Search Results (2,243)

Background/Objectives: Malnutrition is common among women undergoing gynaecologic oncology (GO) surgery and is associated with increased morbidity, prolonged hospitalisation, and reduced survival. Nevertheless, the optimal nutritional screening tools remain uncertain. Methods: We conducted a narrative review of commonly used nutritional screening and assessment tools in surgical GO patients. To highlight practical challenges in accurately identifying at risk individuals, we incorporated findings from our clinical audit. Results: There was a considerable variation between tools. While many tools were associated with adverse outcomes, their clinical value in this population was unclear. The presence of ascites and rapid deterioration in oral intake may contribute to under-recognition of at-risk patients, as illustrated by our audit findings. Emerging strategies including determining body composition from routine pre-operative Computed Tomography (CT) scans, which have shown statistical associations with survival and toxicity in observational studies, but their clinical utility is not yet established. Conclusions: Although several screening tools were statistically associated with adverse outcomes, robust data on their clinical utility are lacking. Current tools may inadequately factor for the specific considerations when screening this group. Consequently, nutritionally vulnerable surgical GO patients requiring nutritional intervention may be missed. As no gold standard currently exists for this population, bespoke, objective approaches and prospective studies are urgently needed to address disease-specific nutritional considerations. Full article

Background: The interrelationship between craniofacial morphology and respiratory function is a central focus of orthodontic and dentofacial orthopedic research. This study aimed to evaluate the volumetric changes in the sinonasal complex (combined nasal cavity and paranasal sinuses) following Right Angle Maxillary Protraction Appliance (RAMPA) therapy using cone-beam computed tomography (CBCT) and to compare these outcomes with established longitudinal growth benchmarks. Methods: A retrospective cohort analysis was conducted on 60 pediatric patients (24 males, 36 females; mean age: 86.60 ± 24.22 months) with radiologically clear paranasal sinuses at baseline (T1). Participants underwent RAMPA therapy for an average of 8.38 months. Volumetric quantification of the entire sinonasal complex—including the nasal cavity and all four paranasal sinuses (maxillary, ethmoid, sphenoid, and frontal)—was performed to ensure methodological alignment with existing normative growth data. Results: Total sinonasal volume increased significantly from 27,741.63 ± 10,675.85 mm³ at T1 to 32,248.00 ± 10,084.07 mm³ at T2 (p < 0.001), representing a mean gain of 4506.37 mm³ (16.24%). Notably, the annualized growth velocity under RAMPA therapy (6453 mm³/year) exceeded the physiological increment of age-matched normative data (~5418 mm³/year) by approximately 1.2 times. Despite a constricted baseline at T1 compared to normative values, the treatment group demonstrated a rapid “catch-up” growth trajectory. Conclusions: RAMPA therapy induces rapid and significant volumetric expansion of the sinonasal complex in pediatric patients, demonstrating a potent “acceleration effect” that surpasses natural physiological maturation. These findings suggest that orthopedic midfacial remodeling can effectively restructure the upper respiratory environment, bridging the gap between pathological constriction and normative developmental benchmarks in patients with maxillary hypoplasia. Full article

The Hough transform (HT) is widely used in computer vision, tomography, and neural networks. Numerous algorithms for HT computation have been proposed, making their systematic comparison essential. However, existing comparative methodologies are either non-universal and limited to certain HT formulations or task-oriented, relying on application-specific criteria that do not fully capture algorithmic properties. This paper introduces a novel unified methodology for the systematic comparison of HT algorithms. It evaluates key characteristics, including computational complexity, accuracy, and auxiliary space complexity, while explicitly accounting for the property of self-adjointness. The methodology integrates both implementation-level and theoretical considerations related to the interpretation of HT as a discrete approximation of the Radon transform. A set of mathematically justified evaluation functions, not previously described in the literature, is proposed to support our methodology. Importantly, the methodology is universal, applicable across diverse HT paradigms, encompasses pattern-based and Fourier-based fast HT (FHT) algorithms, and offers a comprehensive alternative to existing task-specific methodologies. Its application to several state-of-the-art FHT algorithms ($FHT2DT$, $FHT2SP$, $ASD2$, $KHM$, and Fast Slant Stack) yields new experimentally confirmed theoretical insights, identifies $ASD2$ as the most balanced algorithm, and provides practical guidelines for algorithm selection. In particular, the methodology reveals that for image sizes up to 3000, the maximum normalized computational complexity increases as follows: $FHT2DT$ (1.1), $ASD2$ (15.3), and $KHM$ (30.6), while the remaining algorithms exhibit at least 1.1 times higher values. The maximum orthotropic approximation error equals 0.5 for $ASD2$, $KHM$, and Fast Slant Stack; lies between 0.5 and 1.5 for $FHT2SP$; and reaches 2.1 for $FHT2DT$. In terms of worst-case normalized auxiliary space complexity, the lowest values are achieved by $FHT2DT$ (2.0), Fast Slant Stack (4.0, lower bound), and $ASD2$ (6.8), with all other algorithms requiring at least 8.2 times more memory. Full article

