British Journal of Radiology最新文献

{"title":"Computed tomography angiography of the carotid body: bridging the gap between normal and neoplastic lesions.","authors":"Sezer Nil Yılmazer Zorlu, Çağlar Uzun, Ebru Düşünceli Atman, Ruhi Erdem Ergüden, Atilla Halil Elhan","doi":"10.1093/bjr/tqaf096","DOIUrl":"https://doi.org/10.1093/bjr/tqaf096","url":null,"abstract":"<p><strong>Objective: </strong>Sympathetic nervous system hyperactivation in chronic conditions, such as hypertension and metabolic syndrome, can lead to carotid body (CB) hyperplasia, potentially mimicking small carotid body tumors (CBTs) in radiological evaluations. This study aimed to investigate computed tomography angiography (CTA) findings to differentiate CBTs from non-neoplastic CBs.</p><p><strong>Methods: </strong>Patients were categorized into CBT and non-neoplastic CB groups. Demographics (smoking status, hypertension, diabetes mellitus), shape, dimensions, volume, and density (including standard deviations) were assessed. Density ratios were calculated using CB/CBT and ipsilateral common carotid artery density. Diagnostic performance was evaluated via ROC analysis, and logistic regression identified factors associated with increased CBT risk.</p><p><strong>Results: </strong>Significant differences between the CB and CBT groups were found in gender, smoking status, and shape (p < 0.01), while age, location, hypertension, and diabetes mellitus showed no association (p > 0.05). The CBT group had significantly higher density, standard deviation, and density ratios (p < 0.001). Multivariate analysis, adjusted for age, gender, and smoking, showed that saddle shape, standard deviation ≥21.5, and density ratio ≥0.5603 predicted CBT diagnosis with 92.6% sensitivity and 99.3% specificity.</p><p><strong>Conclusions: </strong>Saddle shape, along with increased density and standard deviation values, emerges as findings suggestive of a CBT diagnosis. The proposed imaging features may improve differentiation of small CBTs from non-neoplastic CBs, particularly in cases with enlarged CBs lacking typical tumor features.</p><p><strong>Advances in knowledge: </strong>Specific CTA findings, including saddle shape, increased density, and standard deviation, can effectively differentiate small CBTs from non-neoplastic CBs, offering a novel approach to improving radiological diagnostics in cases with CB hyperplasia.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of Lung Density Quantification across Photon-counting and Conventional Energy-integrating CT: A Comparative Study.","authors":"Saman Sotoudeh-Paima, Ehsan Samei, And Ehsan Abadi","doi":"10.1093/bjr/tqaf103","DOIUrl":"https://doi.org/10.1093/bjr/tqaf103","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate how photon-counting CT (PCCT) reproducibly quantifies lung density compared to conventional CT (energy-integrating CT or EICT) and assess the relevance of image quality.</p><p><strong>Methods: </strong>In this retrospective analysis of a prospective study, subjects underwent acquisitions using EICT and PCCT systems (August-December 2021) on the same day. PCCT projections were reconstructed with four kernels and two voxel sizes using 2024 reconstruction software (ReconCT, Siemens). PCCT and EICT data were compared using lung density measurements: percentage of low-attenuation areas <-950 HU (LAA-950), 15th percentile of lung density histogram (Perc15), and mean lung density (MLD). Measurement reproducibility and its relation to image quality parameters (modulation transfer function and noise) were analyzed.</p><p><strong>Results: </strong>Fifty-four subjects (mean age, 67.4 years ± 9.6, 30 female) were studied. PCCT images had the closest agreement to EICT under identical voxel size and similar kernels, yielding lower LAA-950 (-0.9%±2.7, p < 0.05), higher Perc15 (1.4HU ± 7.9, p > 0.05), and higher MLD (2.4 HU ± 10.8, p > 0.05). At higher PCCT resolution (1024 × 1024 matrix, 0.2 mm slice thickness), the smoother quantitative kernel (Qr36) improved agreement, with differences of -0.5%±3.0, -0.1HU ± 9.8, and 2.8HU ± 11.1, for LAA-950, Perc15, and MLD (p > 0.05). Image quality parameters strongly correlated with density measurements (RPerc152=85.3%).</p><p><strong>Conclusions: </strong>PCCT yields reproducible lung density measurements comparable to EICT, with optimal reproducibility dependent on optimized reconstruction parameters and explainable by image quality parameters.</p><p><strong>Advances in knowledge: </strong>Lung density reproducibility is critical for integrating PCCT into EICT-based workflows. In our study, PCCT aligned more closely with EICT using similar kernels at identical voxel sizes, or smoother kernels at smaller voxel sizes.