{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T09:40:45Z","timestamp":1792402845466,"version":"4.4.0"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"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":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Thermoplastic immobilization remains standard for head and neck radiation therapy, but rigid face masks may produce clinically meaningful anxiety, claustrophobia, and treatment intolerance in some patients. Surface\u2010guided radiation therapy (SGRT) provides non\u2010ionizing surface setup guidance and continuous intrafraction motion monitoring, potentially enabling reduced\u2010immobilization treatment approaches.<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n To describe and initially evaluate the clinical feasibility of a thermoplastic\u2010maskless head and neck radiation therapy workflow using a posterior dorsal shell, SGRT\u2010guided setup, cone\u2010beam computed tomography (CBCT) verification, and real\u2010time intrafraction monitoring with automatic beam\u2010hold.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Ten patients with head and neck cancer were treated without a thermoplastic face mask. Patients were positioned in a posterior dorsal shell. Daily setup began with SGRT followed by CBCT verification and couch correction. During delivery, SGRT (AlignRT v6.3, Vision RT, London, UK) monitored head position in six degrees of freedom (6DoF); automatic beam\u2010hold was triggered when translational displacement exceeded 2\u00a0mm or rotational displacement exceeded 2\u00b0. Post\u2010treatment CBCT and SGRT log files were reviewed for every fraction to characterize residual displacement, threshold events, and repositioning. Intrafraction motion and residual displacement were summarized as medians with interquartile range (IQR).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Across 330 delivered fractions, sgrt\u2010recorded intrafraction motion was small:: per\u2010axis signed real\u2010time deltas had a median [IQR] of 0.10\u00a0mm [\u22120.15, 0.30] translationally and 0.10\u00b0 [\u22120.05, 0.20] rotationally. No fraction had a mean real\u2010time delta exceeding the\u00a0\u00b1\u00a02\u00a0mm\/\u00a0\u00b1\u00a02\u00b0 tolerance, and automatic beam\u2010hold interruptions occurred in approximately 2% of fractions (7 of 330); no fraction was abandoned. Per\u2010axis post\u2010treatment CBCT residuals were \u22120.01\u00a0mm [\u22120.04, 0.05] translationally and 0.15\u00b0 [\u22120.40, 0.55] rotationally. All patients completed the maskless course; 3 of 10 had previously declined or been unable to tolerate mask\u2010based treatment, and all reported the maskless workflow to be well tolerated on an end\u2010of\u2010course questionnaire.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A thermoplastic\u2010maskless head and neck workflow using SGRT, CBCT verification, predefined beam\u2010hold thresholds, and dorsal shell support was feasible in this initial 10\u2010patient experience, maintaining small observed intrafraction motion while directly addressing mask intolerance. Larger prospective evaluation with validated patient\u2010reported outcomes, dosimetric analysis, and multi\u2010institutional QA is warranted.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acm2.70809","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T04:59:57Z","timestamp":1790398797000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maskless head and neck radiotherapy using surface\u2010guided radiation therapy: initial clinical feasibility of real\u2010time setup, intrafraction monitoring, and automatic beam\u2010hold"],"prefix":"10.1002","volume":"27","author":[{"given":"Adi","family":"Robinson","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Medical Physics AdventHealth Celebration Celebration Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shravan","family":"Kandula","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical Physics AdventHealth Celebration Celebration Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2004.04.047"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.346"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmrs.658"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15532"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3681967"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.07.004"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12867"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010023\u201044320\u20102"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110314"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010025\u201002609\u20108"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2023.101390"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2025.110941"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13170"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100563"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2025.110909"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70809","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acm2.70809","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.70809","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T08:54:02Z","timestamp":1792400042000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.70809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/acm2.70809"],"URL":"https:\/\/doi.org\/10.1002\/acm2.70809","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"assertion":[{"value":"2026-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70809"}}