{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T10:07:09Z","timestamp":1770458829834,"version":"3.49.0"},"reference-count":46,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T00:00:00Z","timestamp":1695600000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007210","name":"Varian Medical Systems","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007210","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":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To improve organ at risk (OAR) sparing, dynamic trajectory radiotherapy (DTRT) extends VMAT by dynamic table and collimator rotation during beam\u2010on. However, comprehensive investigations regarding the impact of the gantry\u2010table (GT) rotation gradient on the DTRT plan quality have not been conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the impact of a user\u2010defined GT rotation gradient on plan quality of DTRT plans in terms of dosimetric plan quality, dosimetric robustness, deliverability, and delivery time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The dynamic trajectories of DTRT are described by GT and gantry\u2010collimator paths. The GT path is determined by minimizing the overlap of OARs with planning target volume (PTV). This approach is extended to consider a GT rotation gradient by means of a maximum gradient of the path () between two adjacent control points () and maximum absolute change of <jats:italic>G<\/jats:italic> (). Four DTRT plans are created with different maximum G&amp;\u2206G: &amp;\u00a0=\u00a00.5&amp;0.125 (DTRT\u20101), 1&amp;0.125 (DTRT\u20102), 3&amp;0.125 (DTRT\u20103) and 3&amp;1\u200d(DTRT\u20104), including 3\u20134 dynamic trajectories, for three clinically motivated cases in the head and neck and brain region (A, B, and C). A reference VMAT plan for each case is created. For all plans, plan quality is assessed and compared. Dosimetric plan quality is evaluated by target coverage, conformity, and OAR sparing. Dosimetric robustness is evaluated against systematic and random patient\u2010setup uncertainties between  in the lateral, longitudinal, and vertical directions, and machine uncertainties between in the dynamically rotating machine components (gantry, table, collimator rotation). Delivery time is recorded. Deliverability and delivery accuracy on a TrueBeam are assessed by logfile analysis for all plans and additionally verified by film measurements for one case. All dose calculations are Monte Carlo based.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The extension of the DTRT planning process with user\u2010defined  to investigate the impact of the GT rotation gradient on plan quality is successfully demonstrated. With increasing , slight (case C, : up to\u200d\u22121\u200dGy) and substantial (case A, : up to \u22129.3\u00a0Gy, case\u200dB,: up to \u22124.7\u200dGy) improvements in OAR sparing are observed compared to VMAT, while maintaining similar target coverage. All plans are delivered on the TrueBeam. Expected and actual machine position values recorded in the logfiles deviated by &lt;0.2\u00b0 for gantry, table and collimator rotation. The film measurements agreed by &gt;96% (2%\u200dglobal\/2\u00a0mm Gamma passing rate) with the dose calculation. With increasing , delivery time is prolonged by &lt;2\u00a0min\/trajectory (DTRT\u20104) compared to VMAT and DTRT\u20101. The DTRT plans for case A and B and the VMAT plan for case C plan reveal the best dosimetric robustness for the considered uncertainties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The impact of the GT rotation gradient on DTRT plan quality is comprehensively investigated for three cases in the head and neck and brain region. Increasing freedom in this gradient improves dosimetric plan quality at the cost of increased delivery time for the investigated cases. No clear dependency of GT rotation gradient on dosimetric robustness is observed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16749","type":"journal-article","created":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T20:54:29Z","timestamp":1695675269000},"page":"7104-7117","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of the gradient in gantry\u2010table rotation on dynamic trajectory radiotherapy plan quality"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8439-2464","authenticated-orcid":false,"given":"Hannes A.","family":"Loebner","sequence":"first","affiliation":[{"name":"Division of Medical Radiation Physics and Department of Radiation Oncology Inselspital, Bern University Hospital and University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9835-4362","authenticated-orcid":false,"given":"Silvan","family":"Mueller","sequence":"additional","affiliation":[{"name":"Division of Medical Radiation Physics and Department of Radiation Oncology Inselspital, Bern University Hospital and University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Werner","family":"Volken","sequence":"additional","affiliation":[{"name":"Division of Medical Radiation Physics and Department of Radiation Oncology Inselspital, Bern University Hospital and University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7110-6617","authenticated-orcid":false,"given":"Philipp","family":"Wallimann","sequence":"additional","affiliation":[{"name":"Division of Medical Radiation Physics and Department of Radiation Oncology Inselspital, Bern University Hospital and University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9493-3834","authenticated-orcid":false,"given":"Daniel M.","family":"Aebersold","sequence":"additional","affiliation":[{"name":"Division of Medical Radiation Physics and Department of Radiation Oncology Inselspital, Bern University Hospital and University of Bern  Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7486-6681","authenticated-orcid":false,"given":"Marco F. 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