{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:54:00Z","timestamp":1791986040681,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004700","name":"Taipei Medical University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004700","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":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Helical TomoTherapy provides highly conformal dose distributions for breast irradiation but is limited by extensive low\u2010dose spillage (\u201clow\u2010dose bath\u201d), contributing to increased integral dose and potential long\u2010term toxicities. Complete blocks can suppress low\u2010dose spread, but at the cost of prolonged treatment times on legacy TomoTherapy systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To develop and validate a deformable image registration (DIR)\u2010based workflow that predicts patient\u2010specific low\u2010dose distributions and generates personalized complete blocks for TomoTherapy, aiming to reduce low\u2010dose exposure and integral dose. A secondary objective was to determine whether Radixact, a modern helical platform, could mitigate treatment\u2010time penalties while preserving dosimetric benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010eight patients were retrospectively analyzed (18 tangential partial\u2010arc volumetric modulated arc therapy [t\u2010VMAT], 10 TomoTherapy). DIR\u2010based dose prediction derived from t\u2010VMAT atlases was used to construct complete blocks for replanning on Hi\u2010Art (TOMO_RE) and Radixact (TOMO_FA). Dosimetric endpoints included target conformity, homogeneity, organ\u2010at\u2010risk (OAR) doses, and integral dose (ID). Statistical analyses used Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test for independent cohorts and Friedman\/Wilcoxon tests for paired TomoTherapy plans with Holm\u2013Bonferroni correction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      TOMO_FA significantly reduced low\u2010dose exposure compared with TOMO_ORI, including lower contralateral lung mean dose (0.79\u00a0vs. 3.13\u00a0Gy,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01) and reduced Heart V5 (12.81%\u00a0vs. 20.94%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.027). Body\u2010PTV ID decreased meaningfully (103.14\u00a0vs. 114.52\u00a0Gy\u00b7L,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.012). High\u2010dose cardiac parameters (V25, V40) remained within clinically acceptable limits and comparable to t\u2010VMAT. Treatment time improved substantially on Radixact (587.2\u00a0\u00b1\u00a044.3 s vs. 1118.0\u00a0\u00b1\u00a0135.5 s).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The proposed DIR\u2010based complete block workflow effectively reduces low\u2010dose exposure and integral dose in helical TomoTherapy without compromising delivery efficiency when implemented on Radixact. TOMO_FA represents a practical, personalized planning option, particularly for patients requiring stringent low\u2010dose sparing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70470","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T11:42:15Z","timestamp":1769514135000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reducing low\u2010dose exposure in helical TomoTherapy for locally advanced left\u2010sided breast cancer with a deformable image registration\u2013based dose\u2010mimicking workflow"],"prefix":"10.1002","volume":"27","author":[{"given":"Chih\u2010Chieh","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Shuang Ho Hospital Taipei Medical University  New Taipei Taiwan, ROC"},{"name":"Medical Physics and Radiation Measurements Laboratory National Yang Ming Chiao Tung University  Taipei Taiwan, ROC"},{"name":"Department of Biomedical Imaging and Radiological Sciences National Yang Ming Chiao Tung University  Taipei Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u2010Ting","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shuang Ho Hospital Taipei Medical University  New Taipei Taiwan, ROC"},{"name":"Graduate Institute of Clinical Medicine College of Medicine, Taipei Medical University  Taipei Taiwan, ROC"},{"name":"Department of Radiology, School of Medicine, College of Medicine Taipei Medical University  Taipei Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Ming","family":"Hsu","sequence":"additional","affiliation":[{"name":"Medical Physics and Radiation Measurements Laboratory National Yang Ming Chiao Tung University  Taipei Taiwan, ROC"},{"name":"Department of Biomedical Imaging and Radiological Sciences National Yang Ming Chiao Tung University  Taipei Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(14)60488\u20108"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209825"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.11.004"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.13387"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2015.02.005"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2018.00290"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.768811"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.02.040"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201004601\u20100"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.01.64"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20190792"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12938\u2010020\u201000783\u20102"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.16735"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15020177"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010025\u201002634\u20107"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ab10a0"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ac678a"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ab843e"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13246\u2010017\u20100558\u2010y"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.534"},{"key":"e_1_2_11_23_1","unstructured":"SharpGC LiR WolfgangJ et\u00a0al.Plastimatch: an open source software suite for radiotherapy image processing. 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