{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T10:32:30Z","timestamp":1768213950208,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"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":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent advancements in cone\u2010beam CT (CBCT) technology have significantly improved image quality leading to increased adoption of CBCT\u2010guided online adaptive radiotherapy (ART). However, the impact of subject motion on these novel fast acquisition approaches on ART is not fully understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aims to assess the impact of subject motion on tasks critical to CBCT\u2010guided ART, comparing novel fast CBCT acquisition protocols with different spatiotemporal sampling patterns to diagnostic fan beam CT (FBCT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two phantoms were imaged to characterize motion, an anthropomorphic abdomen and a cylindrical phantom with material inserts in the presence of translational periodic and non\u2010periodic motion using two fast CBCT systems (Halcyon, Varian Medical Systems, and HyperSight, Varian Medical Systems) with acquisition times of 16.6 and 6 s (denoted CB\u201016.6 and CB\u20106), as well as a fan\u2010beam CT (FB\u20100.5) system (Brilliance BigBore, Philips). For the anthropomorphic phantom, geometric distortion was assessed by deformably registering each image to a FB\u20100.5 scan of the stationary phantom and analyzing the resultant motion vector field (MVF). Auto\u2010contouring was performed on all images with a validated deep\u2010learning method and evaluated using Dice similarity coefficient (DSC). Dose delivery accuracy of a synthetic CT\u2010based ART workflow was evaluated through a simulated adaptive planning study using a CBCT\u2010based synthetic CT workflow, comparing Paddick conformity indices (CI) of simulated delivered dose distributions. For the cylindrical phantom, 3D motion patterns more representative of complex patient motion were assessed by measuring and calculating the edge spread function (ESF) and circularity error of the inserts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CB\u201016.6 and CB\u20106 exhibited reduced geometric distortion in the presence of periodic and non\u2010periodic motion compared to FB\u20100.5. Under periodic motion, auto\u2010contouring using FB\u20100.5 provided the highest mean(range) DSC of 0.78(0.39\u20130.99), followed by CB\u20106 with 0.67(0.28\u20130.86), and CB\u201016.6 with 0.62(0.19\u20130.86). Under non\u2010periodic motion, auto\u2010contouring using FB\u20100.5 also provided the highest mean(range) DSC of 0.72(0.46\u20130.80), followed by CB\u20106 with 0.67(0.43\u20130.80), and CB\u201016.6 with 0.64(0.31\u20130.84). For periodic motion, the FB\u20100.5 system shows the largest differences in CI, followed by the CB\u20106 and CB\u201016.6 with mean values of \u20100.249, \u20100.007, and \u20100.002, respectively. For non\u2010periodic motion, again, the FB\u20100.5 exhibited the greatest change, followed by the CB\u201016.6 and CB\u20106 with mean differences in CI values of \u20100.122, \u20100.040, and \u20100.002, respectively. For the cylindrical phantom, the CB\u20106 demonstrated reduced blur and streak artifacts compared to CB\u201016.6 with consistently improved edge sharpness for both low and high contrast edges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CB\u201016.6 and CB\u20106 provided high\u2010quality images for ART. Compared to FB\u20100.5, fast CBCT exhibited increased blurring and streaking but significantly less geometric distortion with increasing motion, leading to reduced dose delivery error in a simulated ART workflow. The complex 3D motion phantom study supported trends observed in the 1D translational phantom study. Faster CBCT (6 vs. 16.6 s) reduced blur, improving auto\u2010contouring performance for both periodic and non\u2010periodic motions, but the interplay between the motion period and 6 s image acquisition must be carefully managed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.70181","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T04:00:14Z","timestamp":1764907214000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of subject motion and acquisition time on cone\u2010beam CT\u2010guided adaptive therapy for novel 6 second fast scanning protocols"],"prefix":"10.1002","volume":"52","author":[{"given":"David P.","family":"Adam","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins University  Baltimore Maryland 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