{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:40:46Z","timestamp":1792402846773,"version":"4.4.0"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"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":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Single\u2010isocenter stereotactic radiosurgery enables efficient treatment of multiple brain metastases (SI\u2010MBM SRS), but demands high geometric accuracy. Plan complexity metrics are increasingly used as indicators for quality assurance (QA) performance, however their applicability to SRS remains uncertain, particularly in the context of multi\u2010institutional variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study evaluated the relationship between plan complexity, target geometry, and end\u2010to\u2010end dosimetric QA outcomes for SI\u2010MBM SRS across multiple institutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty\u2010two SI\u2010MBM SRS plans from different centers and platforms were delivered to polymer gel phantoms, providing high\u2010resolution 3D dose measurements. Gamma passing rates (GPRs) were calculated under 3%\/2\u00a0mm, 5%\/2\u00a0mm and 5%\/1\u00a0mm criteria and were correlated with eleven established complexity metrics calculated per plan. Geometric factors, including target equivalent diameter and distance\u2010to\u2010isocenter, were analyzed. Receiver\u2010operating\u2010characteristic (ROC) analysis was performed to identify optimal thresholds for predicting QA pass\/fail (\u226590% GPR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No statistically significant differences between the different linacs and treatment planning systems were found, nor strong or consistent correlations between complexity metrics and GPRs. In contrast, geometric parameters were more influential: off\u2010axis distance and target size significantly affected QA performance, with the largest differences observed for far\u2010off\u2010axis lesions. ROC analysis identified optimal thresholds of 34.9\u00a0mm for distance\u2010to\u2010isocenter and 4.8\u00a0mm for equivalent diameter in predicting QA outcomes (AUC\u223c0.60\u20100.65), although the predictive performance remained modest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this multi\u2010institutional, gel\u2010based end\u2010to\u2010end study of SI\u2010MBM SRS, target geometry was a stronger QA performance predictor than complexity metrics. These findings emphasize the importance of geometry\u2010aware QA strategies and the need for further standardized, multi\u2010institutional evaluations to clarify the interplay between complexity, geometry, and machine performance in SRS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70758","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:56:56Z","timestamp":1790236616000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the role of plan complexity and target geometry through multi\u2010institutional gel based end\u2010to\u2010end QA in multi\u2010focal single isocenter stereotactic radiosurgery"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8309-7968","authenticated-orcid":false,"given":"Despoina","family":"Stasinou","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Radiology and Radiotherapy Sector University of West Attica  Athens Attica Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2977-7895","authenticated-orcid":false,"given":"Kalliopi","family":"Platoni","sequence":"additional","affiliation":[{"name":"Department of Applied Medical Physics Medical School, Attikon University Hospital National and Kapodistrian University of Athens  Athens Attica Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6271-9607","authenticated-orcid":false,"given":"Vasiliki","family":"Margaroni","sequence":"additional","affiliation":[{"name":"Medical Physics Laboratory School of Medicine National and Kapodistrian University of Athens  Athens Attica Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyveli","family":"Zourari","sequence":"additional","affiliation":[{"name":"Department of Applied Medical Physics University General Hospital of West Attica \u201cH AGIA VARBARA\u201d  Athens Attica Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Zoros","sequence":"additional","affiliation":[{"name":"Medical Physics Laboratory School of Medicine National and Kapodistrian University of Athens  Athens Attica Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niko","family":"Papanikolaou","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas Health Science Center at San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Pappas","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Radiology and Radiotherapy Sector University of West Attica  Athens Attica Greece"},{"name":"School of Biomedical Engineering and Imaging Sciences King's College London, London  England 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