{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:36:05Z","timestamp":1787841365713,"version":"build-2784847793"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study aims to minimize monitor units (MUs) of intensity-modulated treatments in the Monaco treatment planning system while preserving plan quality by optimizing the \u201cMinimum Segment Width\u201d (MSW) and \u201cFluence Smoothing\u201d parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 30 prostate, 30 gynecological, 15 breast cancer, 10 head and neck tumor, 11 radiosurgery, and 10 hypo-fractionated plans. Original prostate plans employed \u201cFluence Smoothing\u201d =\n                      <jats:italic toggle=\"yes\">Off<\/jats:italic>\n                      and were reoptimized with\n                      <jats:italic toggle=\"yes\">Low<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Medium<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">High<\/jats:italic>\n                      settings. The remaining pathologies initially used MSW = 0.5 cm and were reoptimized with MSW = 1.0 cm. Plan quality, including total MU, delivery time, and dosimetric constraints, was statistically analyzed with a paired\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Prostate plans exhibited the highest MU variation when changing \u201cFluence Smoothing\u201d from\n                      <jats:italic toggle=\"yes\">Off<\/jats:italic>\n                      to\n                      <jats:italic toggle=\"yes\">High<\/jats:italic>\n                      (average \u0394MU = \u22125.1%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). However, a\n                      <jats:italic toggle=\"yes\">High<\/jats:italic>\n                      setting may increase overall MU when MSW = 0.5 cm. Gynecological plans changed substantially when MSW increased from 0.5 cm to 1.0 cm (average \u0394MU = \u221229%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Organs at risk sparing and planning target volumes remained within 1.2% differences. Replanning other pathologies with MSW = 1.0 cm affected breast and head and neck tumor plans (average \u0394MU = \u2212168.38, average \u0394t = \u221211.74 s, and average \u0394MU = \u2212256.56, average \u0394t = \u221215.05 s, respectively; all with\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.004). Radiosurgery and hypofractioned highly modulated plans did not yield statistically significant results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In breast, pelvis, head and neck, and prostate plans, starting with MSW = 1.0 cm optimally reduces MU and treatment time without compromising plan quality. MSW has a greater impact on MU than the \u201cFluence Smoothing\u201d parameter. Plans with high modulation might present divergent behavior, requiring a case-specific analysis with MSW values higher than 0.5 cm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmp.jmp_156_23","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T09:25:27Z","timestamp":1719912327000},"page":"250-260","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of the Minimum Segment Width and Fluence Smoothing Tools for Intensity-modulated Techniques in Monaco Treatment Planning System"],"prefix":"10.4103","volume":"49","author":[{"given":"Sara","family":"Jim\u00e9nez-Puertas","sequence":"first","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Gonz\u00e1lez","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Lozares","family":"Cordero","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1s Gonz\u00e1lez","family":"Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier D\u00edez","family":"Chamarro","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica Hern\u00e1ndez","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel Castro","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta S\u00e1nchez","family":"Casi","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Carlos Villa","family":"Gazulla","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almudena Gand\u00eda","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Medical Physics and Radiation Protection, University Hospital Miguel Servet, P.\u00ba de Isabel la Cat\u00f3lica, 1-3, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arantxa 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