{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:39:41Z","timestamp":1785537581450,"version":"3.56.0"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>High\u2010quality CBCT and AI\u2010enhanced adaptive planning techniques allow CBCT\u2010guided stereotactic adaptive radiotherapy (CT\u2010STAR) to account for inter\u2010fractional anatomic changes. Studies of intra\u2010fractional respiratory motion management with a surface imaging solution for CT\u2010STAR have not been fully conducted. We investigated intra\u2010fractional motion management in breath\u2010hold Ethos\u2010based CT\u2010STAR and CT\u2010SBRT (stereotactic body non\u2010adaptive radiotherapy) using optical surface imaging combined with onboard CBCTs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten cancer patients with mobile lower lung or upper abdominal malignancies participated in an IRB\u2010approved clinical trial (Phase I) of optical surface image\u2010guided Ethos CT\u2010STAR\/SBRT. In the clinical trial, a pre\u2010configured gating window (\u00b1\u00a02\u00a0mm in AP direction) on optical surface imaging was used for manually triggering intra\u2010fractional CBCT acquisition and treatment beam irradiation during breath\u2010hold (seven patients for the end of exhalation and three patients for the end of inhalation). Two inter\u2010fractional CBCTs at the ends of exhalation and inhalation in each fraction were acquired to verify the primary direction and range of the tumor\/imaging\u2010surrogate (donut\u2010shaped fiducial) motion. Intra\u2010fractional CBCTs were used to quantify the residual motion of the tumor\/imaging\u2010surrogate within the pre\u2010configured breath\u2010hold window in the AP direction. Fifty fractions of Ethos RT were delivered under surface image\u2010guidance: Thirty\u2010two fractions with CT\u2010STAR (adaptive RT) and 18 fractions with CT\u2010SBRT (non\u2010adaptive RT). The residual motion of the tumor was quantified by determining variations in the tumor centroid position. The dosimetric impact on target coverage was calculated based on the residual motion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We used 46 fractions for the analysis of intra\u2010fractional residual motion and 43 fractions for the inter\u2010fractional motion analysis due to study constraints. Using the image registration method, 43 pairs of inter\u2010fractional CBCTs and 100 intra\u2010fractional CBCTs attached to dose maps were analyzed. In the motion range study (image registration) from the inter\u2010fractional CBCTs, the primary motion (mean\u00a0\u00b1\u00a0std) was 16.6\u00a0\u00b1\u00a09.2\u00a0mm in the SI direction (magnitude: 26.4\u00a0\u00b1\u00a011.3\u00a0mm) for the tumors and 15.5\u00a0\u00b1\u00a07.3\u00a0mm in the AP direction (magnitude: 20.4\u00a0\u00b1\u00a07.0\u00a0mm) for the imaging\u2010surrogate, respectively. The residual motion of the tumor (image registration) from intra\u2010fractional breath\u2010hold CBCTs was 2.2\u00a0\u00b1\u00a02.0\u00a0mm for SI, 1.4\u00a0\u00b1\u00a01.4\u00a0mm for RL, and 1.3\u00a0\u00b1\u00a01.3\u00a0mm for AP directions (magnitude: 3.5\u00a0\u00b1\u00a02.1\u00a0mm). The ratio of the actual dose coverage to 99%, 90%, and 50% of the target volume decreased by 0.95\u00a0\u00b1\u00a00.11, 0.96\u00a0\u00b1\u00a00.10, 0.99\u00a0\u00b1\u00a00.05, respectively. The mean percentage of the target volume covered by the prescribed dose decreased by 2.8\u00a0\u00b1\u00a04.4%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We demonstrated the intra\u2010fractional motion\u2010managed treatment strategy in breath\u2010hold Ethos CT\u2010STAR\/SBRT using optical surface imaging and CBCT. While the controlled residual tumor motion measured at 3.5\u00a0mm exceeded the predetermined setup value of 2\u00a0mm, it is important to note that this motion still fell within the clinically acceptable range defined by the PTV margin of 5\u00a0mm. Nonetheless, additional caution is needed with intra\u2010fractional motion management in breath\u2010hold Ethos CT\u2010STAR\/SBRT using optical surface imaging and CBCT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14242","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T06:53:06Z","timestamp":1704437586000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Feasibility of surface\u2010guidance combined with CBCT for intra\u2010fractional breath\u2010hold motion management during Ethos RT"],"prefix":"10.1002","volume":"25","author":[{"given":"Taeho","family":"Kim","sequence":"first","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Laugeman","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall","family":"Kiser","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Schiff","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0713-4418","authenticated-orcid":false,"given":"Shanti","family":"Marasini","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9515-6291","authenticated-orcid":false,"given":"Alex","family":"Price","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"},{"name":"Radiation Oncology University Hospitals Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H Michael","family":"Gach","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"},{"name":"Radiology and Biomedical Engineering Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nels","family":"Knutson","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Samson","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Robinson","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey","family":"Hatscher","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Henke","sequence":"additional","affiliation":[{"name":"Radiation Oncology Washington University School of Medicine  Washington USA"},{"name":"Radiation Oncology University Hospitals Case Western Reserve University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Varian.Varian Medical Systems I. 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