{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T15:13:34Z","timestamp":1784819614646,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,10,28]],"date-time":"2017-10-28T00:00:00Z","timestamp":1509148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007325","name":"American Association of Physicists in Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To determine the most suitable lesion size and depth for radiotherapy treatments with a prototype kilovoltage x\u2010ray arc therapy (KVAT) system through Monte Carlo simulations of the dose delivered to lesion, dose homogeneity, and lesion\u2010to\u2010skin ratio.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Monte Carlo simulations were used to calculate dose distributions generated by a novel low\u2010energy kilovoltage x\u2010ray system to a variety of clinically relevant lesion sizes and depths in phantoms and for hypothetical partial breast irradiations of patients in supine and prone positions. The treatments by 200 kV KVAT system were modeled for four sizes of tumor (1\u20134 cm diameter) at three depths (superficial, middle, and deep) in two sizes of cylindrical water phantoms (16.2\u2010cm and 32.2\u2010cm diameter). In addition, treatments of 3\u2010cm and 4\u2010cm diameter lesions were modeled for two breast patients in prone and supine positions. Dose distributions were calculated using the EGSnrc\/DOSXYZnrc code package. Phantom study metrics included lesion\u2010to\u2010skin ratio, dose delivered to isocenter (cGy\/min), dose homogeneity, dose profiles, and cumulative dose volume histograms. Lesion\u2010to\u2010skin ratio, lesion\u2010to\u2010rib ratio, dose profiles, and cumulative dose volume histograms were used to evaluate simulated breast patient treatments. Supine breast irradiations were compared to 6\u2010MV VMAT plans. The criterion applied to evaluate the dose distributions was derived from NSABP\u2010B39\/RTOG 0413 for accelerated partial breast irradiation. Skin dose was limited to a maximum of 250 cGy for a prescribed lesion dose of 385 cGy per fraction (with the whole treatment being delivered in 10 fractions). This produced the minimum lesion\u2010to\u2010skin dose ratio of 1.5 that served as the main guideline, along with other metrics, for evaluation of future clinical viability of treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Phantom dose distributions in the centrally located lesions treated with 360\u2010degree KVAT were found to be superior to dose distributions in off\u2010center lesions with the exception of isocenter dose, which was highest for lesions located closer to the phantom surface. Dose metrics were more favorable for smaller lesions, suggesting that KVAT might be most suitable for treatment of lesions of 1\u20132 cm in diameter down to depths of 8.1 cm along with 3 cm lesions at depths from 3 cm to 8.1 cm. In addition, treatments of 4\u2010cm lesions were found to be acceptable down to the depths of 4.1 cm (in the 16.2\u2010cm phantom) and 8.1 cm (in the 32.2\u2010cm phantom). At depths from 8.1\u2010cm to 16.1\u2010cm, treatments of 1\u2010cm to 4\u2010cm lesions are possible at the cost of decreased dose rate. KVAT breast treatments in the supine patient position demonstrated that increasing the arc angle and decreasing lesion size improved lesion\u2010to\u2010skin ratio and lesion\u2010to\u2010rib ratio. Supine breast data indicate that 3\u2010cm lesions are treatable at a minimum depth of 3 cm. The 6\u2010MV VMAT plan resulted in lower doses to the ipsilateral lung and the body, but a higher heart dose compared to the KVAT plans. Dose distributions for the prone breast phantoms were superior to the supine cases due to the increased treatment angle of 360\u2010degrees.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Although nonoptimized KVAT dose distributions presented here were of inferior quality to VMAT plans, this work has demonstrated the feasibility of delivering low\u2010energy kilovoltage x\u2010rays to lesions up to 4 cm in diameter to depths of 8.1 cm while sparing surrounding tissue.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.12619","type":"journal-article","created":{"date-parts":[[2017,10,7]],"date-time":"2017-10-07T15:36:36Z","timestamp":1507390596000},"page":"6548-6559","source":"Crossref","is-referenced-by-count":15,"title":["Monte Carlo simulations of a kilovoltage external beam radiotherapy system on phantoms and breast patients"],"prefix":"10.1002","volume":"44","author":[{"given":"Dylan Y.","family":"Breitkreutz","sequence":"first","affiliation":[{"name":"Department of Physics and Astronomy University of Victoria PO Box 1700 ST CSC Victoria BC V8W 2Y2 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Weil","sequence":"additional","affiliation":[{"name":"Sirius Medicine LLC PO Box 414 Half Moon Bay CA 94019 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergei","family":"Zavgorodni","sequence":"additional","affiliation":[{"name":"Vancouver Island Centre \u2010 BC Cancer Agency 2410 Lee Ave Victoria BC V8R 6V5 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Bazalova\u2010Carter","sequence":"additional","affiliation":[{"name":"Department of Physics and Astronomy University of Victoria PO Box 1700 ST CSC Victoria BC V8W 2Y2 Canada"},{"name":"Vancouver Island Centre \u2010 BC Cancer Agency 2410 Lee Ave Victoria BC V8R 6V5 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,10,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2004.12.007"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","unstructured":"World Health Organization.The Global Burden of Disease: 2004 update. 2004 Updat;2004:146.","DOI":"10.1016\/S0262-1762(04)00136-1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.12.042"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12047"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/57\/22\/7381"},{"key":"e_1_2_8_7_1","unstructured":"KawrakowI Mainegra\u2010HingE RogersDWO TessierF WaltersBRB.The EGSnrc Code System: Monte Carlo Simulation of Electron and Photon Transport;2006:2001\u20102009."},{"key":"e_1_2_8_8_1","unstructured":"WaltersB KawrakowI RogersDWO.DOSXYZnrc Users Manual. 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