{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:56:41Z","timestamp":1783425401124,"version":"3.54.6"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T00:00:00Z","timestamp":1682467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP21he1602004"],"award-info":[{"award-number":["JP21he1602004"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["17K09079"],"award-info":[{"award-number":["17K09079"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["22K07788"],"award-info":[{"award-number":["22K07788"]}],"id":[{"id":"10.13039\/501100001691","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":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>It is important to have precise image guidance throughout proton therapy in order to take advantage of the therapy's physical selectivity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>We evaluated the effectiveness of computed tomography (CT)\u2010image guidance in proton therapy for patients with hepatocellular carcinoma (HCC) by assessing daily proton dose distributions. The importance of daily CT image\u2010guided registration and daily proton dose monitoring for tumors and organs at risk (OARs) was investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis was conducted using 570 sets of daily CT (dCT) images throughout whole treatment fractions for 38 HCC patients who underwent passive scattering proton therapy with either a 66 cobalt gray equivalent (GyE)\/10 fractions (<jats:italic>n<\/jats:italic>\u00a0=\u00a019) or 76 GyE\/20 fractions (<jats:italic>n<\/jats:italic>\u00a0=\u00a019) protocol. The actual daily delivered dose distributions were estimated by forward calculation using the dCT sets, their corresponding treatment plans, and the recorded daily couch correction information. We then evaluated the daily changes of the dose indices D<jats:sub>99%<\/jats:sub>, V<jats:sub>30GyE<\/jats:sub>, and D<jats:sub>max<\/jats:sub> for the tumor volumes, non\u2010tumorous liver, and other OARs, that is, stomach, esophagus, duodenum, colon, respectively. Contours were created for all dCT sets. We validated the efficacy of the dCT\u2010based tumor registrations (hereafter, \u201ctumor registration\u201d) by comparing them with the bone registration and diaphragm registration as a simulation of the treatment based on the positioning using the conventional kV X\u2010ray imaging. The dose distributions and the indices of three registrations were obtained by simulation using the same dCT sets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 66 GyE\/10 fractions, the daily D<jats:sub>99%<\/jats:sub> value in both the tumor and diaphragm registrations agreed with the planned value with 3%\u20136% (SD), and the V<jats:sub>30GyE<\/jats:sub> value for the liver agreed within \u00b13%; the indices in the bone registration showed greater deterioration. Nevertheless, tumor\u2010dose deterioration occurred in all registration methods for two cases due to daily changes of body shape and respiratory condition. In the 76 GyE\/20 fractions, in particular for such a treatment that the dose constraints for the OARs have to be cared in the original planning, the daily D<jats:sub>99%<\/jats:sub> in the tumor registration was superior to that in the other registration (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), indicating the effectiveness of the tumor registration. The dose constraints, set in the plan as the maximum dose for OARs (i.e., duodenum, stomach, colon, and esophagus) were maintained for 16 patients including seven treated with re\u2010planning. For three patients, the daily D<jats:sub>max<\/jats:sub> increased gradually or changed randomly, resulting in an inter\u2010fractional averaged D<jats:sub>max<\/jats:sub> higher than the constraints. The dose distribution would have been improved if re\u2010planning had been conducted. The results of these retrospective analyses indicate the importance of daily dose monitoring followed by adaptive re\u2010planning when needed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The tumor registration in proton treatment for HCC was effective to maintain the daily dose to the tumor and the dose constraints of OARs, particularly in the treatment where the maintenance for the dose constraints needs to be considered throughout the treatment. Nevertheless daily proton dose monitoring with daily CT imaging is important for more reliable and safer treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16433","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T16:29:27Z","timestamp":1682526567000},"page":"3274-3288","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Effectiveness of CT\u2010image guidance in proton therapy for liver cancer and the importance of daily dose monitoring for tumors and organs at risk"],"prefix":"10.1002","volume":"50","author":[{"given":"Yoshikazu","family":"Maeda","sequence":"first","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiji","family":"Kobashi","sequence":"additional","affiliation":[{"name":"Global Center for Biomedical Science and Engineering Faculty of Medicine Hokkaido University  Sapporo Japan"},{"name":"Hitachi Ltd  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Sato","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyasu","family":"Tamamura","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Tatebe","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Asahi","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sae","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Proton Therapy Center Fukui Prefectural Hospital  Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeyuki","family":"Takamatsu","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy Kanazawa University Hospital  Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Hitachi Ltd  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rintaro","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Hitachi Ltd  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Uchinami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Faculty of Medicine Hokkaido University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norio","family":"Katoh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Faculty of Medicine Hokkaido University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidefumi","family":"Aoyama","sequence":"additional","affiliation":[{"name":"Global Center for Biomedical Science and Engineering Faculty of Medicine Hokkaido University  Sapporo Japan"},{"name":"Department of Radiation Oncology Faculty of Medicine Hokkaido University  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,4,26]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2957\/kanzo.57.45"},{"key":"e_1_2_8_4_1","unstructured":"MatsudaT ShibataA HoriM SaikaK Monitoring of Cancer Incidence in Japan MCIJ2015 National Cancer Center for Cancer Control and Information Services. March 2019 (in Japanese).https:\/\/ganjoho.jp\/public\/qa_links\/report\/ncr\/pdf\/mcij2015_report.pdf"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13411"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s1160s4\u2010018\u20100750\u20103"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12744"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031\u20109155\/53\/7\/010"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.09.024"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12858"},{"key":"e_1_2_8_11_1","first-page":"88","article-title":"A proton dose calculation code for treatment planning based on the pencil beam algorithm","volume":"18","author":"Kanematsu N","year":"1998","journal-title":"Jpn J Med Phys"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360\u20103016(00)00518\u20106"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13531"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jicru_ndm021"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/mp.12869"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13015"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.830981"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00066-015-0925-0"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aacaa7"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/56\/15\/019"},{"issue":"5","key":"e_1_2_8_21_1","first-page":"e148","article-title":"Machine learning techniques for biomedical image segmentation: an overview of technical aspects and introduction to state\u2010of\u2010art application","volume":"47","author":"Seo H","year":"2021","journal-title":"Med Phys"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.05.038"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.2478\/raon-2022-0016"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.04.046"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)02846-8"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.11.034"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2019.03.003"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40846\u2010021\u201000673\u20105"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2021.02.012"}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.16433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T08:36:42Z","timestamp":1692434202000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.16433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,26]]},"references-count":28,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6]]}},"alternative-id":["10.1002\/mp.16433"],"URL":"https:\/\/doi.org\/10.1002\/mp.16433","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,26]]},"assertion":[{"value":"2022-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}