{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:32:00Z","timestamp":1787841120055,"version":"build-2784847793"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To quantify inter-fractional translational and rotational setup errors in head-and-neck cancer patients undergoing radiotherapy with daily cone-beam computed tomography (CBCT) and to derive anisotropic clinical-to-planning target volume (CTV-PTV) margins for improved precision and organ-at-risk (OAR) sparing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A retrospective analysis of 1160 daily CBCT scans from 40 patients treated with curative-intent head-and-neck radiotherapy was conducted. Translational (X, Y, and Z) and rotational (pitch, roll, and yaw) displacements were determined by rigid registration of daily CBCT to planning CT. Systematic (\u03a3) and random (\u03c3) errors were computed, and CTV-PTV margins were derived using the ICRU 62, Stroom, and van Herk margin recipes. The frequency of positional deviations exceeding 3 mm and 5 mm and correlations with clinical factors such as weight loss were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean systematic errors were 1.5 mm (X), 1.6 mm (Y), and 1.7 mm (Z), while random errors were 0.5 mm, 1.2 mm, and 1.1 mm, respectively. Mean rotational displacements were 0.6\u00b0 (pitch), 0.5\u00b0 (roll), and 0.7\u00b0 (yaw). Margins derived using van Herk\u2019s formula ranged from 4.10 to 5.02 mm. Weight loss showed a moderate correlation with cranio-caudal setup variability (\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      = 0.42,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.01). Most fractions remained within 3 mm laterally, with greater deviations observed in the cranio-caudal and antero-posterior directions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Daily CBCT allows the precise quantification of inter-fractional setup errors and supports direction-specific margin adaptation. Incorporating clinical parameters such as weight loss and rotational deviation into adaptive workflows can enhance treatment precision, OAR sparing, and overall treatment safety in head-and-neck radiotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmp.jmp_286_25","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T19:00:48Z","timestamp":1774983648000},"page":"97-102","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative Analysis of Inter-fractional Setup Errors and Anisotropic Margin Adaptation Using Daily Cone-beam Computed Tomography in Head-and-neck Radiotherapy"],"prefix":"10.4103","volume":"51","author":[{"given":"Ainain","family":"Baba","sequence":"first","affiliation":[{"name":"Department of Physics, University of Kashmir, Srinagar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obair Yousuf","family":"Baba","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Rajouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abid","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Neonatology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misbah","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"R1-20260403","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4103\/jmp.jmp_123_25","article-title":"Assessing axis-specific set-up errors in rectal cancer radiotherapy: A prospective cone-beam computed tomography-based study with body mass index correlation","volume":"50","author":"Baba","year":"2025","journal-title":"J Med Phys"},{"key":"R2-20260403","doi-asserted-by":"crossref","first-page":"637","DOI":"10.21037\/qims.2018.08.03","article-title":"Analysis of geometric variation of neck node levels during image-guided radiotherapy for nasopharyngeal carcinoma: Recommended planning margins","volume":"8","author":"Tan","year":"2018","journal-title":"Quant Imaging Med Surg"},{"key":"R3-20260403","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11604-016-0604-9","article-title":"Adaptive radiation therapy in head and neck cancer for clinical practice: State of the art and practical challenges","volume":"35","author":"Veresezan","year":"2017","journal-title":"Jpn J Radiol"},{"key":"R4-20260403","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.radonc.2018.06.032","article-title":"The impact of margin reduction on outcome and toxicity in head and neck cancer patients treated with image-guided volumetric modulated arc therapy (VMAT)","volume":"130","author":"Navran","year":"2019","journal-title":"Radiother Oncol"},{"key":"R5-20260403","first-page":"100766","article-title":"Stereotactic ablative radiotherapy for treating primary head and neck cancer and locoregional recurrence: A comprehensive review of the literature","volume":"46","author":"Franzese","year":"2024","journal-title":"Clin Transl Radiat Oncol"},{"key":"R6-20260403","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.semradonc.2018.02.008","article-title":"Current state of image guidance in radiation oncology: Implications for PTV margin expansion and adaptive therapy","volume":"28","author":"Zou","year":"2018","journal-title":"Semin Radiat