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@ARTICLE{Qubala:286386,
      author       = {A. Qubala and J. Shafee and T. Tessonnier and J. Horn and
                      M. Winter and J. Naumann and O. Jäkel$^*$},
      title        = {{C}haracteristics of breathing-adapted gating using surface
                      guidance for use in particle therapy: {A} phantom-based
                      end-to-end test from {CT} simulation to dose delivery.},
      journal      = {Journal of applied clinical medical physics},
      volume       = {25},
      number       = {1},
      issn         = {1526-9914},
      address      = {Reston, Va.},
      publisher    = {ACMP},
      reportid     = {DKFZ-2023-02789},
      pages        = {e14249},
      year         = {2024},
      note         = {#LA:E040# / 2024 Jan;25(1):e14249},
      abstract     = {To account for intra-fractional tumor motion during dose
                      delivery in radiotherapy, various treatment strategies are
                      clinically implemented such as breathing-adapted gating and
                      irradiating the tumor during specific breathing phases. In
                      this work, we present a comprehensive phantom-based
                      end-to-end test of breathing-adapted gating utilizing
                      surface guidance for use in particle therapy. A commercial
                      dynamic thorax phantom was used to reproduce regular and
                      irregular breathing patterns recorded by the GateRT
                      respiratory monitoring system. The amplitudes and periods of
                      recorded breathing patterns were analysed and compared to
                      planned patterns (ground-truth). In addition, the mean
                      absolute deviations (MAD) and Pearson correlation
                      coefficients (PCC) between the measurements and ground-truth
                      were assessed. Measurements of gated and non-gated
                      irradiations were also analysed with respect to dosimetry
                      and geometry, and compared to treatment planning system
                      (TPS). Further, the latency time of beam on/off was
                      evaluated. Compared to the ground-truth, measurements
                      performed with GateRT showed amplitude differences between
                      0.03 ± 0.02 mm and 0.26 ± 0.03 mm for regular and
                      irregular breathing patterns, whilst periods of both
                      breathing patterns ranged with a standard deviation between
                      10 and 190 ms. Furthermore, the GateRT software precisely
                      acquired breathing patterns with a maximum MAD of 0.30 ±
                      0.23 mm. The PCC constantly ranged between 0.998 and 1.000.
                      Comparisons between TPS and measured dose profiles indicated
                      absolute mean dose deviations within institutional
                      tolerances of $±5\%.$ Geometrical beam characteristics also
                      varied within our institutional tolerances of 1.5 mm. The
                      overall time delays were <60 ms and thus within both
                      recommended tolerances published by ESTRO and AAPM of 200
                      and 100 ms, respectively. In this study, a non-invasive
                      optical surface-guided workflow including image acquisition,
                      treatment planning, patient positioning and gated
                      irradiation at an ion-beam gantry was investigated, and
                      shown to be clinically viable. Based on phantom
                      measurements, our results show a clinically-appropriate
                      spatial, temporal, and dosimetric accuracy when using
                      surface guidance in the clinical setting, and the results
                      comply with international and institutional guidelines and
                      tolerances.},
      keywords     = {breathing-adapted gating (Other) / commissioning (Other) /
                      end-to-end testing (Other) / ion beam therapy (Other) /
                      particle therapy (Other) / surface-guided radiotherapy
                      (Other)},
      cin          = {E040},
      ddc          = {530},
      cid          = {I:(DE-He78)E040-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:38128056},
      doi          = {10.1002/acm2.14249},
      url          = {https://inrepo02.dkfz.de/record/286386},
}