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Although bowel and bladder preparation protocols reduce inter\u2010fraction variability, inconsistent patient adherence still results in OAR variability. At many centers without online adaptive machines, radiation therapists use decision trees (DTs) to visually assess patient setup, yet their application varies. To evaluate our center's DTs, we employed deep learning\u2010generated cone\u2010beam computed tomography (CBCT) contours to estimate daily doses to the rectum and bladder, comparing these with planned dose\u2010volume metrics to guide future personalized DT development. Two hundred pretreatment CBCT scans from 40 prostate SABR patients (each receiving 40\u00a0Gy in five fractions) were auto\u2010contoured retrospectively, and daily rectum and bladder doses were estimated by overlaying the planned dose on the CBCT using online rigid registration data. Dose\u2010volume metrics were classified as \u201cno\u201d, \u201cminor\u201d, or \u201cmajor\u201d violations based on meeting preferred or mandatory goals. Twenty\u2010seven percent of fractions exhibited at least one major bladder violation (with an additional 34% minor), while 14% of fractions had a major rectum violation (10% minor). Across treatments, five patients had recurring bladder V37\u00a0Gy major violations and two had rectum V36\u00a0Gy major violations. Bowel and bladder preparation significantly influenced OAR position and volume, leading to unmet mandatory goals. Our retrospective analysis underscores the significant impact of patient preparation on dosimetric outcomes. Our findings highlight that DTs based solely on visual assessment miss dose metric violations due to human error; only 23 of 59 under\u2010filled bladder fractions were flagged. In addition to the insensitivity of visual assessments, variability in DT application further compromises patient setup evaluation. These analyses confirm that reliance on visual inspection alone can overlook deviations, emphasizing the need for automated tools to ensure adherence to dosimetric constraints in prostate SABR.<\/jats:p>","DOI":"10.1002\/acm2.70098","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T05:36:35Z","timestamp":1745386595000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Using deep learning generated CBCT contours for online dose assessment of prostate SABR treatments"],"prefix":"10.1002","volume":"26","author":[{"given":"Conor Sinclair","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Physics and Astronomy University of Victoria  Victoria British Columbia Canada"},{"name":"Department of Medical Physics BC Cancer Victoria  Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Gagne","sequence":"additional","affiliation":[{"name":"Department of Medical Physics BC Cancer Victoria  Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Otto","sequence":"additional","affiliation":[{"name":"Radformation Inc  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carter","family":"Kolbeck","sequence":"additional","affiliation":[{"name":"Radformation Inc  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Giambattista","sequence":"additional","affiliation":[{"name":"Radformation Inc  New York New York USA"},{"name":"Allan Blair Cancer Centre Saskatchewan Cancer Agency  Regina Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology BC Cancer Victoria  Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Murchison","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology BC Cancer Victoria  Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Pritchard","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology BC Cancer Victoria  Victoria British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Mathematics, Physics, and Statistics University of British Columbia\u2013Okanagan  Kelowna British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2021.01.003"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20190789"},{"key":"e_1_2_9_4_1","article-title":"Androgen Suppression With Stereotactic body or external beam radiation therapy (ASSERT): a phase II randomized trial for intermediate and high risk prostate cancer","author":"Alexander A","journal-title":"ClinicalTrials.gov identifier: NCT02594072."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167\u20108140(19)30950\u20108"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12194\u2010020\u201000574\u20103"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010017\u20100815\u2010y"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01659028"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14246116"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010014\u20100270\u2010y"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/app122211681"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010019\u20101392\u2010z"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2020.05.013"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201002330\u2010y"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjr\/tqae077"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ipemt.2023.100018"},{"key":"e_1_2_9_17_1","unstructured":"BartaR NygrenI KirkbyC ShawC SeeS.Qualitative evaluation of AI contours. 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