Background: Hallux valgus (HV) is a complex forefoot deformity influenced by interactions between osseous alignment, ligamentous restraint, and muscle–tendon forces. While the biomechanical role of ligament laxity and bone geometry has been extensively investigated, the contribution of tibialis anterior (TA) tendon insertion variability to medial column mechanics remains insufficiently understood. Materials and Methods: A patient-specific finite element model of the foot was developed from high-resolution computed tomography data. Five anatomically documented TA distal insertion configurations were modeled, representing different distributions of attachment to the medial cuneiform and first metatarsal base. All simulations were performed under identical boundary and loading conditions representative of the stance phase of gait. Global (full-foot) and local (first bone and first metatarsal) mechanical responses were quantified using total deformation, equivalent von Mises stress, and strain distributions. Results: Marked differences in mechanical behavior were observed across TA insertion types. The metatarsal-dominant configuration (Type 3) demonstrated the highest global and local deformation values (global deformation: 1.0928 mm; first bone deformation: 1.0928 mm) and elevated strain distributions, whereas the medial-dominant configuration (Type 2) showed minimal deformation (global: 0.0727 mm; first bone: 0.0350 mm) but the highest global equivalent von Mises stress (5.7698 MPa). The single-band insertion to the medial cuneiform (Type 5) produced the greatest localized stress in the first bone region (3.8634 MPa). Representative strain maps revealed distinct spatial redistribution patterns within the medial column associated with TA insertion geometry. Conclusions: This patient-specific finite element analysis indicated that distal TA insertion variability alone can substantially modify deformation, stress, and strain patterns within the medial column. These findings suggested that TA insertion anatomy may act as a biomechanical modulator of first-ray mechanics and should be considered in future studies investigating hallux valgus pathomechanics and personalized treatment strategies. Full article

Background/Objectives: Novel hotspot displacement radiomic features (normalized hotspot-to-centroid distance [NHOC]/normalized hotspot-to-perimeter distance [NHOP]) are robust against image resampling and spatial resolution variations. However, their reproducibility under respiratory motion remains unvalidated. This study aimed to evaluate the reproducibility, reliability, and survival prognostic value of NHOC/NHOP features in thoracic ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) images with and without respiratory motion correction and to determine whether these features maintain stability and predictive performance for overall survival (OS) compared with respiratory-stable reference features. Methods: We analyzed 138 patients (203 lesions) who underwent ¹⁸F-FDG PET/CT with and without data-driven respiratory gating. Reproducibility and reliability were assessed using the coefficient of variation (CoV) and intraclass correlation coefficient (ICC), respectively. OS prediction was evaluated using Cox regression and concordance index (c-index) analyses. Results: Except for NHOCmax and NHOPpeak, which showed ICC values of 0.782 and 0.93, respectively, the novel morphological features generally exhibited poor reproducibility and moderate reliability (CoV > 20% and ICC < 0.75). In contrast, reference features (entropy-based and sphericity) demonstrated excellent robustness. Motion-corrected NHOCmax showed significant OS prediction for both spatially resampled and non-resampled images. No significant differences in c-indices were observed between motion-corrected and non-corrected features. Conclusions: The marked sensitivity of novel hotspot-displacement features to respiratory motion substantially limits their clinical applicability in thoracic disease. To ensure reproducibility and generalizability in future research, prioritizing inherently robust radiomic parameters, such as entropy-based features, is strongly recommended. Full article

