{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T07:10:13Z","timestamp":1786864213235,"version":"build-2736575974"},"reference-count":34,"publisher":"IOP Publishing","issue":"11","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/iopscience.iop.org\/info\/page\/text-and-data-mining"}],"content-domain":{"domain":["iopscience.iop.org"],"crossmark-restriction":false},"short-container-title":["Phys. Med. Biol."],"published-print":{"date-parts":[[2025,6,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>\n                  <jats:italic>Objective.<\/jats:italic> The objective of this work was to investigate the feasibility of using 0 mm PTV margin in online adaptive radiotherapy for the first fractions, in combination with treatment-specific local compensation of accumulated underdosage to the target in the last fraction. <jats:italic>Approach.<\/jats:italic> Intrafraction motion patterns and delineations of twelve patients with prostate cancer were selected to cover a range of observed systematic and random inter- and intrafraction motion patterns. Treatment plans with 0 and 3 mm margins were created and dose was accumulated rigidly using the observed motion patterns. For the dose-adaptation approach a plan was created for the last treatment fraction locally compensating for dose missed in the previous fractions. Robustness of the accumulation was estimated by simulating treatments with random registration errors added to the observed registrations, with standard deviations of 0.5 and 1.0 mm. <jats:italic>Main results.<\/jats:italic> Target coverage of the dose-adaptive workflow was not-significantly below the standard approach, and at the desired level but for the two patients with the largest systematic prostate motion. The near-maximum dose to the organs at risk is lowered for all patients with a median of 1.5 Gy. The total volume receiving 95% of the prescribed dose was reduced by 15% to 1.6 times the clinical target volume indicating better conformity, at the cost of an increased near-maximum dose to the target. However, the dose-adaptive plan was less robust leading to a median 0.5% decrease in dose to the target also with decreasing robustness with larger motion patterns. <jats:italic>Significance.<\/jats:italic> The results demonstrate that a post-hoc correction of missed dose leads to an overall lower dose to nearby organs at risk at the cost of target dose near-maximum dose, making it a feasible approach for consideration.<\/jats:p>","DOI":"10.1088\/1361-6560\/add984","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T22:55:05Z","timestamp":1747349705000},"page":"115014","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Dose adaptation to compensate for cumulative intra-fraction motion effects in online adaptive radiotherapy"],"prefix":"10.1088","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7663-4390","authenticated-orcid":true,"given":"Erik","family":"van der Bijl","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5492-9307","authenticated-orcid":true,"given":"Robert","family":"Jan Smeenk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3509-4401","authenticated-orcid":true,"given":"Lukas","family":"Schr\u00f6der","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5155-5274","authenticated-orcid":true,"given":"Jan-Jakob","family":"Sonke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4146-6419","authenticated-orcid":false,"given":"Uulke A","family":"van der Heide","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2807-8670","authenticated-orcid":true,"given":"Tomas","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"266","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"pmbadd984bib1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.radonc.2005.09.005","article-title":"Robust treatment planning for intensity modulated radiotherapy of prostate cancer based on coverage probabilities","volume":"78","author":"Baum","year":"2006","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib2","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1038\/nrc.2016.18","article-title":"Radiation oncology in the era of precision medicine","volume":"16","author":"Baumann","year":"2016","journal-title":"Nat. Rev. Cancer"},{"key":"pmbadd984bib3","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/abd3ed","article-title":"End-to-end validation of the geometric dose delivery performance of MR linac adaptive radiotherapy","volume":"66","author":"Bernchou","year":"2021","journal-title":"Phys. Med. Biol."},{"key":"pmbadd984bib4","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1287\/ijoc.2015.0659","article-title":"Optimization of radiation therapy fractionation schedules in the presence of tumor repopulation","volume":"27","author":"Bortfeld","year":"2015","journal-title":"INFORMS J. Comput."},{"key":"pmbadd984bib5","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/abe02a","article-title":"Quantitative investigation of dose accumulation errors from intra-fraction motion in MRgRT for prostate cancer","volume":"66","author":"Bosma","year":"2021","journal-title":"Phys. Med. Biol."