u2010of\u2010the\u2010art radiation therapy system commercialized by Hitachi High\u2010Tech Ltd. in 2023, integrates unique beam delivery and image\u2010guided radiation therapy (IGRT) technologies as the successor to Vero4DRT. This study evaluated the performance of this second\u2010generation O\u2010ring\u2010shaped linear accelerator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The percentage depth dose (\n                      <jats:italic>PDD<\/jats:italic>\n                      ) and off\u2010center ratio (\n                      <jats:italic>OCR<\/jats:italic>\n                      ) were calculated using the RayStation 2023B treatment planning system with multileaf collimator\u2010shaped square fields.\n                      <jats:italic>PDDs<\/jats:italic>\n                      were evaluated up to a depth of 250\u00a0mm and\n                      <jats:italic>OCRs<\/jats:italic>\n                      at depths of 15, 100, and 200\u00a0mm, compared with measurements. Patient\u2010specific quality assurance (PSQA) was conducted for 28 volumetric\u2010modulated arc therapy plans and evaluated using gamma pass rates (GPRs) based on a 3%\/2\u00a0mm criterion. The biaxial rotational dynamic radiation therapy (BROAD\u2010RT) performance was validated with 25 trajectories. A tracking experiment under rotational irradiation was performed to assess the tracking accuracy. Additionally, image\u2010guidance systems (kV X\u2010ray and kV cone\u2010beam computed tomography) were evaluated using anthropomorphic phantoms. The localization accuracy (LA) was determined by comparing the known offsets with the noted differences between the initial and corrected positions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Differences between the calculated and measured data were within the tolerance limits defined in European Society for Radiotherapy and Oncology Booklet 7 and American Association of Physicists in Medicine (AAPM) Medical Physics Practice Guideline 5.b. The median PSQA GPRs exceeded 95%, satisfying AAPM Task Group\u2010218 criteria. BROAD\u2010RT demonstrated submillimeter accuracy (within 0.4\u00a0mm), even for complex trajectories. The tracking accuracy remained within 1\u00a0mm even during rotational delivery. LA was within 0.5\u00a0mm for translational shifts and 0.5\u00b0 for rotational adjustments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>OXRAY demonstrated clinically acceptable beam quality and high\u2010precision dose delivery outcomes. The tracking accuracy was maintained under rotational irradiation. Automatic image registration enabled accurate, reproducible patient positioning, supporting reliable IGRT implementation. These findings offer practical guidance and technical benchmarks for institutions adopting OXRAY.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70329","type":"journal-article","created":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T04:45:32Z","timestamp":1762577132000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Performance evaluation of a second\u2010generation O\u2010ring\u2010shaped image\u2010guided radiotherapy system with a gimbal\u2010mounted linear accelerator and real\u2010time tracking capabilities"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7825-2986","authenticated-orcid":false,"given":"Kohei","family":"Kawata","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology and Image\u2010Applied Therapy Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukako","family":"Kishigami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image\u2010Applied Therapy Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1548-1970","authenticated-orcid":false,"given":"Hideaki","family":"Hirashima","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image\u2010Applied Therapy Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Sawada","sequence":"additional","affiliation":[{"name":"Division of Clinical Radiology Service Kyoto University Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maika","family":"Urago","sequence":"additional","affiliation":[{"name":"Division of Clinical Radiology Service Kyoto University Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Division of Clinical Radiology Service Kyoto University Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuo","family":"Fukuda","sequence":"additional","affiliation":[{"name":"X\u2010ray Therapy Division, Therapy System Business, Healthcare Business Group Hitachi High\u2010Tech Corporation  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-8746","authenticated-orcid":false,"given":"Takashi","family":"Mizowaki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology and Image\u2010Applied Therapy Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6406-2097","authenticated-orcid":false,"given":"Mitsuhiro","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical Physics Graduate School of Medicine Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.07.002"},{"key":"e_1_2_10_3_1","unstructured":"International Atomic Energy Agency (IAEA).Commissioning and quality assurance of computerized planning systems for radiation treatment of cancer. 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