{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:07:23Z","timestamp":1788876443159,"version":"build-2803163510"},"reference-count":40,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Carbon ion radiotherapy (CIRT) offers higher linear energy transfer (LET) and superior relative biological effectiveness, making it a promising option for treating hypoxic, radioresistant tumors. Spot\u2010scanning Hadron Arc (SHArc) therapy enables dose\u2010averaged LET (LET\n                      <jats:sub>d<\/jats:sub>\n                      ) escalation in the tumor but increases planning and setup complexity. Dynamic delivery remains impractical for gantry\u2010based carbon ion arc therapy due to the system's large size and complex control requirements. Step\u2010and\u2010shoot delivery, while less efficient, provides a feasible alternative and represents a key step towards clinical SHArc implementation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This work establishes the first step\u2010and\u2010shoot planning and delivery technique for carbon ion arc therapy (static SHArc) at the Heidelberg Ion\u2010beam Therapy Center using the gantry system. Static SHArc therapy is evaluated in terms of plan quality and delivery feasibility for pancreatic cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Static SHArc plans were optimized for seven pancreatic cancer cases, considering 20 gantry angles. Two distinct energy layer (EL) selection techniques were investigated: (1) Central EL, selecting the seven central ELs per beam, and (2) MU\u2010Based EL, prioritizing ELs contributing the highest monitor units (MU). LET\n                      <jats:sub>d<\/jats:sub>\n                      optimization was performed to escalate the minimum LET\n                      <jats:sub>d<\/jats:sub>\n                      to \u223c50\u201380\u00a0keV\/\u00b5m within the gross tumor volume. Static SHArc plans were compared against conventional IMPT using two single\u2010field optimized posterior oblique beams (2\u2010SFO), in terms of dose conformality, LET\n                      <jats:sub>d<\/jats:sub>\n                      , and robustness against setup (5\u00a0mm) and range (1.5%) uncertainties. Inter\u2010fractional robustness was assessed via forward dose calculation on daily control CT scans. Dosimetric validation and delivery time verification for static SHArc using the heavy ion gantry system were conducted via end\u2010to\u2010end testing with ion chamber and film measurements in a cylindrical PMMA phantom.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Static SHArc plans improved LET\n                      <jats:sub>d<\/jats:sub>\n                      distributions in the tumor without compromising target coverage and clinical OAR constraints. The MU\u2010based EL method increased minimum target dose, whereas Central EL enabled higher LET\n                      <jats:sub>d<\/jats:sub>\n                      concentration in the tumor center. Both energy selection methods for static SHArc exhibited reduced inter\u2010fractional robustness compared to the two\u2010SFO. Dosimetric verification showed deviations\u00a0&lt;\u00a03% and total delivery time was \u223c27 min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This study investigates static SHArc, a step\u2010and\u2010shoot approach for delivering carbon ion arc therapy. While static SHArc can provide dosimetric advantages, particularly in terms of LET\n                      <jats:sub>d<\/jats:sub>\n                      distribution, EL selection plays a key role. Improving inter\u2010fraction robustness remains crucial for clinical implementation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.70055","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T08:24:03Z","timestamp":1759911843000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Development and dosimetric verification of static SHArc: Step\u2010and\u2010shoot carbon ion arc therapy for LET\n                    <sub>d<\/sub>\n                    escalation in pancreatic tumors"],"prefix":"10.1002","volume":"52","author":[{"given":"Filipa","family":"Baltazar","sequence":"first","affiliation":[{"name":"Heidelberg Ion\u2010Beam Therapy Center (HIT) Department of Radiation Oncology  Heidelberg Germany"},{"name":"Clinical Cooperation Unit Radiation Oncology German Cancer Research Center (DKFZ)  Heidelberg Germany"},{"name":"Medical Faculty Heidelberg 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