},{"key":"pmbadd984bib6","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.radonc.2021.12.013","article-title":"Online adaptive radiotherapy potentially reduces toxicity for high-risk prostate cancer treatment","volume":"167","author":"Christiansen","year":"2022","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib7","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s13014-020-1482-y","article-title":"Accuracy of automatic deformable structure propagation for high-field MRI guided prostate radiotherapy","volume":"15","author":"Christiansen","year":"2020","journal-title":"Radiat. Oncol."},{"key":"pmbadd984bib8","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109761","article-title":"Comparing adaptation strategies in MRI-guided online adaptive radiotherapy for prostate cancer: implications for treatment margins","volume":"186","author":"Dassen","year":"2023","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib9","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109713","article-title":"From once-weekly to semi-weekly whole prostate gland stereotactic radiotherapy with focal boosting: primary endpoint analysis of the multicenter phase II hypo-FLAME 2.0 trial","volume":"185","author":"De Cock","year":"2023","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib10","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.radonc.2020.06.044","article-title":"Prostate intrafraction motion during the preparation and delivery of MR-guided radiotherapy sessions on a 1.5T MR-Linac","volume":"151","author":"de Muinck Keizer","year":"2020","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib11","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s00066-023-02189-0","article-title":"Stereotactic body radiotherapy (SIB-VMAT technique) to dominant intraprostatic lesion (DIL) for localized prostate cancer: a dose-escalation trial (DESTROY-4)","volume":"200","author":"Deodato","year":"2024","journal-title":"Strahlenther. Onkol."},{"key":"pmbadd984bib12","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1308406","article-title":"Dosimetric benefit of online treatment plan adaptation in stereotactic ultrahypofractionated MR-guided radiotherapy for localized prostate cancer","volume":"14","author":"Fink","year":"2024","journal-title":"Front. Oncol."},{"key":"pmbadd984bib13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1002\/mp.13919","article-title":"Coping with interfraction time trends in tumor setup","volume":"47","author":"Gi\u017cy\u0144ska","year":"2020","journal-title":"Med. Phys."},{"key":"pmbadd984bib14","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109932","article-title":"Gating and intrafraction drift correction on a 1.5T MR-Linac: clinical dosimetric benefits for upper abdominal tumors","volume":"189","author":"Grimbergen","year":"2023","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib15","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.phro.2022.11.008","article-title":"A margin recipe for the management of intra-fraction target motion in radiotherapy","volume":"24","author":"Janssen","year":"2022","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"pmbadd984bib16","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/1748-717X-6-73","article-title":"Registration accuracy for MR images of the prostate using a subvolume based registration protocol","volume":"6","author":"Jonsson","year":"2011","journal-title":"Radiat. Oncol."},{"key":"pmbadd984bib17","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.ijrobp.2018.01.098","article-title":"Electromagnetic-guided MLC tracking radiation therapy for prostate cancer patients: prospective clinical trial results","volume":"101","author":"Keall","year":"2018","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"pmbadd984bib18","doi-asserted-by":"publisher","first-page":"7233","DOI":"10.1088\/1361-6560\/aa82ae","article-title":"Towards fast online intrafraction replanning for free-breathing stereotactic body radiation therapy with the MR-linac","volume":"62","author":"Kontaxis","year":"2017","journal-title":"Phys. Med. Biol."},{"key":"pmbadd984bib19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00066-024-02346-z","article-title":"Prostate motion in magnetic resonance imaging guided radiotherapy and impact on margins","author":"Kusters","year":"2025","journal-title":"Strahlenther. Onkol."},{"key":"pmbadd984bib20","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1086258","article-title":"Dose accumulation for MR-guided adaptive radiotherapy: from practical considerations to state-of-the-art clinical implementation","volume":"12","author":"McDonald","year":"2023","journal-title":"Front. Oncol."},{"key":"pmbadd984bib21","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109527","article-title":"Applicability and usage of dose mapping\/accumulation in radiotherapy","volume":"182","author":"Murr","year":"2023","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib22","doi-asserted-by":"publisher","first-page":"3096","DOI":"10.1002\/mp.14840","article-title":"Robust dose-painting-by-numbers vs. nonselective dose escalation for non-small cell lung cancer patients","volume":"48","author":"Petit","year":"2021","journal-title":"Med. Phys."