{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T16:42:41Z","timestamp":1793032961750,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["11905150"],"award-info":[{"award-number":["11905150"]}],"id":[{"id":"10.13039\/501100001809","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":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to determine an appropriate frequency of image\u2010guided (IG) schedules for left\u2010sided postmastectomy radiotherapy by comprehensively evaluating dosimetric, radiobiological, imaging dose, and imaging\u2010related cost outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 20 patients treated with volumetric modulated arc therapy (VMAT) was conducted. Virtual CT images were generated by deforming the pCT to daily cone\u2010beam computed tomography (CBCT) using deformable image registration. Accumulated dose, tumor control probability (TCP), normal tissue complication probability (NTCP), imaging dose, and imaging\u2010related cost were compared among six IG schedules: no image\u2010guided (NIG), weekly image\u2010guided (WIG), twice\u2010weekly image\u2010guided (TIG), thrice\u2010weekly image\u2010guided (THRIG), initial 3 days then weekly image\u2010guided (3D + WIG), and daily image\u2010guided (DIG).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Increasing the frequency of IG schedules significantly improved planning target volume (PTV) dose coverage (D\n                      <jats:sub>95<\/jats:sub>\n                      ) and TCP (P\u00a0&lt;\u00a00.001), with DIG achieving optimal target dose delivery. Although no statistically significant differences were observed in dose to organs at risk (OARs) or NTCP, higher\u2010frequency schedules showed a trend toward reduced variability. However, cumulative imaging dose increased linearly with the frequency of IG schedules (e.g., contralateral breast: 1.26\u201331.50 mGy; ipsilateral lung: 2.85\u201371.25 mGy), and imaging\u2010related cost increased substantially from NIG to DIG, with differences of approximately 1.7\u2010 to 25\u2010fold. THRIG demonstrated a favorable balance, with minimal deviations in PTV D\n                      <jats:sub>95<\/jats:sub>\n                      (1.38%) and TCP (0.83%) relative to DIG, while reducing imaging dose and cost to approximately 60% of DIG.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While high frequency IG schedules improve target dose coverage, they are associated with increased imaging dose and imaging\u2010related cost. Within the CBCT\u2010guided VMAT workflow evaluated in this study, THRIG may provide a balanced trade\u2010off between treatment precision, safety, and cost.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70629","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T18:05:42Z","timestamp":1779559542000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimization of CBCT\u2010guided imaging schedules for left\u2010sided postmastectomy radiotherapy using VMAT: A dosimetric, radiobiological, and cost analysis"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7720-4573","authenticated-orcid":false,"given":"Denghong","family":"Liu","sequence":"first","affiliation":[{"name":"Radiotherapy Physics &amp; Technology Center, Cancer Center West China Hospital Sichuan University  Chengdu P.R. 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