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Med. Biol."],"published-print":{"date-parts":[[2026,5,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    Treatment of pancreas using Cyberknife is usually accomplished using radio-opaque fiducial markers that can be visualised on the orthogonal kilovoltage imaging system, but implantation of markers can lead to complications. This study therefore describes a method for pancreas tracking without fiducial markers and estimates the improvement in accuracy that can be achieved by additional daily pre-treatment volumetric imaging.\n                    <jats:italic>Approach.<\/jats:italic>\n                    Fiducial markers were artificially removed from the digitally reconstructed radiographs and treatment images of eight previously treated patients. Pancreas position was identified using a combination of local rigid registrations and inter- and intra-fraction motion models. The optimum effect of daily volumetric imaging was simulated by correcting the mean tracking position to match the mean position observed using fiducials. The impact of residual error on the dose distribution was estimated by shifting and recalculating the treatment plan.\n                    <jats:italic>Main results.<\/jats:italic>\n                    Median absolute tracking accuracy without fiducials over the 2823 acquired images is 3.8 mm (range 0.2\u201319.9 mm) without daily volumetric imaging. The lower bound of accuracy is 2.3 mm (0.1 mm\u201418.5 mm) when daily volumetric imaging is used. The former scenario reduces the\n                    <jats:italic>D<\/jats:italic>\n                    <jats:sub>95%<\/jats:sub>\n                    of the planning target volume by a median of 2.5 Gy (1.0\u201310.2 Gy) compared to the planned dose distribution, whereas the latter scenario reduces\n                    <jats:italic>D<\/jats:italic>\n                    <jats:sub>95%<\/jats:sub>\n                    by 1.4 Gy (0.4\u20132.8 Gy). In neither case is the\n                    <jats:italic>D<\/jats:italic>\n                    <jats:sub>95%<\/jats:sub>\n                    of the clinical target volume (CTV) substantially lowered below the prescription. Median\n                    <jats:italic>D<\/jats:italic>\n                    <jats:sub>0.5cc<\/jats:sub>\n                    to critical structures changes by less than 2 Gy.\n                    <jats:italic>Significance.<\/jats:italic>\n                    When tracking the target without fiducial markers, a planning target margin of 3\u20135 mm is sufficient to ensure that the CTV receives the desired prescribed dose, but the spatial accuracy and target coverage are considerably improved by using daily volumetric imaging.\n                  <\/jats:p>","DOI":"10.1088\/1361-6560\/ae6229","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:55:50Z","timestamp":1776725750000},"page":"095018","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of daily volumetric imaging on target tracking without fiducial markers during robotic treatment of pancreas"],"prefix":"10.1088","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5265-5927","authenticated-orcid":true,"given":"James L","family":"Bedford","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4351-8136","authenticated-orcid":true,"given":"Simeon","family":"Nill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2309-0814","authenticated-orcid":false,"given":"Uwe","family":"Oelfke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"266","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"pmbae6229bib1","doi-asserted-by":"publisher","first-page":"3506","DOI":"10.1002\/mp.13028","type":"journal-article","article-title":"Evaluation of the accuracy of the CyberKnife SynchronyTM respiratory tracking system using a plastic scintillator","volume":"45","author":"Akino","year":"2018","journal-title":"Med. 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