{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:55Z","timestamp":1789740115444,"version":"4.0.1"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"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>Cone\u2010beam computed tomography (CBCT) is widely used in image\u2010guided radiotherapy because it reflects the patient's anatomy immediately before treatment. However, CBCT images of the abdominal organs, including the pancreas, are often degraded by respiratory motion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To address this limitation, this study quantitatively evaluated expiratory\u2010phase CBCT (EP\u2010CBCT), an acquisition method designed to reduce respiratory motion\u2010induced blurring during stereotactic body radiotherapy (SBRT) for pancreatic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis included 10 patients with pancreatic cancer undergoing SBRT at our institution. Daily CT and EP\u2010CBCT scans were acquired on each treatment day. EP\u2010CBCT images were obtained with repeated end\u2010exhalation breath\u2010holds to collect projection data during the expiratory phase. Because of feasibility limitations in routine clinical practice, a direct intra\u2010patient comparison with conventional free\u2010breathing CBCT was not performed. Image quality was evaluated using edge response width (ERW), structural similarity index (SSIM), and a blinded subjective assessment based on mean opinion scores (MOS). A supplementary retrospective comparison with a historical four\u2010dimensional CBCT (4D\u2010CBCT) dataset was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Differences in ERW between daily CT and EP\u2010CBCT (\u0394ERW) were evaluated using equivalence testing with a predefined equivalence margin of\u00a0\u00b1\u00a01\u00a0mm. The mean ERW (98% confidence interval) was 2.04\u00a0mm (1.95\u20132.13) for EP\u2010CBCT and 1.73\u00a0mm (1.66\u20131.79) for daily CT. The mean \u0394ERW was \u22120.31\u00a0mm (\u22120.40 to \u22120.23\u00a0mm). Equivalence testing demonstrated that EP\u2010CBCT was statistically equivalent to daily CT (\n                      <jats:italic>p\u00a0<\/jats:italic>\n                      &lt;\u00a00.01). The mean SSIM value was 0.83, indicating high structural similarity between EP\u2010CBCT and daily CT. Subjective image quality assessment showed significantly higher scores for daily CT than for EP\u2010CBCT, whereas EP\u2010CBCT consistently outperformed historical 4D\u2010CBCT, with good interobserver agreement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that EP\u2010CBCT can reduce respiratory motion\u2010induced blurring to a degree comparable to that of daily CT, supporting its potential utility for anatomical assessment immediately before irradiation in patients undergoing pancreatic SBRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70729","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:47:36Z","timestamp":1785494856000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative evaluation of respiratory motion\u2010induced blurring in expiratory\u2010phase CBCT for pancreatic SBRT"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6753-3473","authenticated-orcid":false,"given":"Airi","family":"Nukushina","sequence":"first","affiliation":[{"name":"Graduate School of Biomedical Science and Engineering Hokkaido University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Radiation Technology Hokkaido University Hospital  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6663-4335","authenticated-orcid":false,"given":"Takaaki","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences Hokkaido University  Sapporo Japan"},{"name":"Global Center for Biomedical Science and Engineering Faculty of Medicine Hokkaido 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