{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:44:35Z","timestamp":1792568675675,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Environ Biophys"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study investigates factors that affect dose delivery in rectal cancer radiotherapy and evaluates the resulting differences between planned and delivered treatment doses using intensity-modulated techniques. Twenty patients were included with 140 cone beam computed tomography (CBCT) images. A correlation analysis was conducted to ascertain the impact of detected misalignment on the Penta-Guide phantom on the planning target volumes (PTVs) and volumes of organs at risk (OARs), and whether shifts from CBCT were affected by patient mass changes. To facilitate a comparative analysis and evaluate dose delivery, Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) plans were simulated in the Monaco treatment planning system and further adapted to each CBCT using the Adapt-to-Shape (ATS) function. Moderate to strong correlations between Penta-Guide detected misalignments and the PTVs, bladder and bowel bag were observed, as well as a strong correlation between translational and rotational shifts and patient mass modifications during treatment. Thus, a reduction in target volume coverage was observed in comparison to the initial plans on CT, with VMAT providing a PTV coverage of nearly 95%, while IMRT resulted in an under-irradiated tumour volume with 93.4% coverage for calculated plans on CBCT. Regarding OARs, a slight decrease was observed in parameter values analyzed on CBCT for bladder (up to 5% for V40 with VMAT), while for bowel bag the evaluated parameters were up to 11% higher for IMRT and 10% for VMAT on CBCT. These results suggest that monitoring organ filling, patient mass, and quality assurance (QA)-related misalignments is essential in rectal cancer radiotherapy to minimize dose discrepancies.<\/jats:p>","DOI":"10.1007\/s00411-026-01255-2","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:19:31Z","timestamp":1790756371000},"page":"1099-1109","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing dose delivery in rectal cancer radiotherapy using CBCT-guided intensity modulated techniques"],"prefix":"10.1007","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2859-8728","authenticated-orcid":false,"given":"Geanina-Mirela","family":"Catona","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana G.","family":"Marcu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"2","key":"1255_CR1","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1093\/jrr\/rrz092","volume":"61","author":"ZA Alickikus","year":"2020","unstructured":"Alickikus ZA, Kuru A, Aydin B, Akcay D, Gorken IB (2020) The importance of mesorectum motion in determining PTV margins in rectal cancer patients treated with neoadjuvant radiotherapy. J Radiat Res 61(2):335\u2013342","journal-title":"J Radiat Res"},{"key":"1255_CR2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijrobp.2007.06.086","volume":"71","author":"JP Bissonnette","year":"2008","unstructured":"Bissonnette JP, Moseley D, White E, Sharpe M, Purdie T, Jaffray DA (2008) Quality Assurance For The Geometric Accuracy Of Cone-Beam CT Guidance In Radiation Therapy. Int J Radiation Oncol Biol Phys 71:1","journal-title":"Int J Radiation Oncol Biol Phys"},{"issue":"3","key":"1255_CR3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74(3):229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"1255_CR4","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1007\/s11547-024-01932-6","volume":"130","author":"GM Catona","year":"2024","unstructured":"Catona GM, Marcu LG (2024) Qualitative and quantitative evaluation of the role of CBCT in rectal cancer radiotherapy. Radiol Med 130(2):150\u2013160","journal-title":"Radiol Med"},{"key":"1255_CR5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s13014-022-02191-3","volume":"18","author":"Y Chang","year":"2023","unstructured":"Chang Y, Liang Y, Qiu BY, Pei X, Xu XG (2023) Dosimetric comparison of deformable image registration and synthetic CT generation based on CBCT images for organs at risk in cervical cancer radiotherapy. Radiat Oncol 18:3","journal-title":"Radiat Oncol"},{"key":"1255_CR6","doi-asserted-by":"publisher","first-page":"1200270","DOI":"10.3389\/fonc.2023.1200270","volume":"13","author":"K Chauhan","year":"2023","unstructured":"Chauhan K, Ebner DK, Tzou K, Ryan K, May J, Kaleem T, Miller D, Stross W, Malouff TD, Landy R, Strong G, Herchko S, Serago C, Trifiletti DM, Miller RC, Buskir S, Waddle MR (2023) Assessment of bladder filling during prostate cancer radiation therapy with ultrasound and cone-beam CT. Front Oncol 