{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:43:41Z","timestamp":1792514621284,"version":"4.5.0"},"reference-count":33,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"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":["R01CA301448"],"award-info":[{"award-number":["R01CA301448"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["75N91019D00024"],"award-info":[{"award-number":["75N91019D00024"]}],"id":[{"id":"10.13039\/100000054","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":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Compared to intensity\u2010modulated proton therapy (IMPT), proton arc therapy (PAT) has various dosimetric advantages. However, questions have been raised over whether the larger low\u2010dose bath during PAT may increase radiation\u2010induced lymphocyte killing, which is correlated with adverse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study is to quantitatively compare radiation dose delivery to circulating blood during IMPT and PAT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      For each of 10 head\u2010and\u2010neck cancer patients, one IMPT and one PAT treatment plan were created, and the hematological dose (HEDOS) blood dose model was used to simulate radiation dose delivery to circulating blood. HEDOS simulations utilized gantry angle\u2010wise dose distributions (including for PAT) and considered gantry rotation and energy layer switching as well as irradiation times. Blood dose histograms as well as the mean dose to all simulation blood particles (D\n                      <jats:sub>mean<\/jats:sub>\n                      ) and the dose delivered to the 90% and 10% of blood particles receiving the highest dose (D\n                      <jats:sub>90%<\/jats:sub>\n                      and D\n                      <jats:sub>10%<\/jats:sub>\n                      ) were then compared between IMPT and PAT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For IMPT, blood dose metrics (in the form of mean over all patients\u00a0\u00b1\u00a0one standard deviation) were (0.522\u00a0\u00b1\u00a00.204)Gy(RBE) for D\n                      <jats:sub>90%<\/jats:sub>\n                      , (0.563\u00a0\u00b1\u00a00.212)Gy(RBE) for D\n                      <jats:sub>mean<\/jats:sub>\n                      , and (0.605\u00a0\u00b1\u00a00.219)Gy(RBE) for D\n                      <jats:sub>10%<\/jats:sub>\n                      . For PAT, D\n                      <jats:sub>90%<\/jats:sub>\n                      was (0.430\u00a0\u00b1\u00a00.184)Gy(RBE), D\n                      <jats:sub>mean<\/jats:sub>\n                      was (0.483\u00a0\u00b1\u00a00.195)Gy(RBE), and D\n                      <jats:sub>10%<\/jats:sub>\n                      was (0.538\u00a0\u00b1\u00a00.207)Gy(RBE). The Wilcoxon signed\u2010rank test indicated statistically significant (\n                      <jats:italic>p\u00a0&lt;<\/jats:italic>\n                      \u00a00.05) differences between blood dose metrics of IMPT and PAT for all patients, and IMPT did not increase the percentage of blood particles which received no radiation dose during the delivery of a single treatment fraction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared to IMPT, proton arc therapy was associated with significantly lower radiation dose delivery to circulating blood across a variety of different metrics. Proton arc therapy for head\u2010and\u2010neck cancer is therefore not expected to result in higher radiation\u2010induced killing of circulating lymphocytes compared to IMPT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70864","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:09:35Z","timestamp":1792512575000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Proton arc therapy reduces the dose delivered to circulating blood compared to intensity\u2010modulated proton therapy for head\u2010and\u2010neck cancer"],"prefix":"10.1002","volume":"27","author":[{"given":"Sebastian","family":"Tattenberg","sequence":"first","affiliation":[{"name":"Division of Life Sciences TRIUMF  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1498-3228","authenticated-orcid":false,"given":"Peilin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology William Beaumont University Hospital, Corewell Health  Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoda","family":"Cong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology William Beaumont University Hospital, Corewell Health  Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Hoehr","sequence":"additional","affiliation":[{"name":"Division of Life Sciences TRIUMF  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuanfeng","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology William Beaumont University Hospital, Corewell Health  Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010020\u20101476\u20109"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1155310"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ad2718"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110421"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.04.032"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.17669"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpt.2025.100749"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110434"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23535"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2016.595"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010020\u201001494\u20107"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.02.015"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361\u20106560\/ac16ea"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2023.11.060"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110603"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.13460"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010017\u201010371\u20105"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10278\u2010013\u20109622\u20107"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.08.049"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.230024"},{"key":"e_1_2_11_22_1","unstructured":"SharpGC LiR WolfgangJ et\u00a0al.Plastimatch\u2014An Open Source Software Suite for Radiotherapy Image Processing.Proceedings of the XVIth ICCR.2010."},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010022\u201002055\u2010w"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.70213"},{"issue":"3","key":"e_1_2_11_25_1","first-page":"5","article-title":"Basic anatomical and physiological data for use in radiological protection: reference values. 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