},{"key":"pmbadd984bib23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.phro.2020.12.004","article-title":"Clinical implementation of artificial intelligence-driven cone-beam computed tomography-guided online adaptive radiotherapy in the pelvic region","volume":"17","author":"Sibolt","year":"2021","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"pmbadd984bib24","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.ijrobp.2005.07.973","article-title":"Automatic prostate localization on cone-beam CT scans for high precision image-guided radiotherapy","volume":"63","author":"Smitsmans","year":"2005","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"pmbadd984bib25","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2025.100711","article-title":"Added value of non-rigid image registration for intrafraction dose accumulation in magnetic resonance imaging-guided prostate radiotherapy","volume":"33","author":"Tsekas","year":"2025","journal-title":"Phys. Imaging Radiat. Oncol."},{"key":"pmbadd984bib26","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1088\/0031-9155\/50\/1\/010","article-title":"Incorporating organ movements in inverse planning: assessing dose uncertainties by Bayesian inference","volume":"50","author":"Unkelbach","year":"2005","journal-title":"Phys. Med. Biol."},{"key":"pmbadd984bib27","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1088\/1361-6560\/ac9175","article-title":"Adaptive margins for online adaptive radiotherapy","volume":"67","author":"Van der Bijl","year":"2022","journal-title":"Phys. Med. Biol."},{"key":"pmbadd984bib28","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/S0360-3016(00)00518-6","article-title":"The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy","volume":"47","author":"van Herk","year":"2000","journal-title":"Int. J. Radiat. Oncol. Biol. Phys. 1"},{"key":"pmbadd984bib29","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1016\/j.ijrobp.2017.12.011","article-title":"Dose response and fractionation sensitivity of prostate cancer after external beam radiation therapy: a meta-analysis of randomized trials","volume":"100","author":"Vogelius","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"pmbadd984bib30","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.radonc.2022.03.013","article-title":"Gating has a negligible impact on dose delivered in MRI-guided online adaptive radiotherapy of prostate cancer","volume":"170","author":"Wahlstedt","year":"2022","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib31","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.radonc.2022.09.004","article-title":"Clinical application of a sub-fractionation workflow for intrafraction re-planning during prostate radiotherapy treatment on a 1.5 Tesla MR-Linac: a practical method to mitigate intrafraction motion","volume":"176","author":"Willigenburg","year":"2022","journal-title":"Radiother. Oncol."},{"key":"pmbadd984bib32","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.ctro.2019.04.001","article-title":"Adaptive radiotherapy: the Elekta Unity MR-linac concept","volume":"18","author":"Winkel","year":"2019","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"pmbadd984bib33","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1088\/0031-9155\/42\/1\/008","article-title":"Adaptive radiation therapy","volume":"42","author":"Yan","year":"1997","journal-title":"Phys. Med. Biol."},{"key":"pmbadd984bib34","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s13014-018-1112-0","article-title":"ONE SHOT\u2014single shot radiotherapy for localized prostate cancer: study protocol of a single arm, multicenter phase I\/II trial","volume":"13","author":"Zilli","year":"2018","journal-title":"Radiat. Oncol."}],"container-title":["Physics in Medicine &amp; Biology"],"original-title":[],"link":[{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984","content-type":"text\/html","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984\/pdf","content-type":"application\/pdf","content-version":"am","intended-application":"similarity-checking"},{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T09:33:41Z","timestamp":1748338421000},"score":1,"resource":{"primary":{"URL":"https:\/\/iopscience.iop.org\/article\/10.1088\/1361-6560\/add984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,5,27]]},"published-print":{"date-parts":[[2025,6,8]]}},"URL":"https:\/\/doi.org\/10.1088\/1361-6560\/add984","relation":{},"ISSN":["0031-9155","1361-6560"],"issn-type":[{"value":"0031-9155","type":"print"},{"value":"1361-6560","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]},"assertion":[{"value":"Dose adaptation to compensate for cumulative intra-fraction motion effects in online adaptive radiotherapy","name":"article_title","label":"Article Title"},{"value":"Physics in Medicine & Biology","name":"journal_title","label":"Journal Title"},{"value":"paper","name":"article_type","label":"Article Type"},{"value":"\u00a9 2025 The Author(s). Published on behalf of Institute of Physics and Engineering in Medicine by IOP Publishing Ltd","name":"copyright_information","label":"Copyright Information"},{"value":"2025-01-02","name":"date_received","label":"Date Received","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2025-05-15","name":"date_accepted","label":"Date Accepted","group":{"name":"publication_dates","label":"Publication dates"}},{"value":"2025-05-27","name":"date_epub","label":"Online publication date","group":{"name":"publication_dates","label":"Publication dates"}}]}}