{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:16:49Z","timestamp":1778221009602,"version":"3.51.4"},"reference-count":51,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":9,"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>Purpose<\/jats:title>\n                    <jats:p>To evaluate the cumulative radiobiological impact of daily megavoltage cone\u2010beam computed tomography (MV\u2010CBCT) imaging dose based on normal tissue complication probability (NTCP) and excess absolute risk (EAR) of secondary malignancies among radiotherapy patients treated for breast, pelvic, and head &amp; neck cancers. This study investigated whether MV\u2010CBCT imaging dose warrants protocol personalization according to patient age, anatomical treatment site, and organ\u2010specific radiosensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included cohorts of breast (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a030), pelvic (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a017), and head &amp; neck (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a020) cancer patients undergoing radiotherapy with daily MV\u2010CBCT. Imaging dose distributions employing two common MV\u2010CBCT protocols (5 and 10\u00a0MU per fraction) were analyzed. NTCP values were estimated using logistic models, while EAR were calculated using Schneider's organ equivalent dose (OED)\u2010based model, integrating organ\u2010specific dose, patient age, and established tissue\u2010specific risk coefficients. Comparative statistical analyses were conducted using paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, and results were further stratified by patient age (&lt;\u00a040, 40\u201360,\u00a0&gt;\u00a060 years).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In breast cancer patients, NTCP values increased significantly for lung tissue when comparing the 10\u00a0MU protocol to the 5\u00a0MU one (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), while those for heart and breast tissues showed minimal and insignificant differences. EAR estimations revealed substantial risk increases among younger breast cancer patients (&lt;\u00a040 years), with some exceeding 15 cases per 10\u00a0000 person\u2010years under the 10\u00a0MU protocol. Conversely, pelvic and head &amp; neck cohorts demonstrated consistently low NTCP and EAR values (&lt;\u00a01%), with no meaningful differences observed between the two imaging protocols. Across all cancer sites, younger age consistently correlated with higher secondary cancer risks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Routine daily MV\u2010CBCT imaging at the 10\u00a0MU protocol possesses minimal additional risk in pelvic and head &amp; neck radiotherapy. However, among breast cancer patients, particularly those under 40 years, the 10\u00a0MU protocol significantly elevates the theoretical secondary cancer risk estimates and lung NTCP. These findings support transitioning from conventional uniform imaging approach toward personalized MV\u2010CBCT protocols, tailored according to patient age, anatomical site, and organ radiosensitivity. A stratified imaging framework is proposed to optimize clinical outcomes, balancing treatment accuracy, and long\u2010term patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70414","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T04:55:11Z","timestamp":1765428911000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["From standard to stratified: Modeling NTCP and EAR to personalize daily MV\u2010CBCT in radiotherapy"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7276-8105","authenticated-orcid":false,"given":"Duong Thanh","family":"Tai","sequence":"first","affiliation":[{"name":"Department of Medical Physics Faculty of Medicine Nguyen Tat Thanh University  Ho Chi Minh City Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0963-1922","authenticated-orcid":false,"given":"Luong Tien","family":"Phat","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Medical Shing Mark Hospital  Dong Nai Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tran Trung","family":"Kien","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Medical Shing Mark Hospital  Dong Nai Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7411-1369","authenticated-orcid":false,"given":"Duong Tuan","family":"Linh","sequence":"additional","affiliation":[{"name":"The Laboratory Center of Hanoi University of Public Health Hanoi University of Public Health  Hanoi Vietnam"},{"name":"Department of Applied Physics School of Engineering Sciences KTH Royal Institute of Technology  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7482-2600","authenticated-orcid":false,"given":"Nguyen Ngoc","family":"Anh","sequence":"additional","affiliation":[{"name":"Phenikaa Institute for Advanced Study (PIAS) Phenikaa University  Hanoi Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9739-301X","authenticated-orcid":false,"given":"Nguyen Quang","family":"Hung","sequence":"additional","affiliation":[{"name":"Institute of Fundamental and Applied Sciences Duy Tan University  Ho Chi Minh City Viet Nam"},{"name":"Faculty of Natural Sciences Duy Tan University  Da Nang Viet Nam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9962-7281","authenticated-orcid":false,"given":"Peter","family":"Sandwall","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology OhioHealth Mansfield  Mansfield Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4847-9068","authenticated-orcid":false,"given":"Parham","family":"Alaei","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9485-5242","authenticated-orcid":false,"given":"David","family":"Bradley","sequence":"additional","affiliation":[{"name":"Applied Radiation Physics and Technologies Group Department of Engineering Sunway University  Petaling Jaya Selangor Malaysia"},{"name":"School of Mathematics and Physics University of Surrey  Guildford Surrey UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4202-4855","authenticated-orcid":false,"given":"James C. 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