{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:49Z","timestamp":1789740109720,"version":"4.0.1"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"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":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Head and neck cancer (HNC) has a high incidence in Brazil. Although Image\u2010Guided Radiation Therapy (IGRT) improves treatment precision, anatomical changes during the treatment course may compromise dose distribution and require replanning.<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n This study investigated the correlation between exit dose fluence and anatomical volumetric variations during HNC radiotherapy. Subsequently, a decision support methodology was proposed and validated to flag potential dosimetric deviations and guide objective replanning strategies.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective study was conducted with 11 patients, totaling 312 fractions treated on a Halcyon\u2010E linear accelerator. Volumetric variations were derived from cone\u2010beam computed tomography (CBCT) and exit dose fluence maps from each fraction were compared with the reference from the first treatment day using gamma analysis (\u03b3_(1%\/1\u00a0mm) to \u03b3_(5%\/5\u00a0mm); 10% threshold). Correlations between normalized volumetric variation (\u0394V) and gamma indices were assessed using Kendall's tau coefficient (\n \u03b1<\/jats:italic>\n \u00a0=\u00a00.05). A decision support methodology for replanning (\u03b3_(1%\/1\u00a0mm)\u00a0<\u00a080% and \u03b3_(2%\/2\u00a0mm)\u00a0<\u00a090%) was proposed and retrospectively validated in an independent cohort of 20 patients, comprising 618 treatment fractions.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Strong negative correlations were observed between \u0394V and gamma indices, with \u03b3_(1%\/1\u00a0mm) showing the highest sensitivity (\n \u03c4<\/jats:italic>\n \u00a0=\u00a0\u22120.83), followed by \u03b3_(2%\/2\u00a0mm) (\n \u03c4<\/jats:italic>\n \u00a0=\u00a0\u22120.75). Volumetric variations exceeding 5% were associated with significant dosimetric degradation. The validation correctly identified all replanned patients and detected potential indicators of dosimetric divergence not recognized in routine clinical practice.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The thresholds \u03b3_(1%\/1\u00a0mm)\u00a0<\u00a080% and \u03b3_(2%\/2\u00a0mm)\u00a0<\u00a090%, combined with \u0394V\u00a0>\u00a05%, proved effective for guiding replanning decisions. The proposed methodology demonstrated high sensitivity for detecting dosimetric deviations, with potential to enhance radiotherapy safety and effectiveness.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acm2.70710","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:48:19Z","timestamp":1784710099000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dosimetric correlation between exit dose maps and anatomical changes in head and neck cancer treatment on Halcyon\u2010E: A gamma analysis approach"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3615-4071","authenticated-orcid":false,"given":"Jayane Julia","family":"Pereira da Silva","sequence":"first","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"},{"name":"Department of Radiotherapy Hospital S\u00e3o Marcos Teresina, Piau\u00ed Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-8377","authenticated-orcid":false,"given":"Caio Weber","family":"Mendanha Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime Luiz","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Rocha Medrado","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno Nunes","family":"Melo da Silva","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayane Cristine","family":"Alves Sarmento","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edilmar","family":"de Moura Santos","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Liga Contra o C\u00e2ncer Natal Rio Grande do Norte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Instituto Nacional de C\u00e2ncer (INCA).Estimativa 2026: Incid\u00eancia de c\u00e2ncer no Brasil.https:\/\/www.gov.br\/inca\/pt\u2010br\/assuntos\/noticias\/2026\/inca\u2010estima\u2010781\u2010mil\u2010novos\u2010casos\u2010de\u2010cancer\u2010por\u2010ano\u2010no\u2010brasil\u2010entre\u20102026\u2010e\u20102028;2026[accessed 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