13:1200270","journal-title":"Front Oncol"},{"key":"1255_CR7","doi-asserted-by":"crossref","unstructured":"Choi HS, Jo GS, Chae JP, Lee SB, Kim CH, Jeong BC, Jeong B, Lee YH, Ha IB, Kang KM, Song JH (2017) Defining the Optimal Time of Adaptive Replanning in Prostate Cancer Patients with Weight Change during Volumetric Arc Radiotherapy: A Dosimetric and Mathematical Analysis Using the Gamma Index. Computational and Mathematical Methods in Medicine; 4149591","DOI":"10.1155\/2017\/4149591"},{"key":"1255_CR8","doi-asserted-by":"crossref","unstructured":"Ergen S, Demir E, Can G, Karacam S, Barlas C, Didem Colpan Oksuz (2023) Evaluation of interfractional organ motion during neoadjuvant radiotherapy for rectal cancer patients. Bratisl Med J ; 124 (4) :280-284.","DOI":"10.4149\/BLL_2023_043"},{"key":"1255_CR10","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.ejmp.2020.06.017","volume":"76","author":"V Giacometti","year":"2020","unstructured":"Giacometti V, Hounsella AR, McGarry CK (2020) A review of dose calculation approaches with cone beam CT in photon and proton therapy. Physica Med 76:243\u2013276","journal-title":"Physica Med"},{"key":"1255_CR9","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.clon.2010.01.005","volume":"22","author":"T Guerrero-Urbano","year":"2010","unstructured":"Guerrero- Urbano T, Khoo V, Staffurth J, Normany A, Buffaz F, Jackson A, Adams E, Hansenx V, Clarkx C, Miles E, McNair H, Nutting C, Parker C, Eeles R, Huddart R, Horwich A, Dearnaley DP (2010) Intensity-modulated Radiotherapy Allows Escalation of the Radiation Dose to the Pelvic Lymph Nodes in Patients with Locally Advanced Prostate Cancer: Preliminary Results of a Phase I Dose Escalation Study. Clin Oncol 22:236\u2013","journal-title":"Clin Oncol"},{"key":"1255_CR11","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s13014-019-1262-8","volume":"14","author":"R Jadon","year":"2019","unstructured":"Jadon R, Higgins E, Hanna L, Evans M, Coles B, Staffurth J (2019) A systematic review of dose-volume predictors and constraints for late bowel toxicity following pelvic radiotherapy. Radiat Oncol 14:57","journal-title":"Radiat Oncol"},{"key":"1255_CR12","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.3390\/cancers15041009","volume":"15","author":"CM Kensen","year":"2023","unstructured":"Kensen CM, Betgen A, Wiersema L, Peters FP, Kayembe MT, Marijnen CAM, van der Heide UA, Janssen TM (2023) Online Adaptive MRI-Guided Radiotherapy for Primary Tumor and Lymph Node Boosting in Rectal Cancer. Cancers 15:1009","journal-title":"Cancers"},{"key":"1255_CR13","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1186\/s13014-017-0918-5","volume":"12","author":"A Kim","year":"2017","unstructured":"Kim A, Karotki A, Presutti J, Gonzales G, Wong S, Chu W (2017) The effect of prone and supine treatment positions for the pre-operative treatment of rectal cancer on organ-at-risk sparing and setup reproducibility using volumetric modulated arc therapy. Radiat Oncol 12:180","journal-title":"Radiat Oncol"},{"issue":"5","key":"1255_CR14","doi-asserted-by":"publisher","first-page":"e0216655","DOI":"10.1371\/journal.pone.0216655","volume":"14","author":"SH Kim","year":"2019","unstructured":"Kim SH, Oh SA, Yea JW, Park JW (2019) Prospective assessment of inter- or intrafractional variation according to body weight or volume change in patients with head and neck cancer undergoing radiotherapy. PLoS ONE 14(5):e0216655","journal-title":"PLoS ONE"},{"key":"1255_CR15","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.clon.2014.09.016","volume":"27","author":"F McDonald","year":"2015","unstructured":"McDonald F, Watersz R, Gullifordx S, Hallz E, James N, Huddart RS (2015) Defining Bowel Dose Volume Constraints for Bladder Radiotherapy Treatment Planning. Clin Oncol 27:22\u201329","journal-title":"Clin Oncol"},{"issue":"1","key":"1255_CR16","doi-asserted-by":"publisher","first-page":"101109","DOI":"10.1016\/j.adro.2022.101109","volume":"8","author":"K Nugent","year":"2022","unstructured":"Nugent K, O\u2019Neill B, Brennan V, Higgins M, Skourou C (2022) Quantifcation of organ motion in male and female patients undergoing long-course radiation therapy for rectal cancer in the supine position. Adv Radiat Oncol 8(1):101109","journal-title":"Adv Radiat Oncol"},{"key":"1255_CR17","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1002\/acm2.13006","volume":"21","author":"D Poppinga","year":"2020","unstructured":"Poppinga D, Kretschmer J, Brodbek L, Meyners J, Poppe B, Looe HK (2020) Evaluation of the RUBY modular QA phantom for planar and non-coplanar VMAT and stereotactic radiations. J Appl Clin Med Phys 21:10:69\u201379","journal-title":"J Appl Clin Med