{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:16:56Z","timestamp":1767179816491,"version":"3.48.0"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T00:00:00Z","timestamp":1763856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["31171038"],"award-info":[{"award-number":["31171038"]}],"id":[{"id":"10.13039\/501100001809","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":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the use of dual\u2010reference lines to reduce positioning errors and optimize modified planning target volume (MPTV) in volume modulated arc therapy (VMAT) for cervical cancers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty\u2010seven patients with FIGO stage IIB\u2010IVA cervical cancer and no distant metastasis, who underwent radiotherapy in a tertiary hospital from June 15 2022 to September 15 2023, were selected and randomly divided into dual positioning reference line group (dual\u2010line group, 21 cases) and single positioning reference line group (single\u2010line group, 16 cases). A single reference line was made in pelvic region in single\u2010line group, while dual reference lines were made in stable abdominopelvic region in dual\u2010line group. The cone\u2010beam computed tomography (CBCT) was conducted to determine the positioning errors and calculate MPTV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Linear error in\n                      <jats:italic>Y<\/jats:italic>\n                      direction, rotational errors in the rotation around\n                      <jats:italic>Y<\/jats:italic>\n                      \u2010axis (\n                      <jats:italic>RY<\/jats:italic>\n                      )\/\n                      <jats:italic>Z<\/jats:italic>\n                      \u2010axis (\n                      <jats:italic>RZ<\/jats:italic>\n                      ) (0.27\u00a0\u00b1\u00a00.12\u00a0cm, 0.60\u00a0\u00b1\u00a00.42\u00b0, 0.48\u00a0\u00b1\u00a00.44\u00b0) in dual\u2010line group were smaller than those (0.35\u00a0\u00b1\u00a00.22\u00a0cm, 0.78\u00a0\u00b1\u00a00.45\u00b0, 0.85\u00a0\u00b1\u00a00.66\u00b0) in single\u2010line group (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). The thresholds of 0.4\u00a0cm and 1.4\u00b0 were set as the boundary values for linear and rotational errors, respectively. There were significant statistical differences in the distribution of positioning errors in the six directions between the two groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), with higher positioning error rates in the\n                      <jats:italic>Y<\/jats:italic>\n                      (77.78%),\n                      <jats:italic>RY<\/jats:italic>\n                      (41.46%), and\n                      <jats:italic>RZ<\/jats:italic>\n                      (53.66%) directions, respectively. Median total positioning time in dual\u2010line group (8.27\u00a0min, interquartile rang [IQR]: 7.65\u20138.63) was shorter than that (8.75\u00a0min, IQR: 7.89\u20139.45) in single\u2010line group (Z\u00a0=\u00a03.53998,\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.001). MPTVs in\n                      <jats:italic>X<\/jats:italic>\n                      ,\n                      <jats:italic>Y<\/jats:italic>\n                      , and\n                      <jats:italic>Z<\/jats:italic>\n                      directions (0.25, 0.37, and 0.10\u00a0cm) in dual\u2010line group were smaller than those (0.31, 0.56, and 0.11\u00a0cm) in single\u2010line group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dual\u2010reference lines improve positioning accuracy, reduce MPTV, and enhance efficiency in VMAT for middle and advanced cervical cancers, offering a clinically practical solution for precision radiotherapy.<\/jats:p>\n                  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