{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:09:23Z","timestamp":1769000963501,"version":"3.49.0"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Radiotherapy of the prostate and the pelvic lymph nodes (LN) is a part of the standard of care treatment for high\u2010risk prostate cancer. The independent translational and rotational (i.e., six\u2010degrees\u2010of\u2010freedom, [6DoF]) motion of the prostate and LN target during and between fractions can perturb the dose distribution. However, no standard dose reconstruction method accounting for differential 6DoF target motion is available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>We present a framework for monitoring motion\u2010induced dose perturbations for two independently moving target volumes in 6DoF. The framework was used to determine the dose perturbation for the prostate and the LN target caused by differential 6DoF motion for a cohort of high\u2010risk prostate cancer patients. As a potential first step toward real\u2010time dose\u2010guided high\u2010risk prostate radiotherapy, we furthermore investigated if the dose reconstruction was fast enough for real\u2010time application for both targets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty high\u2010risk prostate cancer patients were treated with 3\u2010arc volumetric modulated arc therapy (VMAT). Kilovoltage intrafraction monitoring (KIM) with triggered kilovoltage (kV) images acquired every 3 throughout 7\u201310 fractions per patient was used for retrospective 6DoF intrafraction prostate motion estimation. The 6DoF interfraction LN motion was determined from a pelvic bone match between the planning CT and a post\u2010treatment cone beam CT (CBCT). Using the retrospectively extracted motion, real\u2010time 6DoF motion\u2010including dose reconstruction was simulated using the in\u2010house developed software DoseTracker. A data stream with the 6DoF target positions and linac parameters was broadcasted at a 3\u2010Hz frequency to DoseTracker. In a continuous loop, DoseTracker calculated the target dose increments including the specified motion and, for comparison, without motion. The motion\u2010induced change in D<jats:sub>99.5%<\/jats:sub> for the prostate CTV (\u0394D<jats:sub>99.5%<\/jats:sub>) and in D<jats:sub>98%<\/jats:sub> for the LN CTV (\u0394D<jats:sub>98%<\/jats:sub>) was calculated using the final cumulative dose of each fraction and averaged over all imaged fractions. The real\u2010time reconstructed dose distribution of DoseTracker was benchmarked against a clinical treatment planning system (TPS) and it was investigated whether the calculation speed was fast enough to keep up with the incoming data stream.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Translational motion was largest in cranio\u2010caudal (CC) direction (prostate: [\u20105.9,\u00a0+8.4]\u00a0mm; LN: [\u20109.9;\u00a0+11.0] mm) and anterior\u2013posterior (AP) direction (prostate:[\u20105.6;\u00a0+6.9]\u00a0mm; LN: [\u20109.6;\u00a0+11.0]\u00a0mm). The pitch was the largest rotation (prostate: [\u201022.5;\u00a0+25.2] deg; LN: [\u20103.9;\u00a0+5.5] deg). The prostate CTV \u0394D<jats:sub>99.5%<\/jats:sub> was [\u201016.2;\u00a0+2.5]% for single fractions and [\u20103.0;\u00a0+1.7]% when averaged over all imaged fractions. The LN CTV \u0394D<jats:sub>98%<\/jats:sub> was [\u201019.8;\u00a0+1.2]% for single fractions and [\u20103.1;\u00a0+0.9]% after averaging. Mean (Standard deviation) absolute dose errors in DoseTracker of 107.8% (Std: 1.9%) for the prostate and 105.5% (Std:1.4%) for the LN were corrected during dose reconstruction by automatically calculated normalization factors. It resulted in accurate calculation of the motion\u2010induced dose errors with relative differences between DoseTracker and TPS dose calculations of \u20100.1% (Std: 0.5%) (prostate CTV \u0394D<jats:sub>99.5%<\/jats:sub>) and \u20100.2% (Std: 0.5%) (LN CTV \u0394D<jats:sub>98%<\/jats:sub>). The DoseTracker calculation was fast enough to keep up with the incoming inputs for all but two out of 107\u00a0184 dose calculations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using the developed framework for dose perturbation monitoring, we found that the differential 6DoF target motion caused substantial dose perturbation for individual fractions, which largely averaged out after several fractions. The framework was shown to provide reliable dose calculations and a sufficiently high\u2010dose reconstruction speed to be applicable in real\u2010time.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.17366","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T20:44:40Z","timestamp":1725655480000},"page":"8423-8433","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Quantifying dose perturbations in high\u2010risk prostate radiotherapy due to translational and rotational motion of prostate and pelvic lymph nodes"],"prefix":"10.1002","volume":"51","author":[{"given":"Karolina A.","family":"Klucznik","sequence":"first","affiliation":[{"name":"Danish Centre for Particle Therapy Aarhus University Hospital  Aarhus Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Ravkilde","sequence":"additional","affiliation":[{"name":"Department of Oncology Aarhus 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