{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T21:07:45Z","timestamp":1770152865088,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2015,9,23]],"date-time":"2015-09-23T00:00:00Z","timestamp":1442966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation (NSF)","doi-asserted-by":"publisher","award":["CCF-0844765"],"award-info":[{"award-number":["CCF-0844765"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation (NSF)","doi-asserted-by":"publisher","award":["CCF-1318996"],"award-info":[{"award-number":["CCF-1318996"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["CCF\u20100844765"],"award-info":[{"award-number":["CCF\u20100844765"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["CCF\u20101318996"],"award-info":[{"award-number":["CCF\u20101318996"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["CCF-0844765"],"award-info":[{"award-number":["CCF-0844765"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["CCF-1318996"],"award-info":[{"award-number":["CCF-1318996"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aip.org"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec><jats:title>Purpose:<\/jats:title><jats:p>The authors present a novel paddle\u2010based rotating\u2010shield brachytherapy (P\u2010RSBT) method, whose radiation\u2010attenuating shields are formed with a multileaf collimator (MLC), consisting of retractable paddles, to achieve intensity modulation in high\u2010dose\u2010rate brachytherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>Five cervical cancer patients using an intrauterine tandem applicator were considered to assess the potential benefit of the P\u2010RSBT method. The P\u2010RSBT source used was a 50 kV electronic brachytherapy source (Xoft Axxent\u2122). The paddles can be retracted independently to form multiple emission windows around the source for radiation delivery. The MLC was assumed to be rotatable. P\u2010RSBT treatment plans were generated using the asymmetric dose\u2013volume optimization with smoothness control method [Liu <jats:italic>et al.<\/jats:italic>, Med. Phys. <jats:bold>41<\/jats:bold>(11), 111709 (11pp.) (2014)] with a delivery time constraint, different paddle sizes, and different rotation strides. The number of treatment fractions (fx) was assumed to be five. As brachytherapy is delivered as a boost for cervical cancer, the dose distribution for each case includes the dose from external beam radiotherapy as well, which is 45 Gy in 25 fx. The high\u2010risk clinical target volume (HR\u2010CTV) doses were escalated until the minimum dose to the hottest 2 cm<jats:sup>3<\/jats:sup> (<jats:italic>D<\/jats:italic><jats:sub>2cm<\/jats:sub><jats:sup>3<\/jats:sup>) of either the rectum, sigmoid colon, or bladder reached their tolerance doses of 75, 75, and 90 Gy<jats:sub>3<\/jats:sub>, respectively, expressed as equivalent doses in 2 Gy fractions (EQD2 with <jats:italic>\u03b1<\/jats:italic>\/<jats:italic>\u03b2<\/jats:italic> = 3 Gy).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>P\u2010RSBT outperformed the two other RSBT delivery techniques, single\u2010shield RSBT (S\u2010RSBT) and dynamic\u2010shield RSBT (D\u2010RSBT), with a properly selected paddle size. If the paddle size was angled at 60\u00b0, the average <jats:italic>D<\/jats:italic><jats:sub>90<\/jats:sub> increases for the delivery plans by P\u2010RSBT on the five cases, compared to S\u2010RSBT, were 2.2, 8.3, 12.6, 11.9, and 9.1 Gy<jats:sub>10<\/jats:sub>, respectively, with delivery times of 10, 15, 20, 25, and 30 min\/fx. The increases in HR\u2010CTV <jats:italic>D<\/jats:italic><jats:sub>90<\/jats:sub>, compared to D\u2010RSBT, were 16.6, 12.9, 7.2, 3.7, and 1.7 Gy<jats:sub>10<\/jats:sub>, respectively. P\u2010RSBT HR\u2010CTV <jats:italic>D<\/jats:italic><jats:sub>90<\/jats:sub>\u2010values were insensitive to the paddle size for paddles angled at less than 60\u00b0. Increasing the paddle angle from 5\u00b0 to 60\u00b0 resulted in only a 0.6 Gy<jats:sub>10<\/jats:sub> decrease in HR\u2010CTV <jats:italic>D<\/jats:italic><jats:sub>90<\/jats:sub> on average for five cases when the delivery times were set to 15 min\/fx. The HR\u2010CTV <jats:italic>D<\/jats:italic><jats:sub>90<\/jats:sub> decreased to 2.5 and 11.9 Gy<jats:sub>10<\/jats:sub> with paddle angles of 90\u00b0 and 120\u00b0, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>P\u2010RSBT produces treatment plans that are dosimetrically and temporally superior to those of S\u2010RSBT and D\u2010RSBT, although P\u2010RSBT systems may be more mechanically challenging to develop than S\u2010RSBT or D\u2010RSBT. A P\u2010RSBT implementation with 4\u20136 shield paddles would be sufficient to outperform S\u2010RSBT and D\u2010RSBT if delivery times are constrained to less than 15 min\/fx.<\/jats:p><\/jats:sec>","DOI":"10.1118\/1.4930807","type":"journal-article","created":{"date-parts":[[2015,9,23]],"date-time":"2015-09-23T17:01:32Z","timestamp":1443027692000},"page":"5992-6003","update-policy":"https:\/\/doi.org\/10.1063\/aip-crossmark-policy-page","source":"Crossref","is-referenced-by-count":18,"title":["Paddle\u2010based rotating\u2010shield brachytherapy"],"prefix":"10.1002","volume":"42","author":[{"given":"Yunlong","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan T.","family":"Flynn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hossein","family":"Dadkhah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudershan K.","family":"Bhatia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Buatti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiyu","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaodong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,9,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4897617"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2007.04.012"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.04.041"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2010.01.001"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2013.36180"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2011.07.003"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2011.07.002"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360\u20103016(02)02900\u20100"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.01.036"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2009.08.014"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/58\/11\/3931"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4802750"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4828778"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3612878"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4769416"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2011.02.046"},{"key":"e_1_2_7_18_1","first-page":"342","volume-title":"Algorithms and Computation, Lecture Notes in Computer Science","author":"Wu X.","year":"2012"},{"key":"e_1_2_7_19_1","unstructured":"P. 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