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Previous techniques include body surface measurements or radiopaque metal markers, each having known disadvantages.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>We recently proposed a new markerless technique without the disadvantages, where diaphragm was registered between DRR and fluoroscopic x\u2010ray projection images every 180\u00a0ms during VMAT delivery. An initial validation of the proposed diaphragm tracking system (DiaTrak) was performed using a chest phantom to evaluate its characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Diaphragm registration was performed between DRR and projection streaming kV x\u2010ray images of a chest phantom during VMAT delivery. Streaming data including the projection images and the beam angles were transferred from a linac system to an external PC, where the diaphragm registration accuracy and beam\u2010off latency were measured based on image cross correlation between the DRR and the projection images every 180\u00a0ms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>It was shown that the average of the beam\u2010off latency was 249.5\u00a0ms and the average of the diaphragm registration error was 0.84\u00a0mm<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Initial validation of the proposed DiaTrak system for multiple breath\u2010hold VMAT of abdominal tumors has been successfully completed with a chest phantom. The resulting beam\u2010off latency and the diaphragm registration error were regarded clinically acceptable.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.17008","type":"journal-article","created":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T16:40:55Z","timestamp":1709224855000},"page":"2378-2385","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Initial validation of a diaphragm tracking system for multiple breath\u2010hold volumetric modulated arc therapy of abdominal tumors: A phantom study"],"prefix":"10.1002","volume":"51","author":[{"given":"Yuki","family":"Nozawa","sequence":"first","affiliation":[{"name":"Department of Radiology The University of Tokyo Hospital  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Ohta","sequence":"additional","affiliation":[{"name":"Department of Radiology The University of Tokyo Hospital  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsuto","family":"Katano","sequence":"additional","affiliation":[{"name":"Department of Radiology The University of Tokyo Hospital  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanabu","family":"Nawa","sequence":"additional","affiliation":[{"name":"Department of Radiology The University of Tokyo Hospital  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Ohira","sequence":"additional","affiliation":[{"name":"Department of Comprehensive Radiation Oncology The University of Tokyo  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideomi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Radiology The University of Tokyo Hospital  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichi","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Comprehensive Radiation Oncology The University of Tokyo  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,2,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109734"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000017340"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.53183"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010016\u20100716\u20105"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjrcr.20160087"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.2499"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12467"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.03.006"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13194838"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11604\u2010013\u20100199\u20103"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tipsro.2023.100217"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.48188"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.11.024"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13014\u2010021\u201001816\u20103"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.07.028"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.12755"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4961121"},{"key":"e_1_2_9_19_1","unstructured":"vanHerkM.Conquest DICOM software.2023. 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