{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T05:38:45Z","timestamp":1777181925077,"version":"3.51.4"},"reference-count":47,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,4,25]],"date-time":"2022-04-25T00:00:00Z","timestamp":1650844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hypofractionation in prostate radiotherapy is of increasing interest. Steep dose gradients and a large weight on each individual fraction emphasize the need for motion management. Real\u2010time motion management techniques such as multileaf collimator (MLC) tracking or couch tracking typically adjust for translational motion while rotations remain uncompensated with unknown dosimetric impact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study is to demonstrate and validate dynamic real\u2010time rotation\u2010including dose reconstruction during radiotherapy experiments with and without MLC and couch tracking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Real\u2010time dose reconstruction was performed using the in\u2010house developed software DoseTracker. DoseTracker receives streamed target positions and accelerator parameters during treatment delivery and uses a pencil beam algorithm with water density assumption to reconstruct the dose in a moving target. DoseTracker's ability to reconstruct motion\u2010induced dose errors in a dynamically rotating and translating target was investigated during three different scenarios: (1) no motion compensation and translational motion correction with (2) MLC tracking and (3) couch tracking.<\/jats:p><jats:p>In each scenario, dose reconstruction was performed online and in real time during delivery of two dual\u2010arc volumetric\u2010modulated arc therapy prostate plans with a prescribed fraction dose of 7\u00a0Gy to the prostate and simultaneous intraprostatic lesion boosts with doses of at least 8\u00a0Gy, but up to 10\u00a0Gy as long as the organs at risk dose constraints were fulfilled. The plans were delivered to a pelvis phantom that replicated three patient\u2010measured motion traces using a rotational insert with 21 layers of EBT3 film spaced 2.5\u00a0mm apart. DoseTracker repeatedly calculated the actual motion\u2010including dose increment and the planned static dose increment since the last calculation in 84\u00a0500 points in the film stack. The experiments were performed with a TrueBeam accelerator with MLC and couch tracking based on electromagnetic transponders embedded in the film stack.<\/jats:p><jats:p>The motion\u2010induced dose error was quantified as the difference between the final cumulative dose with motion and without motion using the 2D 2%\/2\u00a0mm \u03b3\u2010failure rate and the difference in dose to 95% of the clinical target volume (CTV \u0394<jats:italic>D<\/jats:italic><jats:sub>95%<\/jats:sub>) and the gross target volume (GTV \u0394<jats:italic>D<\/jats:italic><jats:sub>95%<\/jats:sub>) as well as the difference in dose to 0.1\u00a0cm<jats:sup>3<\/jats:sup> of the urethra, bladder, and rectum (\u0394<jats:italic>D<\/jats:italic><jats:sub>0.1CC<\/jats:sub>). The motion\u2010induced errors were compared between dose reconstructions and film measurements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The dose was reconstructed in all calculation points at a mean frequency of 4.7\u00a0Hz. The root\u2010mean\u2010square difference between real\u2010time reconstructed and film\u2010measured motion\u2010induced errors was 3.1%\u2010points (\u03b3\u2010failure rate), 0.13\u00a0Gy (CTV \u0394<jats:italic>D<\/jats:italic><jats:sub>95%<\/jats:sub>), 0.23\u00a0Gy (GTV \u0394<jats:italic>D<\/jats:italic><jats:sub>95%<\/jats:sub>), 0.19\u00a0Gy (urethra \u0394<jats:italic>D<\/jats:italic><jats:sub>0.1CC<\/jats:sub>), 0.09\u00a0Gy (bladder \u0394<jats:italic>D<\/jats:italic><jats:sub>0.1CC<\/jats:sub>), and 0.07\u00a0Gy (rectum \u0394<jats:italic>D<\/jats:italic><jats:sub>0.1CC<\/jats:sub>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a series of phantom experiments, online real\u2010time rotation\u2010including dose reconstruction was performed for the first time. The calculated motion\u2010induced errors agreed well with film measurements. The dose reconstruction provides a valuable tool for monitoring dose delivery and investigating the efficacy of advanced motion\u2010compensation techniques in the presence of translational and rotational motion.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.15660","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T16:59:07Z","timestamp":1649437147000},"page":"3574-3584","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Experimental investigation of dynamic real\u2010time rotation\u2010including dose reconstruction during prostate tracking radiotherapy"],"prefix":"10.1002","volume":"49","author":[{"given":"Casper Gammelmark","family":"Muurholm","sequence":"first","affiliation":[{"name":"Department of Oncology Aarhus University Hospital  Aarhus 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