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@ARTICLE{Berthold:275965,
      author       = {J. Berthold and J. Pietsch and N. Piplack and C.
                      Khamfongkhruea and J. Thiele and T. Hölscher and G.
                      Janssens and J. Smeets and E. Traneus and S. Löck$^*$ and
                      K. Stützer and C. Richter$^*$},
      title        = {{D}etectability of anatomical changes with prompt-gamma
                      imaging: {F}irst systematic evaluation of clinical
                      application during prostate-cancer proton therapy:
                      {D}etectability of anatomical changes with {PGI}.},
      journal      = {International journal of radiation oncology, biology,
                      physics},
      volume       = {117},
      number       = {3},
      issn         = {0360-3016},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2023-00947},
      pages        = {718-729},
      year         = {2023},
      note         = {2023 Nov 1;117(3):718-729},
      abstract     = {The development of online-adaptive proton therapy (PT) is
                      an essential requirement to overcome limitations encountered
                      by day-to-day variations of the patient anatomy. Range
                      verification could play an essential role in an online
                      feedback loop for the detection of treatment deviations such
                      as anatomical changes. Here, we present results of the first
                      systematic patient study regarding the detectability of
                      anatomical changes by a prompt-gamma imaging (PGI)
                      slit-camera system.For 15 prostate-cancer patients, PGI
                      measurements were performed during 105 fractions (201
                      fields) with in-room control CT acquisitions. Field-wise
                      doses on control CT scans were manually classified whether
                      showing relevant or non-relevant anatomical changes. This
                      manual classification of the treatment fields was then used
                      to establish an automatic field-wise ground truth based on
                      spot-wise dosimetric range shifts which were retrieved from
                      integrated depth-dose (IDD) profiles. In order to determine
                      the detection capability of anatomical changes with PGI,
                      spot-wise PGI-based range shifts were initially compared to
                      corresponding dosimetric IDD range shifts. As final
                      endpoint, the agreement of a developed field-wise PGI
                      classification model with the field-wise ground truth was
                      determined. Therefore, the PGI model was optimized and
                      tested for a sub-cohort of 131 and 70 treatment fields,
                      respectively.The correlation between PGI and IDD range
                      shifts was high, ρpearson = 0.67 (p<0.01). Field-wise
                      binary PGI-classification resulted in an area under the
                      curve (AUC) of 0.72 and 0.80 for training and test cohort,
                      respectively. The model detected relevant anatomical changes
                      in the independent test cohort with a sensitivity and
                      specificity of $74\%$ and $79\%,$ respectively.For the first
                      time, evidence of the detection capability of anatomical
                      changes in prostate-cancer PT from clinically acquired PGI
                      data is shown. This emphasizes the benefit of PGI-based
                      range verification and demonstrates its potential for
                      online-adaptive PT.},
      keywords     = {automated classification (Other) / inter-fractional changes
                      (Other) / prompt-gamma imaging (Other) / prostate cancer
                      (Other) / proton therapy (Other) / range verification
                      (Other) / treatment verification (Other)},
      cin          = {DD01},
      ddc          = {610},
      cid          = {I:(DE-He78)DD01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37160193},
      doi          = {10.1016/j.ijrobp.2023.05.002},
      url          = {https://inrepo02.dkfz.de/record/275965},
}