ArticleFrontiers in oncology2023
Intrafraction tumor motion monitoring and dose reconstruction for liver pencil beam scanning proton therapy.
Article in Frontiers in oncology, 2023. 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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7 citing papers in PubMed, 7 citations in OpenAlex.
- Deep learning-based CNN method for fiducial marker detection in kilovoltage X-ray images for liver tumor motion monitoring.Medical physics · 2026Article
- Proton stereotactic body radiotherapy for early-stage non-small cell lung cancer: Influence of case-specific characteristics on dosimetric robustness.Journal of applied clinical medical physics · 2026Article
- Monte Carlo dose calculation for photon and electron radiotherapy on dynamically deforming anatomy.Medical physics · 2025Article
- Motion-induced dose perturbations in photon radiotherapy and proton therapy measured by deformable liver-shaped 3D dosimeters in an anthropomorphic phantom.Physics and imaging in radiation oncology · 2024Article
- A review of the clinical introduction of 4D particle therapy research concepts.Physics and imaging in radiation oncology · 2024Review
- Patient Breathing Motion and Delivery Specifics Influencing the Robustness of a Proton Pancreas Irradiation.Cancers · 2023Article
- Spot Scanning Proton Beam Therapy for Surgery-inaccessible Hepatocellular Carcinoma: Preliminary Results.In vivo (Athens, Greece)Article
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Pencil beam scanning (PBS) proton therapy can provide highly conformal target dose distributions and healthy tissue sparing. However, proton therapy of hepatocellular carcinoma (HCC) is prone to dosimetrical uncertainties induced by respiratory motion. This study aims to develop intra-treatment tumor motion monitoring during respiratory gated proton therapy and combine it with motion-including dose reconstruction to estimate the delivered tumor doses for individual HCC treatment fractions. Methods: Three HCC-patients were planned to receive 58 GyRBE (n=2) or 67.5 GyRBE (n=1) of exhale respiratory gated PBS proton therapy in 15 fractions. The treatment planning was based on the exhale phase of a 4-dimensional CT scan. Daily setup was based on cone-beam CT (CBCT) imaging of three implanted fiducial markers. An external marker block (RPM) on the patient's abdomen was used for exhale gating in free breathing. This study was based on 5 fractions (patient 1), 1 fraction (patient 2) and 6 fractions (patient 3) where a post-treatment control CBCT was available. After treatment, segmented 2D marker positions in the post-treatment CBCT projections provided the estimated 3D motion trajectory during the CBCT by a probability-based method. An external-internal correlation model (ECM) that estimated the tumor motion from the RPM motion was built from the synchronized RPM signal and marker motion in the CBCT. The ECM was then used to estimate intra-treatment tumor motion. Finally, the motion-including CTV dose was estimated using a dose reconstruction method that emulates tumor motion in beam's eye view as lateral spot shifts and in-depth motion as changes in the proton beam energy. The CTV homogeneity index (HI) The CTV homogeneity index (HI) was calculated as Results: The tumor position during spot delivery had a root-mean-square error of 1.3 mm in left-right, 2.8 mm in cranio-caudal and 1.7 mm in anterior-posterior directions compared to the planned position. On average, the CTV HI was larger than planned by 3.7%-points (range: 1.0-6.6%-points) for individual fractions and by 0.7%-points (range: 0.3-1.1%-points) for the average dose of 5 or 6 fractions. Conclusions: A method to estimate internal tumor motion and reconstruct the motion-including fraction dose for PBS proton therapy of HCC was developed and demonstrated successfully clinically.
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