{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T05:50:57Z","timestamp":1774158657631,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100017950","name":"Shanghai Municipal Health Commission","doi-asserted-by":"publisher","award":["20254Y0140"],"award-info":[{"award-number":["20254Y0140"]}],"id":[{"id":"10.13039\/100017950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010876","name":"Shanghai University of Traditional Chinese Medicine","doi-asserted-by":"publisher","award":["23KFL105"],"award-info":[{"award-number":["23KFL105"]}],"id":[{"id":"10.13039\/501100010876","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":[[2026,3]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n To assess how inter\u2010fraction bowel cavity (BC) motion volume influences accumulated dose in rectal cancer radiotherapy and to translate these effects into a clinically interpretable risk construct for acute bowel toxicity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective cohort included 28 consecutive rectal cancer patients treated with 50\u00a0Gy in 25 fractions on a Halcyon v3.0 linac with daily iterative cone beam CT (iCBCT). Patients with\u00a0>\u00a05% bladder\u2010volume or\u00a0>\u00a08% external\u2010contour variation across the course were excluded. For each fraction, per\u2010fraction dose was recalculated on the iCBCT using a scanner\u2010specific HU\u2010relative electron density calibration, rigidly aligned to the planning CT (pCT), deformably registered, and voxel\u2010wise accumulated on pCT. Dosimetric endpoints were PTV\n D<\/jats:italic>\n 2%<\/jats:sub>\n ,\n D<\/jats:italic>\n 50%<\/jats:sub>\n ,\n D<\/jats:italic>\n 98%<\/jats:sub>\n and whole\u2010bowel (WB)\n D<\/jats:italic>\n 0.03cc<\/jats:sub>\n ,\n D<\/jats:italic>\n 150cc<\/jats:sub>\n . Associations between inter\u2010fraction BC motion volume change (\u0394V\n BC<\/jats:sub>\n ) and accumulated dose difference (\u0394D) were quantified using Spearman's f and ordinary\u2010least\u2010squares slopes (Gy per 10% BC expansion); same\u2010day effects were estimated with patient fixed\u2010effects models. To account for multiple testing,\n p<\/jats:italic>\n \u2010values for the five primary endpoints were adjusted using the Benjamini\u2013Hochberg false discovery rate (FDR). Clinical relevance was assessed with a published logistic normal\u2010tissue complication probability (NTCP) model based on WB\n V<\/jats:italic>\n 45<\/jats:sub>\n , defined as the WB volume receiving \u2265 45\u00a0Gy.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Accumulated dose analyses showed selective elevation of high\u2010dose metrics with preservation of near\u2010minimum target coverage. Compared with the plan, accumulated PTV\n D<\/jats:italic>\n 2%<\/jats:sub>\n and\n D<\/jats:italic>\n 50%<\/jats:sub>\n increased by 0.87\u00a0Gy and 0.61\u00a0Gy, respectively, whereas PTV\n D<\/jats:italic>\n 98%<\/jats:sub>\n exhibited no meaningful change. WB\n D<\/jats:italic>\n 0.03cc<\/jats:sub>\n and\n D<\/jats:italic>\n 150cc<\/jats:sub>\n increased by 1.21\u00a0Gy and 1.18\u00a0Gy, respectively. Inter\u2010fraction BC expansion was strongly associated with high\u2010dose escalation: for each 10% increase in BC volume, accumulated WB\n D<\/jats:italic>\n 0.03cc<\/jats:sub>\n increased by 0.31\u00a0Gy (95% CI 0.18\u20130.44; \u03c1\u00a0=\u00a00.78) and PTV\n D<\/jats:italic>\n 2%<\/jats:sub>\n by 0.29\u00a0Gy (0.15\u20130.37; \u03c1\u00a0=\u00a00.66). After FDR adjustment, no endpoint met\n p<\/jats:italic>\n \u00a0<\u00a00.05, but the strongest associations (PTV\n D<\/jats:italic>\n 2%<\/jats:sub>\n , WB\n D<\/jats:italic>\n 0.03cc<\/jats:sub>\n ) remained near\u2010significant and directionally consistent with large, biologically plausible effect sizes. Application of the WB\n V<\/jats:italic>\n 45<\/jats:sub>\n NTCP model indicated modest but consistent risk increments after accumulation, with NTCP for \u2265 grade 2 toxicity increasing from 0.75 to 0.79 (+0.04;\n p<\/jats:italic>\n \u00a0=\u00a00.001) and NTCP for grade 3 toxicity increasing from 0.80 to 0.84 (+0.04;\n p\u00a0<\/jats:italic>\n =\u00a00.002).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Daily iCBCT\u2010based dose accumulation identifies inter\u2010fraction BC motion volume as a selective driver of high\u2010dose escalation to the PTV and WB while largely preserving near\u2010minimum target coverage. Accumulated WB\n V<\/jats:italic>\n 45<\/jats:sub>\n may serve as a practical, delivery\u2010based marker for on\u2010treatment surveillance and risk\u2010adapted intervention, complementing plan\u2010based evaluation in rectal cancer radiotherapy.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acm2.70524","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:23:04Z","timestamp":1772968984000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accumulated dose on daily iCBCT for rectal cancer: Effects of inter\u2010fraction bowel cavity motion volume"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3974-7836","authenticated-orcid":false,"given":"Hongwei","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Radiotherapy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangyu","family":"E","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingping","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Changzhou Cancer Hospital Changzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minghe","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruping","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.70160"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010024\u201002567\u20107"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010024\u201002508\u20104"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.21037\/apm\u201022\u201066"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010019\u20101262\u20108"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1399468"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066\u2010024\u201002323\u20106"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15164037"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1280836"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.12.036"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010018\u20101068\u20100"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100663"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","unstructured":"KongZ WangH LinW et\u00a0al.Indescribable multi\u2010modal spatial evaluator. 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