Dear Dr. Kim,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Christopher Njeh

Academic Editor

PLOS ONE

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Reviewers' comments:

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1:  Strength:

The study addresses a clinically important question about motion management in lung SBRT, specifically examining the effects of respiratory rate and amplitude on dose delivery using a 4DCT phantom and direct dosimetric measurements.

The authors should address the following questions to further strengthen the manuscript:

1. While direct measurement with a glass dosimeter adds robustness, please provide more detail on the calibration, linearity, energy dependence, and measurement uncertainties. Additionally, please clarify the readout process for the glass dosimeters, including how potential signal fading, background correction, or inter-dosimeter variability were addressed. Thank you for describing the dosimeter placements at the center and edges of the PTV if possible, please elaborate on whether these locations correspond to regions of highest dose gradient or areas most at risk of underdosing in clinical SBRT.

2. Given that the ITV was generated from the full phase, while the gated PTV used only the 30–70% phase range, could the authors discuss how this difference in phase selection may affect the comparability of the two approaches?

3. Given the importance of dose accuracy in SBRT, particularly at target edges, could the authors discuss why 2.5 mm was selected for the calculation grid size, and whether any assessment was made of the potential impact compared to a finer resolution?

Reviewer #2:  The manuscript was well written and the data was organized well in its scope. Here are some comments and suggestions:

1. Since the comparison of SBRT plans was done using DCA technique, but not VMAT. It's better to reflect this in the title, as majority of the SBRT plans were made using VMAT now.

2. The figures are really blurry and several labels can not be seen clearly.

3. In line 30, as these are DCA plans, the plans were not really "optimized". Consider to use the phrase "were created".

4. In line 36 and the following context, the term "upper and lower edges" were inaccurate. Please use "anterior and posterior edges" if it's in AP direction and "superior and inferior edges" if it's in SI direction.

5. In line 134, it is mentioned the resolution size is 2.5mm, which is a little bit big for SBRT plan. Please include some explanation for this.

6. In Figure 3 and Figure 4, there is no unit on y axis.

7. In line 178, Are the percentage values in the parenthesis the percentage of the dose delivered to these dosimeters in the plan. Please add some explanation to these values.

8. It would be clearer to include a table like table 2 to show what's the percentage dose change from the original values for different BPM and amplitude at different locations.

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what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

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Reviewer #1: No

Reviewer #2: No

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Influence of inter-fractional respiratory motion changes on dose delivery accuracy in dynamic conformal arc lung stereotactic body radiotherapy: A phantom study

PONE-D-25-24548R1

Dear Dr. Kim,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Christopher Njeh

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #3: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #3: Yes

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Reviewer #1: (No Response)

Reviewer #3: I am satisfied with the modifications and corrections made by the authors according to the Reviewers' comments.

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what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #3: No

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