Background/Objectives: Risk stratification in asymptomatic carotid stenosis has traditionally relied on the degree of luminal narrowing; however, plaque vulnerability may better predict cerebrovascular events. Ipsilateral silent brain lesions (SBLs) are considered surrogate markers of stroke risk. This study aimed to identify carotid plaque features on duplex ultrasound (DUS) and computed tomography angiography (CTA), as well as circulating biomarkers, associated with ipsilateral SBL in patients with clinically asymptomatic ≥70% internal carotid artery stenosis. Methods: This prospective observational study with cross-sectional imaging analysis included 316 clinically asymptomatic patients with ≥70% carotid stenosis treated between January 2022 and October 2024. All patients underwent cranial non-contrast CT for SBL detection, DUS plaque characterization (according to the Gray–Weale classification and plaque surface morphology), and CTA analysis, including plaque surface, composition, length, and attenuation values categorized according to Schroeder’s criteria (<50 HU lipid-rich; 51–120 HU fibrous; >120 HU calcified). Demographic, clinical, and laboratory parameters, including inflammatory biomarkers, were recorded. Multivariate logistic regression was performed to identify independent predictors of SBL. Results: SBL were detected in 72 patients (22.8%). On DUS, SBL were significantly associated with Gray–Weale class II plaques, heterogeneous composition, and irregular or ulcerated surfaces (all p < 0.001). On CTA, lipid-rich plaques (<50 HU), ulcerated surfaces, heterogeneous morphology, and lower median plaque density were significantly more frequent in the SBL group (all p < 0.001). In multivariate analysis, independent predictors of SBL were male sex (OR 2.2; 95% CI 1.2–5.7; p = 0.029), Gray–Weale class II plaques (p = 0.002), lipid-rich plaque morphology (OR 21.39; 95% CI 6.86–66.76; p < 0.001), and ulcerated plaque surface on CTA (OR 20.62; 95% CI 7.37–57.68; p < 0.001). Conclusions: Specific ultrasound and CT plaque characteristics were associated with ipsilateral silent brain lesions in patients with asymptomatic ≥70% carotid stenosis. A multiparametric imaging approach may improve risk stratification beyond stenosis severity alone. Full article

Background/Objectives: Accurate preoperative assessment of renal tumor complexity is essential for surgical planning and for predicting perioperative outcomes after partial nephrectomy (PN). RENAL and PADUA nephrometry scores, traditionally derived from two-dimensional (2D) computed tomography (CT) imaging, are widely used to quantify renal tumor complexity and surgical risk. However, the introduction of hyperaccuracy three-dimensional (HA3D) models has enabled enhanced anatomical visualization, potentially improving the assessment of surgical difficulty and the prediction of postoperative complications. The aim of this study was to compare conventional CT-based RENAL and PADUA scores with HA3D-derived nephrometry scores in predicting perioperative complications in patients undergoing robot-assisted or laparoscopic PN. Methods: A total of 17 consecutive patients with intermediate- or high-complexity category renal tumors (RENAL ≥ 7) and moderate- or high-risk category tumors (PADUA ≥ 8) were prospectively enrolled. Preoperative demographic and clinical parameters, as well as intraoperative and postoperative data, were prospectively collected. Tumor characteristics were evaluated using both CT-based RENAL and PADUA scoring systems and HA3D nephrometry reconstruction. Associations between nephrometry scores and perioperative outcomes were assessed using Spearman’s correlation. Predictive performance for postoperative complications and early chronic kidney disease (CKD) was evaluated using receiver operating characteristic (ROC) analysis. Results: Overall, 41% and 35% of cases were downgraded according to three-dimensional (3D) RENAL and PADUA complexity–risk category assessment, respectively. Operative time demonstrated a moderate correlation with 3D RENAL (ρ = 0.57) and 3D PADUA (ρ = 0.49) scores. ROC curve analysis demonstrated numerical differences in area under the curve (AUC) values between 3D- and 2D-based nephrometry scores in predicting overall complications (RENAL: 0.61 vs. 0.54; PADUA: 0.69 vs. 0.46). 3D RENAL score demonstrated numerically higher AUC values for early postoperative CKD compared with 2D RENAL score (AUC: 0.72 vs. 0.67). Conclusions: HA3D-based nephrometry scores were associated with enhanced anatomical visualization, frequent downgrading of tumor complexity–risk categories, and numerical differences in predictive performance for postoperative complications and early renal functional decline compared with conventional CT-based scores. These findings suggest a potential role for HA3D modeling in preoperative planning for PN. However, given the limited sample size, these observations should be interpreted as exploratory and hypothesis-generating, and warrant validation in larger multicenter cohorts. Full article

