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Gantry\u2010free modality enables the reduction of the overall size, weight, and cost. Among them, upright treatment, which utilizes fixed ion beamlines, in combination with a treatment chair capable of 360\u00b0 rotation and adjustable pitch angle (enabling non\u2010coplanar beam delivery), provides a wider range of beam entry angles compared to conventional couch\u2010based setups and has already been applied in particle radiotherapy for head and neck cancer patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In this study, we analyzed clinical data from the Shanghai Proton and Heavy Ion Center (SPHIC) to quantify residual setup errors across various regions of interest (ROIs) for both upright and supine treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 402 treatment fractions from 28 patients (median 5 fractions, range: 5\u201316 fractions per posture per patient) were enrolled in this study. All these patients were immobilized and scanned in supine posture and received both supine and upright radiotherapy. Three rectangular\u2010shaped ROIs were delineated based on bone structures, encompassing the mandible, orbit, and neck vertebrae C1\u2013C3. Box\u2010based registration, focusing solely on the anatomical structures within the specific ROIs was performed to subtract the correction vector used in treatment, thereby obtaining the residual setup error for each ROI. Margins for each ROIs were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For both postures, the median values of residual setup error for all translational directions were less than 1 mm. The median values did not exceed 0.2 degrees for rotational errors. More than 78% of the fractions for upright treatment fell within the 1 mm\/\u00b0 threshold, while 94% were within the 2 mm\/\u00b0 threshold. In contrast, for supine treatment, over 61% fell within the 1 mm\/\u00b0 threshold, while 86% were within the 2 mm\/\u00b0 threshold. The maximum margin was 3.3 mm in the AP direction of the C1\u2013C3 region for the supine posture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Upright treatments demonstrated comparable residual setup errors to supine treatments, with most errors falling within clinically acceptable thresholds. This study provides valuable clinical evidence for the continued development and implementation of upright radiotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.17824","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T22:50:51Z","timestamp":1744411851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Comparative analysis of residual setup errors in head and neck patients from upright versus supine radiotherapy postures"],"prefix":"10.1002","volume":"52","author":[{"given":"Jiayao","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Medical Physics Shanghai Proton and Heavy Ion Center Fudan University Cancer Hospital  Shanghai China"},{"name":"Shanghai Key Laboratory of Radiation Oncology  Shanghai China"},{"name":"Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy  Shanghai 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