{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:11Z","timestamp":1789700531237,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA272991"],"award-info":[{"award-number":["R01CA272991"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hippocampal avoidance whole\u2010brain radiotherapy (HA\u2010WBRT) is used to treat brain metastases while preserving cognitive function by sparing the hippocampi. Volumetric modulated arc therapy (VMAT) is commonly used due to its ability to generate conformal dose distributions. However, treatment planning remains challenging due to the need for sharp dose fall\u2010off near centrally located hippocampi without compromising whole\u2010brain coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study evaluated the dosimetric impact of a four\u2010arc hybrid geometry (4A\u2010HG) and convergence mode settings for HA\u2010WBRT using a knowledge\u2010based planning (KBP) workflow across two linac platforms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty HA\u2010WBRT patients prescribed 30 Gy in 10 fractions were retrospectively studied. Plans were generated using a KBP model on two linac platforms with different collimation systems: Halcyon and Edge. Four arc configurations were evaluated, including three open\u2010field geometries with different numbers of arcs (2A, 3A, and 4A) and 4A\u2010HG. The 4A\u2010HG consists of two open\u2010field arcs and two partial\u2010field arcs with superior\u2010inferior field restriction near the hippocampal region, which allows improved dose modulation near the hippocampus to potentially enhance hippocampal sparing. Jaw tracking was enabled for all Edge plans. Each arc configuration was combined with three convergence modes (\u201cOff,\u201d \u201cOn,\u201d and \u201cExtended\u201d) on both linac platforms, yielding 24 plans per patient. Plans were normalized so that 95% of the planning target volume (PTV) received 100% of prescription dose. Plan quality was evaluated using Radiation Therapy Oncology Group (RTOG) 0933 metrics, as well as by a dosimetric scorecard incorporating PTV D100% and the Paddick conformity index (PCI). Statistical comparisons were performed using Friedman tests with Holm correction. Patient\u2010specific quality assurance (QA) was performed for the five highest\u2010monitor\u2010unit (MU) plans on each platform.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proposed 4A\u2010HG consistently improved target coverage and hippocampal sparing compared with conventional open\u2010field arc configurations. Notably, PTV D100% was significantly improved with 4A\u2010HG on the Edge with the \u201cOn\u201d and \u201cExtended\u201d convergence modes (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05 compared with other arc configurations). For example, with the \u201cOn\u201d convergence mode, mean PTV D100% across 20 patients increased from 19.433 Gy with 2A to 20.011 Gy with 4A\u2010HG (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.009). The 4A\u2010HG also achieved the highest mean PCI using the \u201cExtended\u201d mode (0.940 on Halcyon, 0.944 on Edge). Hippocampus Dmax was significantly reduced with 4A\u2010HG on Halcyon across all modes (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01) and on Edge for \u201cOn\u201d and \u201cExtended\u201d modes (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). On Halcyon, the mean hippocampus Dmax decreased from 14.446 Gy to 13.662 Gy when changing the arc configuration from 2A to 4A\u2010HG using the \u201cExtended\u201d mode, with a similar reduction observed on Edge (12.945 Gy to 12.566 Gy). More extensive convergence mode settings further improved plan quality, with the highest mean score (157\/184) achieved on Edge using 4A\u2010HG under the \u201cExtended\u201d mode. These improvements were associated with increased MUs; however, all QA results met institutional criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 4A\u2010HG arc configuration and the more extensive convergence mode settings improved plan quality for HA\u2010WBRT within a KBP workflow across two linac platforms. These findings support the clinical implementation of the proposed planning strategies for VMAT\u2010based HA\u2010WBRT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70771","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T07:16:53Z","timestamp":1787642213000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beam geometry optimization and convergence mode evaluation for knowledge\u2010based planning of hippocampal avoidance whole\u2010brain radiotherapy: A cross\u2010platform study with quantitative scorecard assessment"],"prefix":"10.1002","volume":"27","author":[{"given":"Anh","family":"Lam","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"},{"name":"Medical Dosimetry Program Southern Illinois University  Carbondale Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyur D.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Seng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Benner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Kuo","family":"Shu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"},{"name":"Department of Radiation and Cellular Oncology University of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih\u2010Wei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Roper","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab101"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060\u2010009\u20100060\u20109"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.10.021"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.2909"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.02767"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000029144"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1143564"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20180908"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2022.04.003"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/15330338221108529"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010020\u201001488\u20105"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14218"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1465171"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13526"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1460396920001028"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.86280"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14260"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.18773"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.93.supplement"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2020.01.003"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70771","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acm2.70771","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70771","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:06:23Z","timestamp":1789697183000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70771"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/acm2.70771"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70771","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"assertion":[{"value":"2026-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70771"}}