{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T02:58:29Z","timestamp":1782356309216,"version":"3.54.5"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T00:00:00Z","timestamp":1666569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003246","name":"Nederlandse Organisatie voor Wetenschappelijk Onderzoek","doi-asserted-by":"publisher","award":["17515"],"award-info":[{"award-number":["17515"]}],"id":[{"id":"10.13039\/501100003246","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":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Lung stereotactic body radiotherapy (SBRT) has proven an effective treatment for medically inoperable lung tumors, even for (ultra\u2010)central tumors. Recently, there has been growing interest in radiation\u2010induced cardiac toxicity in lung radiotherapy. More specifically, dose to cardiac (sub\u2010)structures (CS) was found to correlate with survival after\u00a0radiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Our goal is first, to investigate the percentage of patients who require CS sparing in an magnetic resonance imaging guided lung SBRT workflow, and second, to quantify how successful implementation of cardiac sparing would be.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The patient cohort consists of 34 patients with stage II\u2013IV lung cancer who were treated with SBRT between 2017 and 2020. A mid\u2010position computed tomography (CT) image was used to create treatment plans for the 1.5 T Unity MR\u2010linac (Elekta AB, Stockholm, Sweden) following clinical templates. Under guidance of a cardio\u2010thoracic radiologist, 11 CS were contoured manually for each patient. Dose constraints for five CS were extracted from the literature. Patients were stratified according to their need for cardiac sparing depending on the CS dose in their non\u2010CS constrained MR\u2010linac treatment plans. Cardiac sparing treatment plans (CSPs) were then created and dosimetrically compared with their non\u2010CS constrained treatment plan counterparts. CSPs complied with the departmental constraints and were considered successful when fulfilling all CS constraints, and partially successful if some CS constraints could be fulfilled. Predictors for the need for and feasibility of cardiac sparing were explored, specifically planning target volume (PTV) size, cranio\u2010caudal (CC) distance, 3D distance, and in\u2010field overlap volume histograms (iOVH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>47% of the patients (16 out of 34) were in need of cardiac sparing. A successful CSP could be created for 62.5% (10 out of 16) of these patients. Partially successful CSPs still complied with two to four CS constraints. No significant difference in dose to organs at risk (OARs) or targets was identified between CSPs and the corresponding non\u2010CS constrained MR\u2010linac plans. The need for cardiac sparing was found to correlate with distance in the CC direction between target and all of the individual CS (Mann\u2013Whitney <jats:italic>U<\/jats:italic>\u2010test <jats:italic>p<\/jats:italic>\u2010values &lt;10<jats:sup>\u22126<\/jats:sup>). iOVHs revealed that complying with dose constraints for CS is primarily determined by in\u2010plane distance and secondarily by PTV\u00a0size.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We demonstrated that CS can be successfully spared in lung SBRT on the MR\u2010linac for most of this patient cohort, without compromising doses to the tumor or to other OARs. CC distance between the target and CS can be used to predict the need for cardiac sparing. iOVHs, in combination with PTV size, can be used to predict if cardiac sparing will be successful for all constrained CS except the left\u00a0ventricle.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16028","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T11:38:14Z","timestamp":1665401894000},"page":"397-409","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["On the feasibility of cardiac substructure sparing in magnetic resonance imaging guided stereotactic lung radiotherapy"],"prefix":"10.1002","volume":"50","author":[{"given":"Luuk H.G.","family":"van der Pol","sequence":"first","affiliation":[{"name":"Department of Radiotherapy University Medical Center Utrecht  Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara L.","family":"Hackett","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy University Medical Center Utrecht  Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firdaus A.A. Mohamed","family":"Hoesein","sequence":"additional","affiliation":[{"name":"Department of Radiology University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louk M.W.","family":"Snoeren","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy University Medical Center Utrecht  Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Pomp","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy University Medical Center Utrecht  Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas W.","family":"Raaymakers","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy University Medical Center Utrecht  Heidelberglaan 100, 3584 CX Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost 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