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Additional dose calculations were performed on corresponding planning 4DCTs and day\u2010of\u2010treatment 4D virtual CTs (4DvCTs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A 4DCBCT correction workflow, previously validated on a phantom, generates 4DvCT (CT\u2010to\u2010CBCT deformable registration) and 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      images (projection\u2010based correction using 4DvCT as a prior) with 10 phase bins, using day\u2010of\u2010treatment free\u2010breathing CBCT projections and planning 4DCT images as input. Using a research planning system, robust IMPT plans administering eight fractions of 7.5\u2009Gy were created on a free\u2010breathing planning CT (pCT) contoured by a physician. The internal target volume (ITV) was overridden with muscle tissue. Robustness settings for range and setup uncertainties were 3% and 6\u2009mm, and a Monte Carlo dose engine was used. On every phase of planning 4DCT, day\u2010of\u2010treatment 4DvCT, and 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      , the dose was recalculated. For evaluation, image analysis as well as dose analysis were performed using mean error (ME) and mean absolute error (MAE) analysis, dose\u2013volume histogram (DVH) parameters, and 2%\/2\u2010mm gamma pass rate analysis. Action levels (1.6% ITV D98 and 90% gamma pass rate) based on our previous phantom validation study were set to determine which patients had a loss of dosimetric\u00a0coverage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Quality enhancements of 4DvCT and 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      over 4DCBCT were observed. ITV D\n                      <jats:sub>98%<\/jats:sub>\n                      and bronchi D\n                      <jats:sub>2%<\/jats:sub>\n                      had its largest agreement for 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      \u20134DvCT, and the largest gamma pass rates (&gt;94%, median 98%) were found for 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      \u20134DvCT. Deviations were larger and gamma pass rates were smaller for 4DvCT\u20134DCT and 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      \u20134DCT. For five patients, deviations were larger than the action levels, suggesting substantial anatomical changes between pCT and CBCT projections\u00a0acquisition.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      This retrospective study shows the feasibility of daily proton dose calculation on 4DCBCT\n                      <jats:sub>cor<\/jats:sub>\n                      for lung tumor patients. The applied method is of clinical interest as it generates up\u2010to\u2010date in\u2010room images, accounting for breathing motion and anatomical changes. This information could be used to trigger\u00a0replanning.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.16335","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T06:24:56Z","timestamp":1677479096000},"page":"4981-4992","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Scatter correction of 4D cone beam computed tomography to detect dosimetric effects due to anatomical changes in proton therapy for lung cancer"],"prefix":"10.1002","volume":"50","author":[{"given":"Henning","family":"Schmitz","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University Hospital, LMU Munich Munich Bavaria Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Rabe","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Hospital, LMU Munich Munich Bavaria 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