ArticleZeitschrift fur medizinische Physik2022
Mitigation of motion effects in pencil-beam scanning - Impact of repainting on 4D robustly optimized proton treatment plans for hepatocellular carcinoma.
Article in Zeitschrift fur medizinische Physik, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Robustness of Tumor Control Against Intrafraction Patient Motion in Lung Stereotactic Body Radiation Therapy.Advances in radiation oncology · 2026Article
- An ESTRO-EPTN Delphi consensus on robustness evaluation in proton therapy.Physics and imaging in radiation oncology · 2026Article
- Dose comparison of proton beam therapy with and without a multileaf collimator in the treatment of multiple hepatocellular carcinoma.Physics and imaging in radiation oncology · 2026Article
- Advances in proton therapy technology and global clinical applications.Frontiers in oncology · 2026Review
- Quantifying interplay effects in lung cancer IMPT: a comprehensive analysis of treatment planning parameter sensitivity.BMC cancer · 2025Article
- An investigation into the impact of volumetric rescanning and fractionation treatment on dose homogeneity in liver cancer proton therapy.Journal of radiation research · 2024Article
- Proton therapy in the treatment of hepatocellular carcinoma.Frontiers in oncology · 2022Review
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Authors and funding
9 authors.
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Abstract
Proton fields delivered by the active scanning technique can be interfered with the intrafractional motion. This in-silico study seeks to mitigate the dosimetric impacts of motion artifacts, especially its interplay with the time-modulated dose delivery. Here four-dimensional (4d) robust optimization and dose repainting, which is the multiple application of the same field with reduced fluence, were combined. Two types of repainting were considered: layered and volumetric repainting. The time-resolved dose calculation, which is necessary to quantify the interplay effect, was integrated into the treatment planning system and validated. Nine clinical cases of hepatocellular carcinoma (HCC) showing motion in the range of 0.4-1.5cm were studied. It was found that the repainted delivery of 4D robustly optimized plans reduced the impact of interplay effect as quantified by the homogeneity index within the clinical target volume (CTV) to a tolerable level. Similarly, the fractional over- and underdosage was reduced sufficiently for some HCC cases to achieve the purpose of motion management. This holds true for both investigated types of repainting with small dosimetric advantages of volume repainting over layered repainting. Volume repainting, however, cannot be applied clinically in proton centers with slow energy changes. Thus, it served as a reference in the in-silico evaluation. It is recommended to perform the dynamic dose calculation for individual cases to judge if robust optimization in conjunction with repainting is sufficient to keep the interplay effect within bounds.
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