{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:26:05Z","timestamp":1789802765308,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T00:00:00Z","timestamp":1612569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R146\u2010A9373"],"award-info":[{"award-number":["R146\u2010A9373"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008363","name":"Kr\u00e6ftens Bek\u00e6mpelse","doi-asserted-by":"publisher","award":["R191\u2010A11526"],"award-info":[{"award-number":["R191\u2010A11526"]}],"id":[{"id":"10.13039\/100008363","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007210","name":"Varian Medical Systems","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007210","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Intrafractional motion during radiotherapy delivery can deteriorate the delivered dose. Dynamic rotational motion of up to 38 degrees has been reported during prostate cancer radiotherapy, but methods to determine the dosimetric consequences of such rotations are lacking. Here, we create and experimentally validate a dose reconstruction method that accounts for dynamic rotations and translations in a commercial treatment planning system (TPS). Interplay effects are quantified by comparing dose reconstructions with dynamic and constant rotations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The dose reconstruction accumulates the dose in points of interest while the points are moved in six degrees of freedom (6DoF) in a precalculated time\u2010resolved four\u2010dimensional (4D) dose matrix to emulate dynamic motion in a patient. The required 4D dose matrix was generated by splitting the original treatment plan into multiple sub\u2010beams, each representing 0.4\u00a0s dose delivery, and recalculating the dose of the split plan in the TPS (Eclipse). The dose accumulation was performed via TPS scripting by querying the dose of each sub\u2010beam in dynamically moving points, allowing dose reconstruction with any dynamic motion.<\/jats:p><jats:p>The dose reconstruction was validated with film dosimetry for two prostate dual arc VMAT plans with intra\u2010prostatic lesion boosts. The plans were delivered to a pelvis phantom with internal dynamic rotational motion of a film stack (21 films with 2.5\u00a0mm separation). Each plan was delivered without motion and with three prostate motion traces. Motion\u2010including dose reconstruction was performed for each motion experiment using the actual dynamic rotation as well as a constant rotation equal to the mean rotation during the experiment. For each experiment, the 3%\/2\u00a0mm \u03b3 failure rate of the TPS dose reconstruction was calculated with the film measurement being the reference. For each motion experiment, the motion\u2010induced 3%\/2\u00a0mm \u03b3 failure rate was calculated using the static delivery as the reference and compared between film measurements and TPS dose reconstruction. DVH metrics for RT structures fully contained in the film volume were also compared between film and TPS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean \u03b3 failure rate of the TPS dose reconstructions when compared to film doses was 0.8% (two static experiments) and 1.7% (six dynamic experiments). The mean (range) of the motion\u2010induced \u03b3 failure rate in film measurements was 35.4% (21.3\u201359.2%). The TPS dose reconstruction agreed with these experimental \u03b3 failure rates with root\u2010mean\u2010square errors of 2.1% (dynamic rotation dose reconstruction) and 17.1% (dose reconstruction assuming constant rotation).<\/jats:p><jats:p>By DVH metrics, the mean (range) difference between dose reconstructions with dynamic and constant rotation was 4.3% (\u22120.3\u201310.6%) (urethra <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/mp14707-math-0001.png\" xlink:title=\"urn:x-wiley:00942405:media:mp14707:mp14707-math-0001\"\/>), \u22120.6% (\u22125.6%\u20132.5%) (urethra <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/mp14707-math-0002.png\" xlink:title=\"urn:x-wiley:00942405:media:mp14707:mp14707-math-0002\"\/>), 1.1% (\u22127.1\u20137.7%) (GTV <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/mp14707-math-0003.png\" xlink:title=\"urn:x-wiley:00942405:media:mp14707:mp14707-math-0003\"\/>), \u22121.4% (\u221217.4\u20137.1%) (GTV <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/mp14707-math-0004.png\" xlink:title=\"urn:x-wiley:00942405:media:mp14707:mp14707-math-0004\"\/>), \u22121.2% (\u221217.1\u20135.7%) (GTV <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/mp14707-math-0005.png\" xlink:title=\"urn:x-wiley:00942405:media:mp14707:mp14707-math-0005\"\/>), and \u22120.1% (\u22123.2\u20137.6%) (GTV mean dose). Dose reconstructions with dynamic motion revealed large interplay effects (cold and hot spots).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A method to perform dose reconstructions for dynamic 6DoF motion in a TPS was developed and experimentally validated. It revealed large differences in dose distribution between dynamic and constant rotations not identifiable through dose reconstructions with constant rotation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.14707","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T05:27:47Z","timestamp":1610515667000},"page":"1427-1435","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Six degrees of freedom dynamic motion\u2010including dose reconstruction in a commercial treatment planning system"],"prefix":"10.1002","volume":"48","author":[{"given":"Simon","family":"Skouboe","sequence":"first","affiliation":[{"name":"Danish Center for Particle Therapy Aarhus University Hospital Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"De Roover","sequence":"additional","affiliation":[{"name":"Department of Oncology KU Leuven Leuven Belgium"},{"name":"Department 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