{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:53Z","timestamp":1789740113428,"version":"4.0.1"},"reference-count":38,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"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":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HyperArc is an effective technique for treating multiple small brain metastases using high\u2010definition, precise radiation. However, the small size of individual lesions makes treatment vulnerable to inherent inaccuracies from beam\u2010limiting devices such as multi\u2010leaf collimators (MLCs), as well as patient setup errors. These uncertainties must be thoroughly evaluated prior to administering a single\u2010fraction, high\u2010dose HyperArc treatment to ensure optimal clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To comprehensively evaluate the robustness of HyperArc VMAT plans for multiple brain metastases (MBT) against (i) high\u2010definition MLC leaf positional errors and (ii) patient rotational and translational setup variations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>\n                      A retrospective analysis of 34 MBT plans from 30 patients with 123 lesions treated using HyperArc VMAT plans was performed. Prescription doses (21\u201324\u00a0Gy) targeted PTVs (GTV + 1\u00a0mm), with each plan addressing 2\u20137 brain metastases (&lt;\u00a02\u00a0cm). D\n                      <jats:sub>100%<\/jats:sub>\n                      for GTV and V\n                      <jats:sub>12Gy<\/jats:sub>\n                      for normal brain were re\u2010evaluated under simulated (i) 20 MLC positional errors (0.2\u20131\u00a0mm) and (ii) 26 patient rotational (Yaw\/Pitch\/Roll by 1\u00b0) and 26 translational errors (SI\/LR\/AP by 1\u00a0mm). The impact of target distance to isocenter (DTI), target volume, and plan modulation factor on plan robustness was assessed. Replans with larger PTV margins, 1.5 and 2\u00a0mm, were investigated for a proper PTV margin for the worst\u2010case scenarios.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Per our cohort, D\n                      <jats:sub>100%<\/jats:sub>\n                      of GTV is highly sensitive to both MLC and patient errors. Their dosimetric effects follow linear regressions: 1\u00a0mm shift reduces GTV D\n                      <jats:sub>100%<\/jats:sub>\n                      by 8%; 1\u00a0mm symmetric MLC openings increase GTV D\n                      <jats:sub>100%<\/jats:sub>\n                      by\u00a0&gt;\u00a022%, while 1\u00a0mm symmetric closings decrease it by\u00a0&gt;\u00a025.8% per 1\u00a0mm; Patient rotation\/translation impacts GTV D\n                      <jats:sub>100%<\/jats:sub>\n                      by 0.04\u20131.28% per 1\u00b0 or \u223c7% per 1\u00a0mm. Normal brain V\n                      <jats:sub>12Gy<\/jats:sub>\n                      is only sensitive to MLC errors, increasing slightly with shifts and significantly with symmetric openings (+5cc\/1\u00a0mm), but decreasing with closings (\u22122.77cc\/1\u00a0mm). DTI shows minimal correlation with MLC shifts but is affected by patient setup uncertainties. Large targets amplify dose sensitivity to symmetric MLC errors, whereas plan modulation factor shows no significant impact. A minimum 1\u00a0mm margin is required to absorb these uncertainties, with 2\u00a0mm margins recommended in the worst cases to ensure treatment accuracy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Overall, the target dose and V\n                      <jats:sub>12Gy<\/jats:sub>\n                      for HyperArc VMAT plans are more significantly affected by symmetric MLC opening and closing errors than by patient rotational setup errors. The pronounced effects of these errors highlight the importance of rigorous plan robustness verification, accounting for target size, margins, and DTI.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70697","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:36:27Z","timestamp":1785346587000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of dosimetric impact and plan robustness of MLC motion and setup errors in SRS for multiple brain metastases"],"prefix":"10.1002","volume":"27","author":[{"given":"Huijun","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiguang","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinghao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannick","family":"Poirier","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junliang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guozhen","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shifeng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoshe","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.14831"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13561"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010020\u201001602\u20107"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2021.100663"},{"key":"e_1_2_10_6_1","unstructured":"KrcRF RyckmanJ ThomasE et\u00a0al.Dosimetric comparison of hyper arc single\u2010isocenter multi\u2010target and gamma knife based stereotactic radiosurgery for a patient with 53 brain metastases.CUREUS J MED SCIENCE.2022;14(2):a726."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13075"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00483"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010017\u20100948\u2010z"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2022.12.001"},{"key":"e_1_2_10_11_1","unstructured":"YangB YuL WangZ et\u00a0al.Comparison between HyperArc and conventional VMAT approach for brain metastases.Chin J Radiat Oncol.2021;6876\u2013881. 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