{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T23:39:54Z","timestamp":1787787594722,"version":"build-2784847793"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013362","name":"Swiss Cancer Research Foundation","doi-asserted-by":"publisher","award":["KFS\u20104399\u201002\u20102018"],"award-info":[{"award-number":["KFS\u20104399\u201002\u20102018"]}],"id":[{"id":"10.13039\/501100013362","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":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Studies comparing different radiotherapy treatment techniques\u2014such as volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT)\u2014typically compare one treatment plan per technique. Often, some dose metrics favor one plan and others favor the other, so the final plan decision involves subjective preferences. Pareto front comparisons provide a more objective framework for comparing different treatment techniques. A Pareto front is the set of all treatment plans where improvement in one criterion is possible only by worsening another criterion. However, different Pareto fronts can be obtained depending on the chosen machine settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To compare VMAT and HT using Pareto fronts and blind expert evaluation, to explain the observed differences, and to illustrate limitations of using Pareto fronts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We generated Pareto fronts for twenty\u2010four prostate cancer patients treated at our clinic for VMAT and HT techniques using an in\u2010house script that controlled a commercial treatment planning system. We varied the PTV under\u2010coverage (100%\u00a0\u2010\u00a0V<jats:sub>95%<\/jats:sub>) and the rectum mean dose, and fixed the mean doses to the bladder and femoral heads. In order to ensure a fair comparison, those fixed mean doses were the same for the two treatment techniques and the sets of objective functions were chosen so that the conformity indexes of the two treatment techniques were also the same. We used the same machine settings as are used in our clinic. Then, we compared the VMAT and HT Pareto fronts using a specific metric (clinical distance measure) and validated the comparison using a blinded expert evaluation of treatment plans on these fronts for all patients in the cohort. Furthermore, we investigated the observed differences between VMAT and HT and pointed out limitations of using Pareto fronts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both clinical distance and blind treatment plan comparison showed that VMAT Pareto fronts were better than HT fronts. VMAT fronts for 10 and 6\u00a0MV beam energy were almost identical. HT fronts improved with different machine settings, but were still inferior to VMAT fronts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>That VMAT Pareto fronts are better than HT fronts may be explained by the fact that the linear accelerator can rapidly vary the dose rate. This is an advantage in simple geometries that might vanish in more complex geometries. Furthermore, one should be cautious when speaking about Pareto optimal plans as the best possible plans, as their calculation depends on many parameters.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16868","type":"journal-article","created":{"date-parts":[[2023,12,7]],"date-time":"2023-12-07T02:19:19Z","timestamp":1701915559000},"page":"3010-3019","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of volumetric modulated arc therapy and helical tomotherapy for prostate cancer using Pareto fronts"],"prefix":"10.1002","volume":"51","author":[{"given":"Diana","family":"W\u00fcthrich","sequence":"first","affiliation":[{"name":"Institute of Radiation Physics Lausanne University Hospital and Lausanne University  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zirun","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute of Radiation Physics Lausanne University Hospital and Lausanne University  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Zeverino","sequence":"additional","affiliation":[{"name":"Institute of Radiation Physics Lausanne University Hospital and Lausanne University  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Bourhis","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Lausanne University Hospital and Lausanne University  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Bochud","sequence":"additional","affiliation":[{"name":"Institute of Radiation Physics Lausanne University Hospital and Lausanne University  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rapha\u00ebl","family":"Moeckli","sequence":"additional","affiliation":[{"name":"Institute of Radiation Physics Lausanne University Hospital and Lausanne University  Lausanne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20180270"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejor.2018.08.019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/51\/13\/R21"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.48550\/arXiv.1305.1546"},{"key":"e_1_2_8_6_1","volume-title":"Manuale di Economia Politica","author":"Pareto V","year":"1906"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598033"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/43\/8\/013"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/02841860802251559"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.05.045"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3326965"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2010.05.001"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.14923"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs\u201058107\/v1"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3592934"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4768159"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2018.08.002"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2017.09.003"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.09.033"},{"key":"e_1_2_8_20_1","unstructured":"RayStation [Computer software]. Version 11A. Stockholm Sweden:RaySearch Laboratories AB;2021."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(89)90972\u20103"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2023.103139"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2335486"},{"key":"e_1_2_8_24_1","unstructured":"ICRU Report 50.Prescribing recording and reporting photon beam therapy.International Commission on Radiation Units & Measurements (ICRU);1993.https:\/\/www.icru.org\/report\/prescribing\u2010recording\u2010and\u2010reporting\u2010photon\u2010beam\u2010therapy\u2010report\u201050\/"},{"key":"e_1_2_8_25_1","unstructured":"ICRU Report 62.Prescribing recording and reporting photon beam therapy (Supplement to ICRU 50).International Commission on Radiation Units & Measurements (ICRU);1999.https:\/\/www.icru.org\/report\/prescribing\u2010recording\u2010and\u2010reporting\u2010photon\u2010beam\u2010therapy\u2010report\u201062\/"},{"key":"e_1_2_8_26_1","unstructured":"ICRU Report 83.Prescribing recording and reporting intensity\u2010modulated photon\u2010beam therapy (IMRT).International Commission on Radiation Units & Measurements (ICRU);2010.https:\/\/www.icru.org\/report\/prescribing\u2010recording\u2010and\u2010reporting\u2010intensity\u2010modulated\u2010photon\u2010beam\u2010therapy\u2010imrticru\u2010report\u201083\/"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.08.007"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.06.1953"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2011.06.032"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.03.056"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.11.015"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2016.03.003"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.03.078"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.09.046"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360\u20103016(96)00601\u20103"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2000.93.supplement_3.0219"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4615-5563-6"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/44\/2\/014"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/47\/20\/302"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/54\/23\/011"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2012.734926"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2015.1080855"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/54\/1\/n02"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/54\/8\/l03"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.04.073"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2008.07.021"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u2010717x\u20106\u201020"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/52\/14\/006"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2014.07.001"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/54\/8\/l03"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.16868","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T15:32:01Z","timestamp":1712244721000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.16868"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,6]]},"references-count":49,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1002\/mp.16868"],"URL":"https:\/\/doi.org\/10.1002\/mp.16868","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,6]]},"assertion":[{"value":"2023-06-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}