{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T03:02:31Z","timestamp":1789700551503,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"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>Volumetric modulated arc therapy (VMAT) is increasingly used for breast and chest wall (CW) treatment with regional nodal irradiation (RNI) because of its ability to sculpt dose around complex target volumes. However, VMAT can increase low\u2010dose radiation to surrounding normal tissues and particularly increase cardiac dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the dosimetric impact of a strategic aperture\u2010restricted beam geometry, compared with traditional open\u2010field geometry in VMAT planning for comprehensive left\u2010sided breast\/CW irradiation with RNI across three linac platforms. The impact of convergence mode settings was also investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fourteen patients with left\u2010sided breast\/CW irradiation including comprehensive RNI were retrospectively included. For each patient, a patient\u2010specific optimization template with a prescription of 40.05\u00a0Gy in 15 fractions was applied across three linac platforms (Varian TrueBeam, Varian Halcyon, and Elekta Versa HD), using two beam geometries: an open\u2010field approach, in which field sizes fully encompassed the targets, and an aperture\u2010restricted approach, in which the deep field border was limited to reduce beam entry to the heart and ipsilateral lung. Jaw tracking was enabled on the TrueBeam and Versa HD linacs. Each plan was also evaluated across three convergence modes (\u201cOff,\u201d \u201cOn,\u201d and \u201cExtended\u201d), resulting in 18 plans per patient. All plans were normalized such that 95% of the breast\/CW planning target volume received 95% of the prescription dose. Dosimetric endpoints include mean heart dose, ipsilateral lung V17Gy, contralateral lung V4Gy, and contralateral breast\/CW V5Gy. Total monitor units (MUs) were evaluated, and patient\u2010specific quality assurance (PSQA) was performed for the three highest\u2010MU plans on each linac platform. Paired tests were used to compare across plans.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Target coverage was maintained after plan normalization. Aperture\u2010restricted VMAT significantly reduced mean heart dose compared with open\u2010field geometry across all linac platforms and convergence modes. The proportion of plans exceeding mean heart dose of 4\u00a0Gy was substantially lower with aperture\u2010restricted geometry compared to open\u2010field plans (2.4%\u00a0vs 26.2%). The largest reduction in mean heart dose was observed with the \u201cOff\u201d convergence mode, decreasing from 4.20 to 2.71\u00a0Gy on TrueBeam, 3.32 to 2.58\u00a0Gy on Halcyon, and 3.97 to 2.84\u00a0Gy on Versa HD. Ipsilateral lung V17Gy was also significantly reduced with aperture\u2010restricted beam geometry, with only one exception on Halcyon using the \u201cExtended\u201d mode. No significant differences were observed in contralateral lung V4Gy, although contralateral breast\/CW V5Gy increased significantly, representing a dosimetric tradeoff associated with the aperture\u2010restricted geometry. Aperture\u2010restricted beam geometry significantly increased MUs; however, PSQA passed for the three highest\u2010MU plans on each linac platform according to our clinical criteria. Additionally, more extensive convergence modes were associated with improved plan quality, particularly in reducing hotspot dose (D0.1cc) and enhancing cardiac and ipsilateral lung sparing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Aperture\u2010restricted beam geometry significantly reduced mean heart dose and ipsilateral lung dose while maintaining target coverage across all three linac platforms, supporting its potential clinical value in VMAT planning for comprehensive left\u2010sided breast\/CW irradiation with RNI, albeit with increased contralateral breast\/CW dose. When combined with a more extensive convergence mode, overall plan quality was further improved.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70775","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T08:25:01Z","timestamp":1787732701000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dosimetric impact of aperture\u2010restricted VMAT on heart dose in breast cancer treated with regional nodal irradiation"],"prefix":"10.1002","volume":"27","author":[{"given":"Anh Hong","family":"Duong","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":"Mandeep","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory 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