{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T05:50:59Z","timestamp":1774158659639,"version":"3.50.1"},"reference-count":30,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":17,"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>Purpose<\/jats:title>\n                    <jats:p>Total body irradiation (TBI) is an important part of conditioning regimens prior to hematopoietic stem cell transplantation (HSCT). At our institution, a conventional TBI technique employing bilateral fields at extended source\u2010to\u2010axis distance (eSAD) and a solid three\u2010dimensional (3D) compensator has been standard practice since the 80s. However, its ability to minimize lung dose remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims to modernize the existing TBI technique using the capabilities of our treatment planning system (TPS). The proposed hybrid method replaces solid compensators with virtual compensation by combining bilateral intensity\u2010modulated radiotherapy (IMRT) fields at eSAD of 500\u00a0cm with volumetric modulated arc therapy (VMAT) fields at standard SAD 100\u00a0cm for the thoracic region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>At first, the Anisotropic Analytical Algorithm (AAA) V16 and AcurosXB (AXB) V16 dose calculation algorithms of the Eclipse TPS (Varian) were commissioned for use at eSAD. Dosimetric measurements were performed in water, solid water, and inhomogeneous phantoms. Subsequently, a treatment planning strategy was developed to minimize the influence of positioning uncertainties on lung dose. Anonymized computed tomography (CT) datasets representing diverse patient anatomies were utilized for treatment planning evaluation. Final validation was conducted through an end\u2010to\u2010end test using an anthropomorphic phantom. SAD VMAT and eSAD IMRT fields were verified using a two\u2010dimensional (2D) dosimetry chamber array positioned at both caudal and cranial thoracic levels under SAD and eSAD setups. The resulting cumulative dose was then compared with the AXB\u2010calculated dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At eSAD, mean measured\u2013calculated dose deviations were\u00a0&lt;\u00a02% for AXB and\u00a0&lt;\u00a04% for AAA, with confidence limits of 3.5% and 5%, respectively. These results affirmed the clinical viability of both algorithms, with AXB providing superior dose calculation accuracy. Planning studies showed consistent PTV coverage with lung dose reduction across diverse anatomies, and end\u2010to\u2010end phantom validation confirmed the workflow practicability. Verification of summed dose using the 2D array, with 95% of evaluated points meeting a gamma criterion of 5\u00a0mm and 5%, provided additional confidence in the dosimetric robustness of the treatment concept.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study showed the feasibility of a novel hybrid eSAD IMRT\/VMAT TBI technique providing a clinically viable approach enabling effective lung dose sparing while maintaining the robustness of large\u2010field irradiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70529","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T01:20:03Z","timestamp":1773883203000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Total body irradiation (TBI) combining volumetric modulated arc therapy (VMAT) for thorax at standard source axis distance (SAD) with intensity modulated radiation therapy (IMRT) at extended SAD"],"prefix":"10.1002","volume":"27","author":[{"given":"Marc","family":"Delaperri\u00e8re","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University Hospital Schleswig\u2010Holstein (Universit\u00e4tsklinikum Schleswig\u2010Holstein, UKSH) Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Hirt","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Hospital Schleswig\u2010Holstein (Universit\u00e4tsklinikum Schleswig\u2010Holstein, UKSH) Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian Felix","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Hospital Schleswig\u2010Holstein (Universit\u00e4tsklinikum Schleswig\u2010Holstein, UKSH) Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank Andr\u00e9","family":"Siebert","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Hospital Schleswig\u2010Holstein (Universit\u00e4tsklinikum Schleswig\u2010Holstein, UKSH) Kiel 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