{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:02:16Z","timestamp":1792785736227,"version":"4.5.0"},"reference-count":23,"publisher":"IOP Publishing","issue":"5","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/info\/page\/text-and-data-mining"}],"funder":[{"name":"Varian Medical Systems","award":["research grant (E Onjukka)"],"award-info":[{"award-number":["research grant (E Onjukka)"]}],"id":[{"id":"https:\/\/ror.org\/05yab6874","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["iopscience.iop.org"],"crossmark-restriction":false},"short-container-title":["Biomed. Phys. Eng. Express"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Purpose.<\/jats:italic>\n                    The aim of this study was to investigate if the same planning target volume margins should be used for the breast\/thoracic wall and lymph nodes when treated simultaneously with hypofractionated radiotherapy in deep inspiration breath-hold (DIBH) and free breathing (FB).\n                    <jats:italic>Methods.<\/jats:italic>\n                    For 80 patients (40 treated in FB and 40 in DIBH), nine anatomy sites were evaluated. Three were located in relation to the lymph node region and six in relation to the breast\/thoracic wall. For three treatment fractions, a cone beam CT was acquired before and after the treatment and compared to the planning CT. Margins were calculated based on the inter- and intra-fractional uncertainties, ensuring 90% of the patients receiving 95% of the prescribed dose to the clinical target volume. Margin calculation was done for the full patient data set as well as for a subgroup of patients with set-up errors below the clinical action level, excluding patients with set-up errors larger than 7 mm.\n                    <jats:italic>Results.<\/jats:italic>\n                    For the full patient data set, margins of up to 14 mm were calculated. However, for patients with set-up errors below the clinical action level, the largest margins calculated for the lymph node region for treatments in DIBH were 8.5 mm, 8.7 mm and 6.6 mm in the vertical, longitudinal, and lateral directions respectively compared to 8.4 mm, 7.9 mm and 5.9 mm for treatments in FB. For the breast\/thoracic wall, the largest margins were 5.9 mm, 6.4 mm and 5.5 mm for treatments in DIBH and 5.8 mm, 7.2 mm and 5.8 mm for treatments in FB in the vertical, longitudinal and lateral directions respectively.\n                    <jats:italic>Conclusion.<\/jats:italic>\n                    Treatments in DIBH and FB can use the same margins. However, the lymph node region requires a larger margin than the breast\/thoracic wall region, due to greater anatomical mobility.\n                  <\/jats:p>","DOI":"10.1088\/2057-1976\/ae9ffb","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T22:48:01Z","timestamp":1787957281000},"page":"055015","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Should breast\/thoracic wall and lymph node volumes have the same margin in hypofractionated radiotherapy?"],"prefix":"10.1088","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3840-1068","authenticated-orcid":true,"given":"Marianne","family":"Falk","sequence":"first","affiliation":[{"name":"Karolinska University Hospital"},{"name":"Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9139-0309","authenticated-orcid":true,"given":"Mattias","family":"Hedman","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"},{"name":"Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Mimmi-Caroline","family":"Bolin","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Jens","family":"Falk","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0184-6767","authenticated-orcid":true,"given":"Kristin","family":"Karlsson","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"},{"name":"Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9113-4044","authenticated-orcid":true,"given":"Eva","family":"Onjukka","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"},{"name":"Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Bruno","family":"Sorcini","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Giovanna","family":"Gagliardi","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital"},{"name":"Karolinska Institutet"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"266","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"bpexae9ffbbib1","doi-asserted-by":"publisher","DOI":"10.1177\/1533033819853847","type":"journal-article","article-title":"Setup error assessment and correction in planar kV image- versus cone beam CT image-guided radiation therapy: a clinical study of early breast cancer treated with external beam partial breast irradiation","volume":"18","author":"Wang","year":"2019","journal-title":"Technol. Cancer Res. Treat."