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In this work, we present a comprehensive phantom\u2010based end\u2010to\u2010end test of breathing\u2010adapted gating utilizing surface guidance for use in particle therapy. A commercial dynamic thorax phantom was used to reproduce regular and irregular breathing patterns recorded by the GateRT respiratory monitoring system. The amplitudes and periods of recorded breathing patterns were analysed and compared to planned patterns (ground\u2010truth). In addition, the mean absolute deviations (MAD) and Pearson correlation coefficients (PCC) between the measurements and ground\u2010truth were assessed. Measurements of gated and non\u2010gated irradiations were also analysed with respect to dosimetry and geometry, and compared to treatment planning system (TPS). Further, the latency time of beam on\/off was evaluated. Compared to the ground\u2010truth, measurements performed with GateRT showed amplitude differences between 0.03\u00a0\u00b1\u00a00.02\u00a0mm and 0.26\u00a0\u00b1\u00a00.03\u00a0mm for regular and irregular breathing patterns, whilst periods of both breathing patterns ranged with a standard deviation between 10 and 190\u00a0ms. Furthermore, the GateRT software precisely acquired breathing patterns with a maximum MAD of 0.30\u00a0\u00b1\u00a00.23\u00a0mm. The PCC constantly ranged between 0.998 and 1.000. Comparisons between TPS and measured dose profiles indicated absolute mean dose deviations within institutional tolerances of\u00a0\u00b15%. Geometrical beam characteristics also varied within our institutional tolerances of 1.5\u00a0mm. The overall time delays were\u00a0&lt;60\u00a0ms and thus within both recommended tolerances published by ESTRO and AAPM of 200 and 100\u00a0ms, respectively. In this study, a non\u2010invasive optical surface\u2010guided workflow including image acquisition, treatment planning, patient positioning and gated irradiation at an ion\u2010beam gantry was investigated, and shown to be clinically viable. Based on phantom measurements, our results show a clinically\u2010appropriate spatial, temporal, and dosimetric accuracy when using surface guidance in the clinical setting, and the results comply with international and institutional guidelines and tolerances.<\/jats:p>","DOI":"10.1002\/acm2.14249","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T15:44:34Z","timestamp":1703173474000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Characteristics of breathing\u2010adapted gating using surface guidance for use in particle therapy: A phantom\u2010based end\u2010to\u2010end test from CT simulation to dose delivery"],"prefix":"10.1002","volume":"25","author":[{"given":"Abdallah","family":"Qubala","sequence":"first","affiliation":[{"name":"Heidelberg Ion Beam Therapy Center (HIT)  Heidelberg Germany"},{"name":"Faculty of Medicine University of Heidelberg  Heidelberg 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