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuro applications of photon-counting CT.","authors":"Akio Hiwatashi, Masahiro Nakashima, Kazuhisa Matsumoto, Takatsune Kawaguchi, Misugi Urano, Tatsuya Kawai","doi":"10.1093/bjr/tqaf082","DOIUrl":"https://doi.org/10.1093/bjr/tqaf082","url":null,"abstract":"<p><p>Photon-counting detector CT, a recent advance in CT technology, has several advantages over conventional energy-integrating detector CT. These include increased spatial resolution, reduced image noise, increased soft-tissue and iodine contrast, lower radiation dose, and inherent spectral imaging. This article comments on recent literatures in neuroradiology covering the vessels, pituitary adenoma, temporal bone, and myelography while addressing certain issues and outlining future directions.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical photon-counting CT increases CT number precision and reduces patient size dependence compared to single- and dual-energy CT.","authors":"Jessica D Flores, Gavin Poludniowski, Adrian Szum, Georg Walther, Johan Lundberg, Patrik Nowik, Tobias Granberg","doi":"10.1093/bjr/tqaf052","DOIUrl":"10.1093/bjr/tqaf052","url":null,"abstract":"<p><strong>Objectives: </strong>To study whether photon-counting computed tomography (PCCT) can improve CT number accuracy and precision and reduce patient size dependence compared to dual-energy CT (DECT) virtual monoenergetic imaging (VMI) and single-energy CT (SECT).</p><p><strong>Methods: </strong>Clinical PCCT, DECT, and SECT scanners were used to image a multi-energy quality assurance phantom and tissue-equivalent inserts with/without an outer nested annulus, representing 2 object sizes (18 and 33 cm). CT numbers were converted to linear attenuation coefficients (LAC) and regions of interest applied. Theoretical monoenergetic LAC were calculated from known elemental compositions as a ground truth. Percent differences in mean LAC between phantom sizes, between mean and theoretical LAC, and its coefficient of variation (COV) were calculated.</p><p><strong>Results: </strong>Mean LAC percent differences between small and larger phantoms were highest in DECT (within -3% to 9%) and SECT (within 1%-5%), particularly at higher calcium and iodine concentrations, while being relatively constant in PCCT over material concentrations and VMI energies (within ±2%). The COV in mean LAC was consistently lower (about 2-5 times) in PCCT relative to DECT and SECT for calcium in the large phantom. With consideration of the theoretical uncertainties of 2%, both PCCT and DECT showed comparable agreement to theoretical LAC.</p><p><strong>Conclusions: </strong>PCCT VMI produces CT numbers with less dependence on patient size and increased precision in large object sizes than DECT VMI and SECT.</p><p><strong>Advances in knowledge: </strong>Clinical PCCT provides less variable CT numbers than DECT and SECT with less sensitivity to the imaged object size.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"721-733"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancement of colorectal cancer liver metastases with gadoxetate-enhanced MRI at multiple time points is associated with disease-free survival following hepatectomy.","authors":"Joshua Shur, Leila Kafaei, Angela Riddell, Ian Chau, Ricky Bhogal, Long Jiao, Dow-Mu Koh","doi":"10.1093/bjr/tqaf040","DOIUrl":"10.1093/bjr/tqaf040","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate signal intensity of colorectal cancer liver metastases (CRLM) at hepatobiliary phase (HBP) gadoxetate-enhanced MRI at 2 time points pre- (TP1) and post- chemotherapy (TP2) and association with disease-free survival (DFS) in patients undergoing curative liver resection.</p><p><strong>Methods: </strong>Retrospective study was conducted. Single largest tumours were outlined and HBP T1 signal intensity was measured and normalized to skeletal muscle at TP1 and TP2. Enhancement thresholds were defined and risk groups at each TP and Kaplan-Meier survival curves were compared using the log-rank test. Univariate and multivariate association of enhancement and 8 clinical features with risk of recurrence were calculated using Cox proportional hazards.</p><p><strong>Results: </strong>82 patients (48 male, mean age 59 years) underwent 135 imaging studies, 58 at TP1, 77 at TP2, and 53 patients at TP1 + 2. Of 82 patients, 58 recurred with a median time to recurrence of 11.7 months. Enhancement of ≥135 and ≥15 at TP1 and TP2, respectively, were predictive of reduced risk of recurrence (P < .05), although not when corrected for multiple testing (P = .33 and .20, respectively). Enhancement was not associated with recurrence in multivariate model including 8 clinical features (P > .05). Change in enhancement between TP was not associated with risk of recurrence; however, tumours that consistently exhibited low enhancement were 9 times more likely to recur.</p><p><strong>Conclusions: </strong>Increased CRLM enhancement in the HBP following gadoxetic acid at 2 TPs is associated with improved DFS in patients undergoing liver resection. This initial observation warrants further investigation of serial enhancement measurements as prognostic biomarkers.</p><p><strong>Advances in knowledge: </strong>Dual-time point signal assessment may be informative for clinical outcomes in CRLM undergoing resection.