{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:46:43Z","timestamp":1783442803525,"version":"3.54.6"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["201809150003"],"award-info":[{"award-number":["201809150003"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C7893\/A28990"],"award-info":[{"award-number":["C7893\/A28990"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To incorporate small non\u2010rigid variations of head and neck patients into the robust evaluation of intensity\u2010modulated proton therapy (IMPT) for the selection of robust treatment\u00a0plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 20 nasopharynx cancer patients with weekly kilovoltage CT (kVCT) and 15 oropharynx cancer patients with weekly cone\u2010beam CT (CBCT) were retrospectively included. Anatomical variations between week 0\/week 1 of treatment were acquired using deformable image registration (DIR) for all 35 patients and then applied to the planning CT of four patients who have kVCT scanned each week to simulate potential small non\u2010rigid variations (sNRVs). The robust evaluations were conducted on IMPT plans with: (1) different number of beam fields from 3\u2010field to 5\u2010field; (2) different beam angles. The robust evaluation before treatment, including the sNRVs and setup uncertainty, referred to as sNRV+R evaluation was compared with the conventional evaluation (without sNRVs) in terms of robustness consistency with the gold standard evaluation based on weekly\u00a0CT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among four patients (490 scenarios), we observed a maximum difference in the sNRV+R evaluation to the nominal dose of: 9.37% dose degradation on <jats:italic>D<\/jats:italic><jats:sub>95<\/jats:sub> of clinical target volumes (CTVs), increase in mean dose (<jats:italic>D<\/jats:italic>) of parotid 11.87\u00a0Gy, increase in max dose (<jats:italic>D<\/jats:italic>) of brainstem 20.82\u00a0Gy. In contrast, in conventional evaluation, we observed a maximum difference to the nominal dose of: 7.58% dose degradation on <jats:italic>D<\/jats:italic><jats:sub>95<\/jats:sub> of the CTVs, increase in parotid D by 4.88\u00a0Gy, increase in brainstem <jats:italic>D<\/jats:italic> by 13.5 Gy. In the measurement of the robustness ranking consistency with the gold standard evaluation, the sNRV+R evaluation was better or equal to the conventional evaluation in 77% of cases, particularly, better on spinal cord, parotid glands, and low\u2010risk\u00a0CTV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study demonstrated the additional dose discrepancy that sNRVs can make. The inclusion of sNRVs can be beneficial to robust evaluation, providing information on clinical uncertainties additional to the conventional rigid isocenter\u00a0shift.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.15971","type":"journal-article","created":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T20:55:38Z","timestamp":1662756938000},"page":"7683-7693","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Pre\u2010treatment analysis of non\u2010rigid variations can assist robust intensity\u2010modulated proton therapy plan selection for head and neck patients"],"prefix":"10.1002","volume":"49","author":[{"given":"Ying","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Medical Physics and Biomedical Engineering University College London Gower Street London 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