{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:31:21Z","timestamp":1792182681094,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>This study aimed to evaluate the dosimetric performance and robustness of volumetric modulated arc therapy (VMAT) planning techniques\u2014planning target volume with internal margin (INT), auto flash (AF), and virtual bolus (VB)\u2014under simulated geometric changes during whole\u2010breast radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine patients with left\u2010sided breast cancer were included. Three planning techniques were compared: INT with a 5\u2010mm skin\u2010sparing internal margin, AF with a 1\u2010cm automatic skin flash margin, and VB with a 5\u2010mm optimization bolus applied only during the planning. Respiratory motion was simulated by shifting the plan center (\u00b1\u00a03\u00a0mm and\u00a0\u00b1\u00a05\u00a0mm) and recalculating the dose distributions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Under static conditions, all plans provided adequate target coverage, with planning target volume (PTV) V95% values of 96.45% (INT), 97.35% (AF), and 98.19% (VB). Under breast swelling of up to 5\u00a0mm, AF maintained the most stable coverage (PTV V95%\u00a0=\u00a099.10%), outperforming VB (95.02%) and INT (92.31%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In simulated incomplete inspiration (5\u00a0mm), VB showed superior robustness, achieving a PTV V95% of 90.46% compared with AF (85.30%) and INT (85.08%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.008). AF met the ideal criteria in all cases under swelling conditions, whereas the VB was more effective against suboptimal respiration.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In VMAT breast radiation therapy (RT), the conventional INT approach was the least robust against variations, and additional techniques are required. AF effectively compensates for breast swelling, whereas VB preserves the target coverage under insufficient breath\u2010hold conditions. Surface\u2010guided radiation therapy (SGRT) and visual guidance are recommended to ensure accurate treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70471","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:18:02Z","timestamp":1772968682000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dosimetric effects of internal margin, auto flash, and virtual bolus in VMAT\u2010based whole\u2010breast radiotherapy under motion variations"],"prefix":"10.1002","volume":"27","author":[{"given":"Ji Hyeon","family":"Joo","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Republic of Korea"},{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Woon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wontaek","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Republic of Korea"},{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiho","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Republic of Korea"},{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dahl","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youn Joo","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Surgery Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Yul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery Pusan National University Yangsan Hospital  Yangsan Republic of Korea"},{"name":"Department of Surgery Pusan National University School of Medicine  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ki Seok","family":"Choo","sequence":"additional","affiliation":[{"name":"Department of Radiology Pusan National University School of Medicine Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Jin","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Radiology Pusan National University School of Medicine Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Bong","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Pusan National University School of Medicine Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Joon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology Pusan National University Yangsan Hospital  Yangsan Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongkan","family":"Ki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Republic of Korea"},{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Republic of 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