{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:46:49Z","timestamp":1781804809133,"version":"3.54.5"},"reference-count":47,"publisher":"IOP Publishing","issue":"1","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/publishingsupport.iopscience.iop.org\/iop-standard\/v1"},{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/info\/page\/text-and-data-mining"}],"funder":[{"name":"Friend Association of the University of Navarra"},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"crossref","award":["PI16\/00899"],"award-info":[{"award-number":["PI16\/00899"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Elekta"},{"DOI":"10.13039\/501100003425","name":"Departamento de Educaci\u00f3n, Gobierno de Navarra","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003425","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["iopscience.iop.org"],"crossmark-restriction":false},"short-container-title":["Phys. Med. Biol."],"published-print":{"date-parts":[[2023,1,7]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:italic>\n . Periodic respiratory motion and inter-fraction variations are sources of geometric uncertainty in stereotactic body radiation therapy (SBRT) of pulmonary lesions. This study extensively evaluates and validates the separate and combined dosimetric effect of both factors using 4D-CT and daily 4D-cone beam CT (CBCT) dose accumulation scenarios.\n Approach<\/jats:italic>\n . A first cohort of twenty early stage or metastatic disease lung cancer patients were retrospectively selected to evaluate each scenario. The planned-dose (3D\n Ref<\/jats:sub>\n ) was optimized on a 3D mid-position CT. To estimate the dosimetric impact of respiratory motion (4D\n Ref<\/jats:sub>\n ), inter-fractional variations (3D\n Acc<\/jats:sub>\n ) and the combined effect of both factors (4D\n Acc<\/jats:sub>\n ), three dose accumulation scenarios based on 4D-CT, daily mid-cone beam CT (CBCT) position and 4D-CBCT were implemented via CT-CT\/CT-CBCT deformable image registration (DIR) techniques. Each scenario was compared to 3D\n Ref.<\/jats:sub>\n A separate cohort of ten lung SBRT patients was selected to validate DIR techniques. The distance discordance metric (DDM) was implemented per voxel and per patient for tumor and organs at risk (OARs), and the dosimetric impact for CT-CBCT DIR geometric errors was calculated.\n Main results.<\/jats:italic>\n Median and interquartile range (IQR) of the dose difference per voxel were 0.05\/2.69 Gy and \u22120.12\/2.68 Gy for\n \n \n \n <\/jats:tex-math>\n \n 3<\/mml:mn>\n \n D<\/mml:mi>\n Acc<\/mml:mi>\n <\/mml:msub>\n \n \u2212<\/mml:mo>\n 3<\/mml:mn>\n \n D<\/mml:mi>\n Ref<\/mml:mi>\n <\/mml:msub>\n <\/mml:math>\n <\/jats:inline-formula>\n and\n \n \n \n <\/jats:tex-math>\n \n 4<\/mml:mn>\n \n D<\/mml:mi>\n Acc<\/mml:mi>\n <\/mml:msub>\n \u2212<\/mml:mo>\n 3<\/mml:mn>\n \n D<\/mml:mi>\n Ref<\/mml:mi>\n <\/mml:msub>\n .<\/mml:mo>\n <\/mml:math>\n <\/jats:inline-formula>\n For\n \n \n \n <\/jats:tex-math>\n \n 4<\/mml:mn>\n \n D<\/mml:mi>\n Ref<\/mml:mi>\n <\/mml:msub>\n \u2212<\/mml:mo>\n 3<\/mml:mn>\n \n D<\/mml:mi>\n Ref<\/mml:mi>\n <\/mml:msub>\n <\/mml:math>\n <\/jats:inline-formula>\n the IQR was considerably smaller \u22120.15\/0.78 Gy. These findings were confirmed by dose volume histogram parameters calculated in tumor and OARs. For CT-CT\/CT-CBCT DIR validation, DDM (95th percentile) was highest for heart (6.26 mm)\/spinal cord (8.00 mm), and below 3 mm for tumor and the rest of OARs. The dosimetric impact of CT-CBCT DIR errors was below 2 Gy for tumor and OARs.\n Significance<\/jats:italic>\n . The dosimetric impact of inter-fraction variations were shown to dominate those of periodic respiration in SBRT for pulmonary lesions. Therefore, treatment evaluation and dose-effect studies would benefit more from dose accumulation focusing on day-to-day changes then those that focus on respiratory motion.\n <\/jats:p>","DOI":"10.1088\/1361-6560\/aca94d","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T19:41:16Z","timestamp":1670355676000},"page":"015005","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Detailed dosimetric evaluation of inter-fraction and respiratory motion in lung stereotactic body radiation therapy based on daily 4D cone beam CT images"],"prefix":"10.1088","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2290-0176","authenticated-orcid":false,"given":"Carlos","family":"Huesa-Berral","sequence":"first","affiliation":[{"name":"The Netherlands Cancer Institute"},{"name":"University of Navarra"},{"name":"University of Navarra Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Juan-Cruz","sequence":"additional","affiliation":[{"name":"The Netherlands Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"van Kranen","sequence":"additional","affiliation":[{"name":"The Netherlands Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Rossi","sequence":"additional","affiliation":[{"name":"The Netherlands Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Belderbos","sequence":"additional","affiliation":[{"name":"The Netherlands Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7242-4169","authenticated-orcid":false,"given":"Juan","family":"Diego Azcona","sequence":"additional","affiliation":[{"name":"University of Navarra Clinic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Burguete","sequence":"additional","affiliation":[{"name":"University of Navarra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5155-5274","authenticated-orcid":false,"given":"Jan-Jakob","family":"Sonke","sequence":"additional","affiliation":[{"name":"The Netherlands Cancer Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"266","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"pmbaca94dbib1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.radonc.2007.11.022","type":"journal-article","article-title":"Dose calculations accounting for breathing motion in stereotactic lung radiotherapy based on 4D-CT and the internal target volume","volume":"86","author":"Admiraal","year":"2008","journal-title":"Radiother. 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