Oncol"},{"key":"R7-20260403","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/S0360-3016(00)00518-6","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":"R8-20260403","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/S0167-8140(02)00140-8","article-title":"Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report","volume":"64","author":"Stroom","year":"2002","journal-title":"Radiother Oncol"},{"key":"R10-20260403","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.rpor.2015.03.002","article-title":"Effects of remedies made in patient setup process on residual setup errors and margins in head and neck cancer radiotherapy based on 2D image guidance","volume":"20","author":"Kapanen","year":"2015","journal-title":"Rep Pract Oncol Radiother"},{"key":"R11-20260403","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1080\/0284186X.2018.1505053","article-title":"Adaptive radiotherapy for head and neck cancer","volume":"57","author":"Castelli","year":"2018","journal-title":"Acta Oncologica"},{"key":"R12-20260403","doi-asserted-by":"crossref","first-page":"2899","DOI":"10.3390\/cancers16162899","article-title":"Open-face masks in radiotherapy: Enhancing therapeutic strategies for head and neck and brain cancer patients-a comprehensive scoping review","volume":"16","author":"Lastrucci","year":"2024","journal-title":"Cancers (Basel)"},{"key":"R13-20260403","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13014-023-02390-6","article-title":"Prospects for online adaptive radiation therapy (ART) for head and neck cancer","volume":"19","author":"Guberina","year":"2024","journal-title":"Radiat Oncol"},{"key":"R14-20260403","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.radonc.2021.07.016","article-title":"Reduction of GTV to high-risk CTV radiation margin in head and neck squamous cell carcinoma significantly reduced acute and late radiation-related toxicity with comparable outcomes","volume":"162","author":"Al-Mamgani","year":"2021","journal-title":"Radiother Oncol"},{"key":"R15-20260403","doi-asserted-by":"crossref","first-page":"e38529","DOI":"10.1097\/MD.0000000000038529","article-title":"Does adaptive radiotherapy for head and neck cancer favorably impact dosimetric, clinical, and toxicity outcomes? A review","volume":"103","author":"Simopoulou","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"R16-20260403","doi-asserted-by":"crossref","first-page":"616156","DOI":"10.3389\/fonc.2021.616156","article-title":"MR-guided radiotherapy for head and neck cancer: Current developments, perspectives, and challenges","volume":"11","author":"Boeke","year":"2021","journal-title":"Front Oncol"},{"key":"R17-20260403","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1177\/1533034616662165","article-title":"Adaptive radiotherapy for head and neck cancer","volume":"16","author":"Surucu","year":"2017","journal-title":"Technol Cancer Res Treat"},{"key":"R18-20260403","first-page":"12","article-title":"Evaluation of set-up shift values detected in CBCT and kV-kV images taken on set-up day and interfraction treatment days in patients with laryngeal cancer who underwent image-guided radiotherapy","volume":"9","author":"\u00c7ini","year":"2023","journal-title":"Demiroglu Sci Univ Florence Nightingale J Med"},{"key":"R19-20260403","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.radonc.2022.09.011","article-title":"An online adaptive plan library approach for intensity modulated proton therapy for head and neck cancer","volume":"176","author":"Oud","year":"2022","journal-title":"Radiother Oncol"},{"key":"R20-20260403","article-title":"Adaptive Strategies Based on Artificial Intelligence for Radiotherapy of Head-and-Neck Cancer Treatment","author":"Costea","year":"2023","journal-title":"HAL Sciences"},{"key":"R21-20260403","doi-asserted-by":"crossref","first-page":"1424034","DOI":"10.3389\/fonc.2024.1424034","article-title":"Improved quality of life in head and neck cancer patients treated with modern arc radiotherapy techniques \u2013 A prospective longitudinal analysis","volume":"14","author":"Chuang","year":"2024","journal-title":"Front Oncol"},{"key":"R22-20260403","doi-asserted-by":"crossref","first-page":"18","DOI":"10.37549\/ARO1076","article-title":"Evolution of treatment planning techniques in external-beam radiation therapy for head and neck cancer","volume":"4","author":"Shang","year":"2015","journal-title":"Appl Radiat Oncol"},{"key":"R23-20260403","doi-asserted-by":"crossref","first-page":"109676","DOI":"10.1016\/j.radonc.2023.109676","article-title":"The use of in-vivo dosimetry to identify head and neck cancer patients needing adaptive radiotherapy","volume":"184","author":"Fiagan","year":"2023","journal-title":"Radiother Oncol"}],"container-title":["Journal of Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmp.jmp_286_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:42:44Z","timestamp":1787838164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmp.jmp_286_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jmp.jmp_286_25","relation":{},"ISSN":["0971-6203","1998-3913"],"issn-type":[{"value":"0971-6203","type":"print"},{"value":"1998-3913","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}