{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T21:52:15Z","timestamp":1790545935084,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The widespread use of deformable dose accumulation (DDA) in adaptive radiotherapy (ART) has been limited due to the lack of clinically compatible methods to consider its related uncertainties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>We estimate dose reconstruction uncertainties in daily DDA during CT\u2010guided radiotherapy of head\u2010and\u2010neck cancer (HNC). We project confidence intervals of cumulative dose\u2013volume parameters to the parotids and determine threshold values to guide clinical decision\u2010making in ART.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Doses from daily images (megavoltage CTs [MVCTs]) of 20 HNC patients treated with tomotherapy were reconstructed and accumulated in the planning CT (PCT) utilizing a commercial DDA algorithm (PreciseART, Accuray, Inc.). For each mapped fraction, we warped the planning contours to the MVCT. Dose\u2013volume histograms (DVHs) calculated in the MVCT (with warped contour and native dose) and the PCT (with native contour and mapped dose) were compared; the observed inconsistencies were associated with dose reconstruction errors. We derived uncertainty bounds for the transferred dose to voxels within the structure of interest in the PCT. The confidence intervals of cumulative dose\u2013volume parameters were mid\u2010treatment projected and evaluated as predictors of the end of treatment cumulative metrics. The need for plan adaptation was tested by comparing the projected uncertainty bounds with the treatment constraint points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among all cases, the uncertainty in mean values of daily dose distributions mapped to the reference parotid's contours averaged between 2.8% and 3.8% of typical single fraction planning values and less than 1% for the planning target volume (PTV) <jats:italic>D<\/jats:italic>95%. These daily inconsistencies were higher in the ipsilateral compared to the contralateral parotid and increased toward the end of treatment. The magnitude of the uncertainty bounds for the cumulative treatment mean dose, <jats:italic>D<\/jats:italic>50%, and <jats:italic>V<\/jats:italic>20\u00a0Gy to the parotids, and PTV <jats:italic>D<\/jats:italic>95% were on average 3.5%, 6.6%, 4.6%, and 0.4% of the planned or prescribed values, with confidence intervals of 97.1%\u2013107.0%, 98.2%\u2013110.4%, 95.6%\u2013111.1%, and 98.2%\u2013100.2% respectively. The uncertainty intervals projected at mid\u2010treatment intersected with the end of treatment bounds in 82% of the parotid's metrics; half of them presented an overlapping percentage greater than 60%. In five patients, the cumulative mean doses were projected at mid\u2010treatment to exceed the total treatment constraint point by at least 3%; this threshold was exceeded at the end of treatment in the five cases. Underdosing was projected in only one case; the cumulative PTV <jats:italic>D<\/jats:italic>95% at the end of treatment was below the clinical threshold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Uncertainty bounds were incorporated into the results of a commercial DDA tool. The cohort's statistics showed that the parotids\u2019 cumulative DVH metrics frequently exceeded the planning values if confidence intervals were included. Most of the uncertainty bounds of the PTV metrics were kept within the clinical thresholds. We verified that mid\u2010treatment violation projections led to exceeding the constraint point at the end of the treatment. Based on a 3% threshold, approximately one fourth of the patients are expected to be replanned at mid\u2010treatment for parotids sparing during HNC radiotherapy.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16085","type":"journal-article","created":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T06:54:53Z","timestamp":1667890493000},"page":"2474-2487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Incorporating uncertainty bounds in daily deformable dose accumulation for adaptive radiation therapy of head\u2010and\u2010neck cancer"],"prefix":"10.1002","volume":"50","author":[{"given":"Juan A.","family":"Garc\u00eda\u2010Alvarez","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hualiang","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"X. Allen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristofer","family":"Kainz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41199\u2010019\u20100046\u2010z"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2018.1505053"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(12)70237\u20101"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12256"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2021.02.007"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2019.02.007"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.1949749"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/52\/16\/001"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/53\/3\/013"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/54\/19\/010"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3301594"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/59\/1\/173"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3666948"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/54\/18\/014"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.12.009"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.09.012"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2019.02.002"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.08.047"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.08.049"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.15375"},{"key":"e_1_2_8_22_1","unstructured":"KainzK LimS ChenG\u2010P LiXA.PreciseART Adaptive Radiation Therapy Software: Dose Monitoring Re\u2010planning and Delivery Verification. 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