},{"key":"bpexae9ffbbib2","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1016\/j.ijrobp.2007.07.2344","type":"journal-article","article-title":"Assessment of the residual error in soft tissue setup in patients undergoing partial breast irradiation: results of a prospective study using cone-beam computed tomography","volume":"70","author":"Fatunase","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"bpexae9ffbbib3","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1007\/s13246-017-0529-3","type":"journal-article","article-title":"Risks and benefits of reducing target volume margins in breast tangent radiotherapy","volume":"40","author":"Basaula","year":"2017","journal-title":"Australas. Phys. Eng. Sci. Med."},{"key":"bpexae9ffbbib4","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.jmir.2020.12.004","type":"journal-article","article-title":"Cardiac dose reduction using deep inspiratory breath hold (DIBH) in radiation treatment of left sided breast cancer patients with breast conservation surgery and modified radical mastectomy","volume":"52","author":"Misra","year":"2021","journal-title":"J. Med. Imaging Radiat. Sci."},{"key":"bpexae9ffbbib5","doi-asserted-by":"publisher","first-page":"2120","DOI":"10.1007\/s12094-021-02617-6","type":"journal-article","article-title":"Surface-guided radiation therapy for breast cancer: more precise positioning","volume":"23","author":"Gonz\u00e1lez-sanchis","year":"2021","journal-title":"Clin. Transl. Oncol."},{"key":"bpexae9ffbbib6","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/j.prro.2019.03.002","type":"journal-article","article-title":"Assessment of setup accuracy using anatomical landmarks for breast and chest wall irradiation with surface guided radiation therapy","volume":"9","author":"Kost","year":"2019","journal-title":"Pract. Radiat. Oncol."},{"key":"bpexae9ffbbib7","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1002\/acm2.12700","type":"journal-article","article-title":"Surface guided radiotherapy (SGRT) improves breast cancer patient setup accuracy","volume":"20","author":"K\u00fcgele","year":"2019","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"bpexae9ffbbib8","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1016\/S0140-6736(20)30932-6","type":"journal-article","article-title":"Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial","volume":"395","author":"Murray Brunt","year":"2020","journal-title":"Lancet"},{"key":"bpexae9ffbbib9","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.radonc.2012.03.015","type":"journal-article","article-title":"How does imaging frequency and soft tissue motion affect the PTV margin size in partial breast and boost radiotherapy?","volume":"103","author":"Harris","year":"2012","journal-title":"Radiother. Oncol."},{"key":"bpexae9ffbbib10","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.ijrobp.2014.09.007","type":"journal-article","article-title":"An image-guided study of setup reproducibility of postmastectomy breast cancer patients treated with inverse-planned intensity modulated radiation therapy","volume":"91","author":"Feng","year":"2015","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"bpexae9ffbbib11","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.radonc.2021.02.021","type":"journal-article","article-title":"Intrafraction motion monitoring to determine PTV margins in early stage breast cancer patients receiving neoadjuvant partial breast SABR","volume":"158","author":"Mouawad","year":"2021","journal-title":"Radiother. Oncol."},{"key":"bpexae9ffbbib12","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1002\/jmrs.117","type":"journal-article","article-title":"An imaging evaluation of the simultaneously integrated boost breast radiotherapy technique","volume":"62","author":"Turley","year":"2015","journal-title":"J. Med. Radiat. Sci."},{"key":"bpexae9ffbbib13","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.rpor.2014.05.001","type":"journal-article","article-title":"Estimation of optimal matching position for orthogonal kV setup images and minimal setup margins in radiotherapy of whole breast and lymph node areas","volume":"19","author":"Laaksomaa","year":"2014","journal-title":"Rep. Pract. Oncol. Radiother."},{"key":"bpexae9ffbbib14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejmp.2019.07.021","type":"journal-article","article-title":"Breast deformation during the course of radiotherapy: the need for an additional outer margin","volume":"65","author":"Sepp\u00e4l\u00e4","year":"2019","journal-title":"Phys. Med."