{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T11:16:53Z","timestamp":1767179813956,"version":"3.48.0"},"reference-count":33,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":11,"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":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Cone beam CT (CBCT) has been reported for intensity\u2010modulated radiation therapy (IMRT) of various cancers due to its real\u2010time imaging capabilities, but studies on its application in orbital diseases, particularly moderate to severe thyroid\u2010associated ophthalmopathy (TAO), remain limited.<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n To investigate the clinical applications of CBCT in IMRT for TAO, with a focus on setup accuracy, dosimetric impact, and short\u2010term changes in eye prominence.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 115 CBCT scans from 17 TAO patients were analyzed. Pretreatment CBCT scans were registered to the planning CT using bony anatomy. The resulting setup errors were quantified in three translational directions. Residual shifts after online correction were tracked to assess interfractional variation and trends throughout the treatment course. Dose\u2010volume histogram from plans recalculated with simulated setup errors (mean and maximum values) were compared to the original plan. Eye prominence was measured on serial CBCT scans, and its correlation with cumulative dose was analyzed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Mean setup errors were (\u20130.16\u00a0\u00b1\u00a01.09) mm, (\u20130.19\u00a0\u00b1\u00a01.18) mm, and (\u20130.55\u00a0\u00b1\u00a01.05) mm in X, Y, and Z directions. Errors significantly decreased planning target volume (PTV) conformity (\n p<\/jats:italic>\n \u00a0<\u00a00.05) and increased\n D<\/jats:italic>\n mean<\/jats:sub>\n ,\n D<\/jats:italic>\n max<\/jats:sub>\n ,\n D<\/jats:italic>\n 2%,<\/jats:sub>\n and\n D<\/jats:italic>\n 50%<\/jats:sub>\n (\n p<\/jats:italic>\n \u00a0<\u00a00.05). For organs at risk (OARs), maximum and mean doses increased, with left lens\n D<\/jats:italic>\n max<\/jats:sub>\n increasing by 21.3%, 32.7%, 33.8%, and 13.2% for mean setup errors and X, Y, and Z maximum errors. Right lens showed similar increases. A correlation between CBCT\u2010measured eye prominence and total radiotherapy dose was observed, with the binomial fit: y\u00a0=\u00a022.43\n +<\/jats:bold>\n 0.12x \u2212 (9.94 \u00d7 10\n \u22123<\/jats:sup>\n ) x\n 2<\/jats:sup>\n (\n \n R\n 2<\/jats:sup>\n <\/jats:italic>\n \u00a0=\u00a00.96). Mean eye prominence decreased significantly from (21.74\u00a0\u00b1\u00a01.74) mm pre\u2010treatment to (20.94\u00a0\u00b1\u00a01.73) mm after 18\u00a0Gy of IMRT (\n p<\/jats:italic>\n \u00a0<\u00a00.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n CBCT image guidance for IMRT in moderate to severe TAO improves target conformity and coverage while reducing OAR doses, particularly for lenses. CBCT also shows promise for short\u2010term efficacy assessment of eye prominence in radiotherapy patients which may alleviate patient anxiety with preliminary observation thereby improving patient compliance with radiotherapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acm2.70416","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T09:05:21Z","timestamp":1765530321000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical application of cone beam CT in intensity\u2010modulated radiotherapy for the moderate to severe thyroid\u2010associated ophthalmopathy"],"prefix":"10.1002","volume":"26","author":[{"given":"Dan","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Oncology The Third Xiangya Hospital, Central South University Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Oncology The Third Xiangya Hospital, Central South University Changsha Hunan China"},{"name":"Radiotherapy Center The Third Xiangya Hospital, Central South University Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuyun","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Oncology The Third Xiangya Hospital, Central South University Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0315-5305","authenticated-orcid":false,"given":"Shizhen","family":"Bin","sequence":"additional","affiliation":[{"name":"Department of Oncology The Third Xiangya Hospital, Central South University Changsha Hunan 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