{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:05:29Z","timestamp":1790769929374,"version":"4.1.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Strahlenther Onkol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Online adaptive radiotherapy (oART) minimizes inter-fractional variation, yet intra-fractional motion (IFM) remains a\u00a0source of uncertainty. We quantified intra-adaptational motion (IAM) using routinely recorded couch shifts between pre-adaptation (CBCT1) and pre-treatment (CBCT2) scans to derive motion-related components of the CTV\u2013PTV margins in a\u00a0large clinical cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 1378 fractions from 69\u00a0prostate cancer patients treated with 60\u202fGy in 20\u00a0fractions as oART on the Varian Ethos platform (vision 1.1; Varian Medical Systems, Palo Alto, CA, USA). Couch shifts were calculated based on rigid registration targeting the CTV. Systematic and random errors were calculated for right\u2013left (RL), anterior\u2013posterior (AP), and superior\u2013inferior (SI) directions. Margins were estimated using the van Herk formula. Correlations between couch shifts and the CBCT1\u2013CBCT2 time interval were assessed using Spearman\u2019s\u00a0\u03c1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Couch shifts showed substantial inter-patient variability. Population mean, systematic, and random errors ranged from 0.05 to 1.4\u202fmm, 0.6 to 1.3\u202fmm, and 1.0 to 1.4\u202fmm, respectively. The mean adaptation time was 17.5\u202f\u00b1\u20095.1\u202fmin (median: 16.6\u202fmin, interquartile range [IQR]: 14.0\u201320.3\u202fmin). The resulting IAM-related margins were 2.3\u00a0(R), 2.2\u00a0(L), 2.2\u00a0(S), 3.2\u00a0(I), 2.9\u00a0(A), and 5.7\u202fmm\u00a0(P). Positive correlations were observed between the time interval and motion in AP (\u03c1\u202f=\u20090.26), SI (\u03c1\u202f=\u20090.30), and vector magnitude (\u03c1\u202f=\u20090.29; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intra-adaptational motion varies substantially between patients, supporting the consideration of patient-specific margins. Verification CBCT2 is essential in oART due to potentially large positional shifts occurring during the adaptation process. The calculated margins represent upper bounds for motion-related margins, as they incorporate registration errors and cover longer intervals than actual beam delivery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00066-026-02609-x","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:44:10Z","timestamp":1790768650000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intra-adaptational motion during online adaptive radiotherapy: analysis of couch shifts and implications for margin design"],"prefix":"10.1007","author":[{"given":"Johannes","family":"Hecking","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Malygina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Palm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Salazar Zuniga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Knobe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Dzierma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Hecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Auerbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"1","key":"2609_CR1","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1053\/j.semradonc.2003.10.003","volume":"14","author":"M van Herk","year":"2004","unstructured":"van Herk\u00a0M (2004) Errors and margins in radiotherapy. 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In accordance with the Declaration of Helsinki, informed consent was obtained from all participants and approved by the\n                      \u00c4rztekammer des Saarlandes\n                      (Saarland Medical Association; ethics vote 111\/23).","order":1,"name":"Ethics","label":"Ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Department of Radiotherapy and Radiation Oncology is a\u00a0Reference Site for Siemens Healthineers Center of Excellence for Advanced Radiation Oncology. J.\u00a0Palm has received a\u00a0speaker honorarium from Varian Medical Systems, Inc. M.\u00a0Hecht has received a\u00a0speaker honorarium and travel support from Varian Medical Systems, Inc. J.\u00a0Hecking, H.\u00a0Malygina, B.\u00a0Salazar Zuniga, S.\u00a0Knobe, Y.\u00a0Dzierma, and H.\u00a0Auerbach declare that they have no competing interests.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}