Phys"},{"issue":"1","key":"1255_CR18","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s11547-020-01193-z","volume":"126","author":"C Rosa","year":"2021","unstructured":"Rosa C, Caravatta L, Di Tommas M, Fasciolo D, Gasparini L, Di Guglielmo FC, Augurio A, Vinciguerra A, Vecchi C, Genovesi D (2021) Cone-beam computed tomography for organ motion evaluation in locally advanced rectal cancer patients. Radiol Med 126(1):147\u2013154","journal-title":"Radiol Med"},{"key":"1255_CR19","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1002\/jmrs.602","volume":"69","author":"V Seah","year":"2022","unstructured":"Seah V, Dundas K, Hudson F, Surjan Y, Bartlett R, Ko R, Smith S, Arumugam S, Johnston M, Wong K, Lee M (2022) Correcting rotational error in rectal cancer radiation therapy: can planning target volume margins be safely reduced. J Med Radiat Sci 69:473\u2013483","journal-title":"J Med Radiat Sci"},{"key":"1255_CR20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.12659\/PJR.890745","volume":"79","author":"K Srinivasan","year":"2014","unstructured":"Srinivasan K, Mohammadi M, Shepherd J (2014) Applications of linac-mounted kilovoltage cone-beam computed tomography in modern radiation therapy. Pol J Radiol 79:181\u2013193","journal-title":"Pol J Radiol"},{"key":"1255_CR21","doi-asserted-by":"crossref","unstructured":"The International Commission on Radiation Units and Measurements Journal of the ICRU 10(1), 2010. Report 83, Oxford University Press","DOI":"10.1093\/jicru\/ndq001"},{"key":"1255_CR22","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ctro.2019.04.001","volume":"18","author":"D Winkel","year":"2019","unstructured":"Winkel D, Bol GH, Kroon PS, Asselen B, Hackett SS, Werensteijn-Honingh AM, Intven MPW, Eppinga WSC, Tijssen RHB, Kerkmeijer LGW, de Boer HCJ, Mook S, Meijer GJ, Hes J, Willemsen-Bosman M, de Groot-van Breugel EN, J\u00fcrgenliemk-Schulz IM, Raaymakers BW (2019) Adaptive radiotherapy: The Elekta Unity MR-linac concept. Clin Translational Radiation Oncol 18:54\u201359","journal-title":"Clin Translational Radiation Oncol"},{"key":"1255_CR23","doi-asserted-by":"crossref","unstructured":"Wo JY, Ashman BJ, Bhadkamkar NA, Bradfield L, Chang DT, Hanna N, Hawkins M, Holtz M, Kim E, Kelly P, Ling DC, Olsen JR, Palta M, Raldow AC, Ruiz-Garcia E, Sheybani A, Stitzenberg KB, Das P (2025) Radiation Therapy for Rectal Cancer: An ASTRO Clinical Practice Guideline Focused Update. Practical Radiation Oncol ; 15, 124\u2009\u2013\u2009143.","DOI":"10.1016\/j.prro.2024.11.003"},{"issue":"24","key":"1255_CR24","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.21037\/atm-22-6157","volume":"10","author":"H Yang","year":"2022","unstructured":"Yang H, Zhao X, He Y, Tan X, Peng H, Zhong M, Li Q, Liu X, He Y, Luo H, Jin F (2022) Dosimetric impacts of cone-beam computed tomography (CBCT)-based anatomic changes in intensity-modulated radiotherapy for cervical cancer. Ann Transl Med 10(24):1381","journal-title":"Ann Transl Med"},{"key":"1255_CR25","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s13014-023-02285-6","volume":"18","author":"Z Zhang","year":"2023","unstructured":"Zhang Z, Yu S, Peng F, Tan Z, Zhang L, Li D, Yang P, Peng Z, Li X, Fang C, Wang Y, Liu Y (2023) Advantages and robustness of partial VMAT with prone position for neoadjuvant rectal cancer evaluated by CBCT-based offline adaptive radiotherapy. Radiat Oncol 18:102","journal-title":"Radiat Oncol"}],"container-title":["Radiation and Environmental Biophysics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00411-026-01255-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00411-026-01255-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00411-026-01255-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:32:48Z","timestamp":1792567968000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00411-026-01255-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["1255"],"URL":"https:\/\/doi.org\/10.1007\/s00411-026-01255-2","relation":{},"ISSN":["0301-634X","1432-2099"],"issn-type":[{"value":"0301-634X","type":"print"},{"value":"1432-2099","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"assertion":[{"value":"18 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"N\/A. The Institutional Review Board of the County Emergency Clinical Hospital, Oradea, assessed the current study and concluded that no approval was required as the study did not enrol patients. This work analysed the data of patients that had been treated as per the normal medical protocol without any change induced by this study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that there is no conflict of interest regarding the publication of this paper.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}