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"744-751"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental breast cancer on CT: factors associated with detection and relationship to prognostics and treatment options.","authors":"Ali Abougazia, Deepali Sharma, Omnia Abdelghani","doi":"10.1093/bjr/tqaf044","DOIUrl":"10.1093/bjr/tqaf044","url":null,"abstract":"<p><strong>Objectives: </strong>With the increasing use of CT, it may help detecting incidental breast cancers. Our study analysed the relationship between breast cancer detection on CT and features of the cancer, factors related to the scan and report, the treatment offered, and cancer prognostics, in NHS settings.</p><p><strong>Methodology: </strong>56 scans in 42 patients were retrospectively included.</p><p><strong>Results: </strong>38 reports (67.9%) missed the breast cancers. Missed cancers were found to be smaller (P = .0042), progressed more by the time they were diagnosed (P = .0011), and their initial treatment was delayed by a median of 3.4 years (P < .0001). Cancers were more likely to be missed out of hours (P = .0485), in an outpatient reporting session (P = .0397), when the cancer presented as a circumscribed mass (P = .0196), and when the breasts were dense (P = .0250).</p><p><strong>Conclusion: </strong>A significant percentage of breast cancer is missed on CT, with subsequent delay in starting treatment. Systematic approach when reporting, awareness of atypical cancer presentations, and minimizing distractions while reporting, may improve the detection of breast cancer on CT.</p><p><strong>Advances in knowledge: </strong>This study identified opportunities to detect, and the factors associated with missing and delayed treatment of, incidental breast cancer on CT, specifically in NHS settings. By increasing radiologists' awareness of those factors, it is hoped to prevent delay in treatment of this cohort of cancer patients.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"752-763"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mastering CT-based radiomic research in lung cancer: a practical guide from study design to critical appraisal.","authors":"Ashley Horne, Azadeh Abravan, Isabella Fornacon-Wood, James P B O'Connor, Gareth Price, Alan McWilliam, Corinne Faivre-Finn","doi":"10.1093/bjr/tqaf051","DOIUrl":"10.1093/bjr/tqaf051","url":null,"abstract":"<p><p>Radiomics is a health technology that has the potential to extract clinically meaningful biomarkers from standard of care imaging. Despite a wealth of exploratory analysis performed on scans acquired from patients with lung cancer and existing guidelines describing some of the key steps, no radiomic-based biomarker has been widely accepted. This is primarily due to limitations with methodology, data analysis, and interpretation of the available studies. There is currently a lack of guidance relating to the entire radiomic workflow from study design to critical appraisal. This guide, written with early career lung cancer researchers, describes a more complete radiomic workflow. Lung cancer image analysis is the focus due to some of the unique challenges encountered such as patient movement from breathing. The guide will focus on CT imaging as these are the most common scans performed on patients with lung cancer. The aim of this article is to support the production of high-quality research that has the potential to positively impact outcome of patients with lung cancer.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"653-668"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"18F-FDG PET or PET/CT in detecting high-grade transformation of chronic lymphocytic leukaemia and indolent lymphomas: a systematic review and meta-analysis.","authors":"Osher N Y Lee, John Kuruvilla, David C Hodgson, Patrick Veit-Haibach, Ur Metser","doi":"10.1093/bjr/tqaf028","DOIUrl":"10.1093/bjr/tqaf028","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of 18F-FDG positron emission tomography (PET) or PET/computed tomography (CT) in detecting histological transformation (HT) of indolent lymphomas.</p><p><strong>Methods: </strong>A systematic search of articles up to July 2024 was performed in Embase and Medline. Eligible studies included adults with histologically proven indolent lymphoma, 18F-FDG PET or PET/CT as the index test, and sufficient data to assess diagnostic performance. Summary receiver operating characteristic curves were plotted using a bivariate model to estimate diagnostic accuracy with area under the curve (AUC).</p><p><strong>Results: </strong>Fifteen studies with 1307 participants were included. Ten studies assessed PET ability to detect Richter's transformation, and 5 studies focused on HT in follicular lymphoma and other subtypes. A meta-analysis of the former showed pooled sensitivity of 0.90 (95% CI, 0.84-0.93) and specificity of 0.54 (95% CI, 0.28-0.77) when using a maximum standardized uptake value (SUVmax) threshold of around 5. AUC was 0.89. Pooled sensitivity was 0.74 (95% CI, 0.54-0.87), and specificity was 0.84 (95% CI, 0.67-0.93) when using an SUVmax threshold of around 10. Area under the curve was 0.84. For detecting HT in follicular lymphoma, thresholds were found higher than those for Richter's transformation.