{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:12:45Z","timestamp":1790161965670,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"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 Current Lattice radiation therapy (LRT) mainly uses inverse IMRT\/VMAT optimization, which is time\u2010consuming and complex; however the high modulation complexity compromises dosimetric accuracy and blurs the peak\u2011to\u2011valley dose ratio.<\/jats:p>\n <\/jats:sec>\n \n Purpose<\/jats:title>\n This study presents a simple noncoplanar vertex arrangement for dynamic conformal arc (DCA)\u2011based LRT and evaluates its feasibility.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Different noncoplanar vertex geometries were generated in a water phantom, and DCA\u2011based LRT plans were designed using Eclipse v15.6 (Varian). The LRT target volume (LTV) was the union of all vertices. Single\u2011fraction 20\u2011Gy plans were generated with three coplanar 6\u2011MV FFF beams and calculated with AcurosXB calculation. Optimal vertex geometry was selected based on high\u2011dose proportion (measured with the volume ratio of prescribed dose structure to GTV [V\n Dp<\/jats:sub>\n \/ V\n GTV<\/jats:sub>\n ], and the volume ratio of LTV to GTV [V\n LTV<\/jats:sub>\n \/ V\n GTV<\/jats:sub>\n ]), GTV dose metrics, heterogeneity(measured with peak\u2010to\u2010valley\u2010dose\u2010ratio [PVDR], Volume Dose Ratio [VDR] and other three dose ratios defined as Dose matrix of \u2018peak\u2019 \/ \u2018valley\u2019 [Dp \/ D\n 95% Gap<\/jats:sub>\n , D\n mean LTV<\/jats:sub>\n \/ D\n mean Gap<\/jats:sub>\n , and D\n 2cc GTV<\/jats:sub>\n \/ D\n 95% Gap<\/jats:sub>\n ]), valley dose (D\n 95% Gap<\/jats:sub>\n and D\n 5% Gap<\/jats:sub>\n ) and normal tissue(NT) max dose, dose profiles\/isodose distributions and plan complexity (MCS, SAS, MU\/cGy). The same strategy was applied to two gastrointestinal stromal tumor (GIST) patients with evaluation of OAR sparing and planning time.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In the phantom, six noncoplanar vertex configurations and one coplanar vertex configuration were generated, and corresponding DCA plans were designed for each. All plans achieved a high\u2011dose volume proportion exceeding 1% and EUD\n GTV<\/jats:sub>\n of 5.07\u00a0Gy \u2010 6.78\u00a0Gy, with high dose heterogeneity (high PVDR, Dp \/ D\n 95% Gap<\/jats:sub>\n , D\n mean V<\/jats:sub>\n \/ D\n mean Gap<\/jats:sub>\n and moderate VDR). Plan complexity remained low across all configurations, with MCS ranged 0.68\u20130.79. Optimal vertex geometry was 1\u2010cm diameter with a 4\u2010cm center\u2011to\u2011center distance, providing a favorable balance between dose heterogeneity and valley dose sparing. Moreover, the DCA plan based on noncoplanar vertex arrangement yielded dose distributions comparable to those of the non\u2010coplanar plan with couch rotation. Importantly, both normal tissue (NT) doses in all phantom plans were very low. The clinical applicability was verified in two patients, with all dosimetric parameters meeting the recommended LRT ranges. Consistent with the phantom findings, patient NT and OAR doses remained far below the SBRT constraints, with a total planning time of \u223c1\u00a0hour per patient, supporting the safety and translational potential of this approach.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n DCA\u2011based LRT with noncoplanar vertices is feasible on linacs, simplifying planning and enabling accurate delivery. It offers a valuable alternative method for patients with couch rotation limit. Optimal vertex arrangement with 1\u2011cm diameter and 3.5\u20134\u00a0cm center to center distance obtained in water phantom. Two patient cases met LRT criteria, with a total planning time of approximately one hour per patient, supporting clinical applicability in complex anatomies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acm2.70818","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T10:29:54Z","timestamp":1790159394000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility of lattice radiation therapy using a noncoplanar vertex arrangement and dynamic conformal arcs"],"prefix":"10.1002","volume":"27","author":[{"given":"Haixia","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Oncology Key Laboratory of Immunity Inflammation & Cancer (Chongqing Municipal Health Commission) The First Affiliated Hospital of Chongqing Medical University Chongqing 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