Background: Endovascular aneurysm repair (EVAR) requires lifelong imaging surveillance because endoleaks, aneurysm sac expansion, and severe adverse events occur in up to one-third of the patients. Conventional follow-up based on sac diameter and visual assessment may fail to detect early microstructural changes that precede clinical deterioration. Methods: This narrative review summarizes the current evidence on texture-based radiomics and artificial intelligence (AI) applied to computed tomography (CT) and CT angiography (CTA) for post-EVAR outcome prediction and surveillance. Original studies evaluating radiomic features and AI-based models for endoleak detection, aneurysm sac behavior, and EVAR-related adverse events were included and qualitatively synthesized. Results: Ten studies were included. Radiomic features describing texture heterogeneity, gray-level nonuniformity, entropy, and spatial complexity were extracted from the aneurysm sac, intraluminal thrombus, and perivascular adipose tissue. Machine learning and deep learning models achieved good to excellent performance, with reported AUC values ranging from 0.78 to 0.95 for predicting endoleaks, sac expansion, and severe adverse events. Texture-based radiomics consistently outperformed morphology-only assessments and showed complementary value to deep learning, including applications on non-contrast CT. Conclusions: CT texture radiomics combined with AI represents an emerging research approach with potential relevance for post-EVAR surveillance, although current evidence remains limited. By capturing tissue heterogeneity beyond conventional morphology, radiomics may enable the earlier detection of complications and support risk-adapted follow-up. However, the heterogeneity of methods limited external validation, and reproducibility issues remain major barriers to clinical translation. Full article

Background/Objectives: Post-COVID-19 fibrotic-like lung changes (PC19-FLC), which may represent persistent post-inflammatory abnormalities or early fibrotic remodeling, have emerged as an important long-term pulmonary sequela following SARS-CoV-2 infection. However, the underlying pathogenic mechanisms remain incompletely understood. This study aimed to investigate the potential association between mammalian target of rapamycin (mTOR) activity and the presence of PC19-FLC. Methods: This single-center, cross-sectional study included 70 patients who met the predefined inclusion criteria. Participants were categorized according to the presence or absence of PC19-FLC on chest computed tomography. Demographic, laboratory, and radiological data were collected. Serum mTOR levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: Serum mTOR levels and modified Medical Research Council (mMRC) dyspnea scores were significantly higher in patients with PC19-FLC compared with those without fibrotic-like changes. Receiver operating characteristic (ROC) curve analysis identified a serum mTOR cut-off value of 6.15 ng/mL (sensitivity 83%, specificity 94%) for discriminating patients with PC19-FLC in this cohort. Serum mTOR levels were significantly correlated with forced vital capacity (FVC%), mMRC dyspnea score, and peripheral oxygen saturation (SpO₂). Conclusions: Increased serum mTOR levels were associated with the presence of fibrotic-like lung changes after COVID-19 and may help distinguish patients with such CT abnormalities in this cohort. Higher mTOR levels were also associated with greater dyspnea severity, lower lung volumes, and reduced peripheral oxygen saturation. These findings suggest a potential role of mTOR signaling in post-COVID-19 pulmonary sequelae and warrant further investigation in larger, multicenter studies. Full article