},{"key":"bpexae9ffbbib15","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.14271","type":"journal-article","article-title":"Setup margins based on the inter- and intrafractional setup error of left-sided breast cancer radiotherapy using deep inspiration breath-hold technique (DIBH) and surface guided radiotherapy (SGRT)","volume":"25","author":"Rudat","year":"2024","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"bpexae9ffbbib16","doi-asserted-by":"publisher","first-page":"e1051","DOI":"10.1259\/bjr\/28845176","type":"journal-article","article-title":"Clinical implementation of kilovoltage cone beam CT for the verification of sequential and integrated photon boost treatments for breast cancer patients","volume":"85","author":"Donovan","year":"2012","journal-title":"Br. J. Radiol."},{"key":"bpexae9ffbbib17","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1016\/j.ijrobp.2008.06.1924","type":"journal-article","article-title":"Breast-conserving therapy: radiotherapy margins for breast tumor bed boost","volume":"72","author":"Topolnjak","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"bpexae9ffbbib18","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.meddos.2021.12.003","type":"journal-article","article-title":"Patient setup accuracy in DIBH radiotherapy of breast cancer with lymph node inclusion using surface tracking and image guidance","volume":"47","author":"Rossi","year":"2022","journal-title":"Med. Dosim."},{"key":"bpexae9ffbbib19","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s13014-018-1200-1","type":"journal-article","article-title":"Image-guided study of inter-fraction and intra-fraction set-up variability and margins in reverse semi-decubitus breast radiotherapy","volume":"13","author":"Lee","year":"2018","journal-title":"Radiat. Oncol."},{"key":"bpexae9ffbbib20","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/1748-717X-5-96","type":"journal-article","article-title":"Impact of residual and intrafractional errors on strategy of correction for image-guided accelerated partial breast irradiation","volume":"5","author":"Cai","year":"2010","journal-title":"Radiat. Oncol."},{"key":"bpexae9ffbbib21","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/s0360-3016(00)00518-6","type":"journal-article","article-title":"The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy","volume":"47","author":"van Herk","year":"2000","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"bpexae9ffbbib22","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1016\/s0360-3016(01)01624-8","type":"journal-article","article-title":"A protocol for the reduction of systematic patient setup errors with minimal portal imaging workload","volume":"50","author":"de Boer","year":"2001","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"bpexae9ffbbib23","doi-asserted-by":"publisher","first-page":"e135","DOI":"10.1016\/j.prro.2014.10.005","type":"journal-article","article-title":"Set-up verification and 2-dimensional electronic portal imaging device dosimetry during breath hold compared with free breathing in breast cancer radiation therapy","volume":"5","author":"Brouwers","year":"2015","journal-title":"Pract. Radiat. Oncol."}],"container-title":["Biomedical Physics &amp; Engineering Express"],"original-title":[],"link":[{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb","content-type":"text\/html","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"similarity-checking"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:40:40Z","timestamp":1789627240000},"score":1,"resource":{"primary":{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/2057-1976\/ae9ffb"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9,17]]},"published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1088\/2057-1976\/ae9ffb","relation":{},"ISSN":["2057-1976"],"issn-type":[{"value":"2057-1976","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"assertion":[{"value":"Should breast\/thoracic wall and lymph node volumes have the same margin in hypofractionated radiotherapy?","name":"article_title","label":"Article Title"},{"value":"Biomedical Physics & Engineering Express","name":"journal_title","label":"Journal Title"},{"value":"paper","name":"article_type","label":"Article Type"},{"value":"\u00a9 2026 The Author(s). Published by IOP Publishing Ltd","name":"copyright_information","label":"Copyright Information"},{"value":"2026-04-21","name":"date_received","label":"Date Received","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-08-28","name":"date_accepted","label":"Date Accepted","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2026-09-17","name":"date_epub","label":"Online publication date","group":{"name":"publication_dates","label":"Publication dates"}}]}}