{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:49:14Z","timestamp":1790660954487,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T00:00:00Z","timestamp":1670630400000},"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":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Deformable dose accumulation (DDA) has uncertainties which impede the implementation of DDA\u2010based adaptive radiotherapy (ART) in clinic. The purpose of this study is to develop a multi\u2010layer quality assurance (MLQA) program to evaluate uncertainties in DDA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A computer program is developed to generate a pseudo\u2010inverse displacement vector field (DVF) for each deformable image registration (DIR) performed in Accuray's PreciseART. The pseudo\u2010inverse DVF is first used to calculate a pseudo\u2010inverse consistency error (PICE) and then implemented in an energy and mass congruent mapping (EMCM) method to reconstruct a deformed dose. The PICE is taken as a metric to estimate DIR uncertainties. A pseudo\u2010inverse dose agreement rate (PIDAR) is used to evaluate the consequence of the DIR uncertainties in DDA and the principle of energy conservation is used to validate the integrity of dose mappings. The developed MLQA program was tested using the data collected from five representative cancer patients treated with tomotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>DIRs were performed in PreciseART to generate primary DVFs for the five patients. The fidelity index and PICE of these DVFs on average are equal to 0.028\u00a0mm and 0.169\u00a0mm, respectively. With the criteria of 3\u00a0mm\/3% and 5\u00a0mm\/5%, the PIDARs of the PreciseART\u2010reconstructed doses are 73.9\u00a0\u00b1\u00a04.4% and 87.2\u00a0\u00b1\u00a03.3%, respectively. The PreciseART and EMCM\u2010based dose reconstructions have their deposited energy changed by 5.6\u00a0\u00b1\u00a03.9% and 2.6\u00a0\u00b1\u00a01.5% in five GTVs, and by 9.2\u00a0\u00b1\u00a07.8% and 4.7\u00a0\u00b1\u00a03.6% in 30 OARs, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A pseudo\u2010inverse map\u2010based EMCM program has been developed to evaluate DIR and dose mapping uncertainties. This program could also be used as a sanity check tool for DDA\u2010based ART.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16137","type":"journal-article","created":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T18:33:14Z","timestamp":1669487594000},"page":"1766-1778","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Development of a multi\u2010layer quality assurance program to evaluate the uncertainty of deformable dose accumulation in adaptive radiotherapy"],"prefix":"10.1002","volume":"50","author":[{"given":"Hualiang","family":"Zhong","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan A.","family":"Garcia\u2010Alvarez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristofer","family":"Kainz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ergun","family":"Ahunbay","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"X. Allen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Medical College of Wisconsin  Milwaukee WI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1533034617708076"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12256"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4819945"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971-6203.181641"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2021.02.012"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1120\/jacmp.v14i1.4066"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/52\/16\/001"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/54\/18\/014"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semradonc.2019.02.002"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/53\/21\/017"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2008.10.040"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aa9dc2"},{"key":"e_1_2_8_14_1","volume-title":"The ITK Software Guide","author":"Ibanez L","year":"2005"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.1949749"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13246-014-0262-0"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2163252"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2968215"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/54\/19\/010"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-21966-x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.2816107"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3301594"},{"key":"e_1_2_8_23_1","unstructured":"KainzK LimS ChenGP LiXA. PreciseART Adaptive radiation therapy software: dose monitoring re\u2010planning and delivery verification. 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