Background: Traumatic head injury (THI) includes a diverse range of hemorrhagic brain lesions (HBL), which are distinct phenotypes with characteristic pathophysiological mechanisms. Computed tomography (CT) is the cornerstone of the initial assessment and diagnosis; however, its sensitivity is limited, especially in mild head injury. Blood-derived biomarkers, including Neuron-Specific Enolase (NSE) and S-100B, have been extensively studied; however, their efficacy in distinguishing HBL subtypes remains unclear. We evaluated whether circulating serum levels of S-100B and NSE can discriminate between distinct intracranial HBLs and extracranial hemorrhagic lesions (ECH). Methods: This is an interim analysis of a prospective, randomized, double-blind clinical trial including 434 adult patients with blunt THI. HBL phenotypes identified by CT scan included subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma (EDH), and brain contusion (BC). Unique lesions were considered while overlapping lesions were excluded. Subgaleal hematoma (SGH) was included as an example of ECH. Serum S-100B was assessed within 6 h post-injury, while serum NSE was evaluated at admission, 24 h, and 48 h thereafter. Serum NSE and inflammatory cytokines were quantified in duplicates using a Human Magnetic Luminex 5-plex assay, while serum S-100B concentrations were measured separately. Serum epinephrine concentrations were quantified using an ELISA. Biomarker profiles were analyzed based on lesion phenotype, lesion multiplicity, injury pattern, and clinical outcomes, including hospital length of stay (HLOS) and the Glasgow Outcome Scale—Extended (GOSE). Results: Admission median S-100B levels were higher in patients with SAH (495 pg/mL) and lower in those with SGH (191 pg/mL); however, they did not show statistically significant difference among HBL phenotypes. They were significantly higher in patients with polytrauma TBI (420 pg/mL) compared to isolated TBI (258 pg/mL). Baseline and 48 h NSE concentrations were significantly higher in SDH (25,089 and 28,438 pg/mL) than in other THI lesions (p = 0.04). There were no statistically significant changes in NSE values over time across all THI lesions except for SDH in which they raised more after 48 h (p = 0.02). They had a significant drop in polytrauma over the time (p = 0.001). Compared to intracranial lesions, S-100 B levels were significantly lower in SGH and in skull fractures without intracranial hematomas. Both S-100B and NSE levels were elevated in individuals with unfavorable GOSE scores. Conclusions: In this secondary exploratory analysis, elevated serum NSE and S-100B levels discriminate between extra- and intracranial lesions and appear to represent distinct but complementary aspects of THI, indicating neuronal damage and its temporal evolution, and predicting clinical and functional outcomes. The present findings reflect association and not causation. Future studies incorporating larger or multicenter cohorts, volumetric imaging, and long-term outcomes are required to validate and refine biomarker-guided algorithms for personalized THI care. Full article

Background: Visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) are increasingly recognized as relevant contributors to cardiometabolic alterations and subclinical myocardial dysfunction, independently of overall obesity. Their pathogenic role extends beyond simple fat accumulation, encompassing inflammatory activation, lipotoxicity, and altered myocardial metabolism. Objective: This narrative review synthesizes current evidence on the relationships between VAT/EAT and myocardial strain parameters, with emphasis on subclinical cardiovascular risk detection and nutritional interventions. Methods: We conducted a comprehensive review of studies published between 2003–2025, focusing on imaging-based assessments of adipose tissue distribution and strain parameters using echocardiography, computed tomography, and cardiac magnetic resonance. Results: Increased EAT and, to a lesser extent, VAT showed significant associations with impaired global longitudinal strain (GLS) across imaging-based studies. In patients with type 2 diabetes, VAT mediated a substantial proportion of the association between insulin resistance and left ventricular dysfunction. Mediterranean diet adherence was associated with lower epicardial adipose tissue burden, while higher EAT was associated with persistent atrial fibrillation among patients with atrial fibrillation undergoing catheter ablation. Speckle-tracking echocardiography consistently showed superior prognostic value compared to ejection fraction for detecting subclinical dysfunction. Conclusions: VAT and EAT represent important mechanistic links between body composition and early myocardial dysfunction, identifiable through advanced strain imaging before clinical disease becomes apparent. These findings support the integration of multimodal cardiac imaging and nutritional interventions into cardiovascular prevention strategies, providing novel opportunities for early risk stratification and personalized treatment approaches. Full article

Background/Objectives: This study aimed to evaluate pancreatic steatosis and its association with the triglyceride index in patients with pheochromocytoma and paraganglioma (PPGL). Methods: In this retrospective single-center study conducted between 2 January 2019 and 30 April 2024, thirty-three patients with confirmed PPGL and thirty-three age-, sex-, and body mass index (BMI)-matched healthy controls were evaluated. The mean age of the study population was 49.7 ± 12.3 years, and 32 participants (48.5%) were female. Pancreatic fat infiltration was assessed via computed tomography (CT). Body composition parameters, including visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle area (SMA), and skeletal muscle area index (SMAI), were also measured. Laboratory data, including lipid profiles, glucose, hemoglobin A1c (HbA1c), and triglyceride index (TyG), were analyzed. Results: Pancreatic steatosis, as indicated by significantly lower pancreatic attenuation values, was markedly higher in the PPGL group compared to controls (p < 0.001). No significant differences were observed between the groups in terms of VFA (p = 0.218), SFA (p = 0.413), SMA (p = 0.669), or SMAI (p = 0.562). Pancreatic fat was positively correlated with triglyceride levels, VLDL, TyG index, BMI, and VFA. No correlation was found between catecholamine levels and pancreatic steatosis. Conclusions: Our findings indicate an increase in pancreatic steatosis in patients with PPGL, suggesting a potential association between catecholamine excess and the development of ectopic fat deposition. These results support considering pancreatic fat as a marker of metabolic dysfunction in PPGL. Full article

