{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:06:11Z","timestamp":1790697971890,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":27,"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"}],"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>Background<\/jats:title>\n                    <jats:p>Breast cancer is the most common malignancy in women, and adjuvant radiotherapy is an essential component of curative treatment. Despite advances in hypofractionated whole\u2010breast irradiation (HF\u2010WBI), incidental lung exposure remains unavoidable and predisposes to radiation\u2010induced pulmonary injury, including radiation pneumonitis (RP). Traditional predictors such as mean lung dose (MLD) may inadequately capture the heterogeneous intrapulmonary dose distribution typical of breast radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to evaluate whether heterogeneity\u2010sensitive dosimetric metrics and functional lung imaging better predict radiation\u2010induced perfusion changes and RP in patients undergoing HF\u2010WBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective study, 48 node\u2010negative breast cancer patients treated with conformal HF\u2010WBI were evaluated. Pulmonary perfusion scans (PPS) were acquired pre\u2010RT and 6\u20139 months post\u2010RT. Dose\u2013volume histogram (DVH) parameters, including MLD, uniform effective dose (D\n                      <jats:sub>eff<\/jats:sub>\n                      ), and V\n                      <jats:sub>5<\/jats:sub>\n                      \u2013V\n                      <jats:sub>40<\/jats:sub>\n                      , were extracted from three\u2010dimensional conformal radiotherapy (3DCRT) or forward\u2010planned intensity\u2010modulated RT (FIMRT) plans. D\n                      <jats:sub>eff<\/jats:sub>\n                      was calculated using the Lyman\u2013Kutcher\u2013Burman (LKB) model to integrate dose heterogeneity. Associations between dosimetric metrics, perfusion changes, and RP were analyzed using correlation and ROC analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PPS revealed modest but detectable post\u2010RT perfusion declines, most pronounced in lung regions receiving higher doses. Three patients (6.3%) developed Grade 2 RP. D\n                      <jats:sub>eff<\/jats:sub>\n                      and high\u2010dose lung volumes (V\n                      <jats:sub>35<\/jats:sub>\n                      \u2013V\n                      <jats:sub>40<\/jats:sub>\n                      ) demonstrated the strongest correlations with perfusion loss and RP (AUC 0.81\u20130.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01), whereas MLD showed weaker predictive value. ROC analysis identified clinically relevant thresholds: D\n                      <jats:sub>eff<\/jats:sub>\n                      \u2264 13.6\u00a0Gy, V\n                      <jats:sub>35<\/jats:sub>\n                      \u2264 37.5%, V\n                      <jats:sub>40<\/jats:sub>\n                      \u2264 32%, and a \u22654% decline in total perfusion, below which minimal functional impairment and RP were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      D\n                      <jats:sub>eff<\/jats:sub>\n                      and high\u2010dose volumetric constraints outperform MLD in predicting decrease in lung perfusion in HF\u2010WBI. Quantitative PPS provides complementary functional validation, and integration of dosimetric and functional parameters may refine lung\u2010sparing strategies in breast radiotherapy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70641","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:49:29Z","timestamp":1779965369000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Characterization of dosimetric predictors for pulmonary perfusion changes before and after hypofractionated whole\u2010breast radiotherapy in node\u2010negative breast cancer patients: A prospective study"],"prefix":"10.1002","volume":"27","author":[{"given":"Farzaneh","family":"Allaveisi","sequence":"first","affiliation":[{"name":"Department of Medical Physics Faculty of Medicine Kurdistan University of Medical Sciences  Sanandaj 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