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Med. Biol."],"published-print":{"date-parts":[[2026,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective<\/jats:italic>\n                    . Motion management is a critical challenge in proton therapy for mobile tumours. This study aims to develop and evaluate a novel four-dimensional (4D) pencil beam delivery strategy that incorporates respiratory motion into a dynamic treatment plan to improve dose conformity and treatment efficiency.\n                    <jats:italic>Approach<\/jats:italic>\n                    . To assess this 4D pencil beam delivery strategy, a mobile phantom was used. The generated 4D treatment plans were assessed with various scanner configurations, including gantry-less and magnet-free scanner heads. For each setup, the treatment time, dose conformity, and robustness against irregular breathing patterns were quantified. The influence of scanner head design and patient-specific motion irregularities on overall plan quality was evaluated.\n                    <jats:italic>Main Results<\/jats:italic>\n                    . The 4D planning tool generated treatment plans that achieved clinically acceptable dose distributions across all configurations. In magnet-free configurations, static beam operation substantially increased treatment time and reduced dose conformity. In contrast, configurations using a single scanner magnet, without a gantry, maintained acceptable conformity within practical treatment times.\n                    <jats:italic>Significance<\/jats:italic>\n                    . The proposed 4D delivery strategy demonstrates feasibility for treating mobile targets with simplified, gantry-less and magnet-free scanner designs. Further improvements could be achieved by synchronising the patient\u2019s breathing with 4D delivery, which may enhance dose accuracy during irregular or interrupted breathing. By reducing system complexity while preserving dosimetric performance, this approach offers a pathway toward more accessible and cost-effective proton beam therapy for motion-affected tumours. 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