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@ARTICLE{Saito:136796,
      author       = {N. Saito$^*$ and D. Schmitt$^*$ and M. Bangert$^*$},
      title        = {{C}orrelation between intrafractional motion and dosimetric
                      changes for prostate {IMRT}: {C}omparison of different
                      adaptive strategies.},
      journal      = {Journal of applied clinical medical physics},
      volume       = {19},
      number       = {4},
      issn         = {1526-9914},
      address      = {Reston, Va.},
      publisher    = {ACMP},
      reportid     = {DKFZ-2018-01234},
      pages        = {87 - 97},
      year         = {2018},
      abstract     = {To retrospectively analyze and estimate the dosimetric
                      benefit of online and offline motion mitigation strategies
                      for prostate IMRT.Intrafractional motion data of 21 prostate
                      patients receiving intensity-modulated radiotherapy was
                      acquired with an electromagnetic tracking system. Target
                      trajectories of 734 fractions were analyzed per delivered
                      multileaf-collimator segment in five motion metrics:
                      three-dimensional displacement, distance from beam axis
                      (DistToBeam), and three orthogonal components. Time-resolved
                      dose calculations have been performed by shifting the target
                      according to the sampled motion for the following scenarios:
                      without adaptation, online-repositioning with a minimum
                      threshold of 3 mm, and an offline approach using a modified
                      field order applying horizontal before vertical beams.
                      Change of D95 (targets) or V65 (organs at risk) relative to
                      the static case, that is, ΔD95 or ΔV65, was extracted per
                      fraction in percent. Correlation coefficients (CC) between
                      the motion metrics and the dose metrics were extracted. Mean
                      of patient-wise CC was used to evaluate the correlation of
                      motion metric and dosimetric changes. Mean and standard
                      deviation of the patient-wise correlation slopes (in
                      $\%/mm)$ were extracted.For ΔD95 of the prostate, mean
                      DistToBeam per fraction showed the highest correlation for
                      all scenarios with a relative change of $-0.6 ± 0.7\%/mm$
                      without adaptation and $-0.4 ± 0.5\%/mm$ for the
                      repositioning and field order strategies. For ΔV65 of the
                      bladder and the rectum, superior-inferior and
                      posterior-anterior motion components per fraction showed the
                      highest correlation, respectively. The slope of bladder
                      (rectum) was 14.6 ± 5.8 $(15.1 ± 6.9) \%/mm$ without
                      adaptation, 14.0 ± 4.9 $(14.5 ± 7.4) \%/mm$ for
                      repositioning with 3 mm, and 10.6 ± 2.5
                      $(8.1 ± 4.6) \%/mm$ for the field order approach.The
                      correlation slope is a valuable concept to estimate
                      dosimetric deviations from static plan quality directly
                      based on the observed motion. For the prostate, both
                      mitigation strategies showed comparable benefit. For organs
                      at risk, the field order approach showed less sensitive
                      response regarding motion and reduced interpatient
                      variation.},
      cin          = {E040},
      ddc          = {530},
      cid          = {I:(DE-He78)E040-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29862644},
      pmc          = {pmc:PMC6036361},
      doi          = {10.1002/acm2.12359},
      url          = {https://inrepo02.dkfz.de/record/136796},
}