</p><p><strong>Conclusions: </strong>18F-FDG PET or PET/CT demonstrates good diagnostic accuracy to detect Richter's transformation, best when employing SUVmax ≥ 5. SUVmax thresholds may be limited in discriminating follicular lymphoma from HT, and alternatives should be sought.</p><p><strong>Advances in knowledge: </strong>If biopsy is feasible, SUVmax ≥ 5 can guide biopsy in patients with clinically suspicious Richter's transformation. If biopsy is infeasible, SUVmax ≥ 10 can better identify HT and guide patient management.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"669-678"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREDICTing Post-Embolization Syndrome after uterine fibroid embolization: the PREDICT-PES study.","authors":"Warren Clements, Matthew W Lukies, Madeleine Coleman, Rohan Nandurkar, Laura Le Mercier, Georgina Venn, Jim Koukounaras","doi":"10.1093/bjr/tqaf036","DOIUrl":"10.1093/bjr/tqaf036","url":null,"abstract":"<p><strong>Objectives: </strong>To identify the rate of clinically significant post-embolization syndrome (csPES) in our cohort of patients after uterine artery embolization (UAE) for symptomatic fibroids and to identify risk factors associated with the development of csPES.</p><p><strong>Methods: </strong>Retrospective case-control study. All patients who underwent UAE for symptomatic fibroids between the 18-month period of March 1, 2022 and September 1, 2023 were recruited. csPES was defined as maximum pain score on visual analogue scale of >5 out of 10, plus at least 1 of: morphine patient-controlled analgesia dose >10 mg, fever, or use of 2 or more antiemetics.</p><p><strong>Results: </strong>A total of 69 patients were included, mean age 46.2 years, and median uterine volume 393 mL (range 80-2288 mL). The rate of csPES was 47.8% (33 patients). After adjusting for confounding using multiparametric logistic regression, a positive association was seen between nulliparity and developing csPES (OR: 5.51, 95% CI: 1.297-23.410, P = .021). In addition, a trend was shown between increasing age and a reduced odds of developing csPES (OR: 0.87, 95% CI: 0.748-1.002, P = .054).</p><p><strong>Conclusion: </strong>The rate of csPES in our cohort was 47.8%, and nulliparity was strongly associated with the development of csPES. We can use this to better counsel our patients regarding the odds of csPES when these risks are present at pre-procedure consultation and target additional interventions at reducing csPES in this population.</p><p><strong>Advances in knowledge: </strong>Clinically significant post-embolization syndrome is common after UAE for symptomatic fibroids. This study showed that nulliparity is a risk factor for developing, previously not known or reported.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"709-714"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of plan complexity on dose delivery deviations resulting from multileaf collimator positioning errors in volumetric modulated arc therapy.","authors":"Qinghe Peng, Peng Fan, Xunyu Wang, Fali Tao, Ruijun Niu, Li Chen","doi":"10.1093/bjr/tqaf053","DOIUrl":"10.1093/bjr/tqaf053","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the effect of plan complexity on dosimetric alterations induced by multileaf collimator (MLC) misplacements in volumetric modulated arc therapy (VMAT).</p><p><strong>Methods: </strong>Volumetric modulated arc therapy plans for 14 cervical and 10 lung cancer cases were reoptimized utilizing 3 distinct aperture shape controller (ASC) settings (none, very high, and very low), resulting in 3 plan groups: ASC-none, ASC-vh, and ASC-vl. Four types of MLC position errors were simulated: total shifts (Type 1), open/closed (Type 2), right-side shifts (Type 3), and left-side shifts (Type 4). Plan complexity was assessed using the small aperture score (SAS). Dose deviations resulting from various MLC positioning errors and SAS values were calculated and compared among the 3 ASC groups.</p><p><strong>Results: </strong>The variations in planning target volume (PTV) D95% for cervical cancer were approximately 0.6%, 3.7%, 1.9%, and 1.8% per millimetre for Types 1-4 errors, respectively. In the case of lung cancer, the changes were 2.3%, 9.3%, 5.3%, and 4.6% per millimetre. The ASC-vh and ASC-vl groups exhibited significantly reduced dose changes and SAS values in response to MLC errors, as compared to the ASC-none group (P < .05).</p><p><strong>Conclusions: </strong>Highly complex plans exhibit greater dose sensitivity to MLC positional errors. The application of ASC proves effective in reducing plan complexity and mitigating the influence of MLC errors on dose deviation.</p><p><strong>Advances in knowledge: </strong>By elucidating the relationship between dosimetric impacts from MLC errors and plan complexity, this study offers valuable guidance for the design of radiotherapy plans, helping to enhance the accuracy and effectiveness of VMAT treatments.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":"785-792"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}