This study develops a multi-scale fiber-reinforced cementitious composite (MFRC) by hybridizing calcium carbonate whisker (CW), polyvinyl alcohol (PVA) fiber, and steel fiber. The interfacial micromechanical properties between steel fiber/matrix and PVA fiber/matrix under the influence of CW were systematically examined through single-fiber pull-out tests. The two-dimensional and three-dimensional distribution characteristics of fibers in the MFRC were analyzed using backscattered electron imaging (BSE) and X-ray computed tomography (X-CT), respectively. Based on the fiber distribution characteristics, flexural strength prediction models were developed with R² values of 0.79 (2D) and 0.82 (3D). Experimental validation via splitting tensile tests and three-point bending tests confirmed the model’s effectiveness in simultaneously predicting splitting tensile strength (R² = 0.89) and flexural strength (R² = 0.93). These findings demonstrate the reliability and universality of the proposed model for predicting flexural–tensile strength in an MFRC. Full article

To address the challenge of coarse aggregates hindering steel fiber dispersion and reducing toughening efficiency in ultra-high-performance concrete containing coarse aggregate (UHPC-CA), this study proposes a hybrid fiber design method based on reverse adaptation to the aggregate structure: a paradigm where fiber proportions are inversely designed to match the quantified void size distribution within the coarse aggregate skeleton. Industrial X-ray computed tomography (X-CT) was employed to capture the internal structure of UHPC-CA. Digital image processing techniques were used to quantitatively characterize the size distribution within the coarse aggregate skeleton gap. Based on this distribution, the blending proportions of multi-scale (3–16 mm) copper-plated steel fibers were systematically determined. Three fiber configurations were compared: mono-sized 13 mm fibers (Type A), an empirical model based on aggregate size (Type B), and a quantitatively designed blend based on skeleton gap distribution (Type C). At the same fiber volume fraction, the mechanical property test results show that the C type achieves approximately 18.6% higher flexural strength and 29.1% higher splitting tensile strength compared to the A type, while showing 5.3% and 6.7% improvements over the B type, and the compressive strength also increased slightly (about 3.0%). The microanalysis further confirms that the fiber distribution in the C-type design was more uniform, and the bridging effect and crack resistance were more sufficient. The proposed gap-adaptive fiber design paradigm offers an effective approach for optimizing reinforcement distribution in composites, providing theoretical and practical value for high-performance UHPC-CA applications. Full article

Objectives: This study aimed to evaluate the setup accuracy and intrafractional geometric stability of surface-guided radiation therapy (SGRT) under frameless immobilization in lung cancer radiotherapy and to assess its clinical utility in a relatively large patient cohort. Materials and Methods: A total of 678 treatment fractions from 52 patients with primary non-small cell lung cancer (NSCLC), treated between October 2024 and November 2025, were retrospectively analyzed. Patient setup was performed using SGRT with the Identify system, and cone-beam computed tomography (CBCT) served as the reference for internal target localization Intrafractional setup displacements, center-of-mass (COM) shifts, residual setup errors, and intrafractional clinical target volume (CTV) variations were evaluated. Spatial agreement between planned and intrafractional tumor volumes was quantified using the Dice Similarity Coefficient (DSC). Results: The mean CBCT-based intrafractional shifts were −0.01 mm (vertical), 0.03 mm (longitudinal), and 0.01 mm (lateral), indicating negligible systematic errors. The greatest variability was observed in the longitudinal direction (standard deviation, 1.32 mm), with a maximum displacement of 4.58 mm. COM-based analysis demonstrated near-zero mean displacements in all directions, with standard deviations ranging from 0.01 to 0.02 mm. DSC values ranged from 0.91 to 0.98, with a mean of 0.96, indicating excellent spatial agreement between planned and intrafractional tumor volumes. Residual setup errors were predominantly within ±1 mm, and the mean intrafractional CTV volume change was minimal (0.27 cm³). Conclusions: SGRT-based frameless lung cancer radiotherapy demonstrated high setup accuracy and robust intrafractional geometric stability. Although slightly greater variability was observed in the longitudinal direction, overall positional deviations and volumetric changes remained within clinically acceptable limits. These findings support the feasibility of integrating SGRT with CBCT-guided radiotherapy and suggest potential benefits for workflow efficiency and planning target volume margin optimization. Full article