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@ARTICLE{Galeone:353200,
      author       = {Galeone, Cosimo and Steinsberger, Timo and Donetti, M. and
                      Martire, Maria Chiara and Milian, F. M. and Sacchi, R. and
                      Vignati, A. and Volz, Lennart and Durante, Marco and
                      Giordanengo, S. and Graeff, Christian},
      title        = {{R}eal-time delivered dose assessment in carbon ion therapy
                      of moving targets},
      journal      = {Physics in medicine and biology},
      volume       = {69},
      number       = {20},
      issn         = {0031-9155},
      address      = {Bristol},
      publisher    = {IOP Publ.},
      reportid     = {GSI-2024-00807},
      pages        = {205001},
      year         = {2024},
      note         = {Original content from this work may be used under the terms
                      of the Creative Commons Attribution 4.0 licence.Grants:
                      European Union’s Horizon 2020 research and innovation
                      program under the Marie Sklodowska-Curie Grant},
      abstract     = {Objective. Real-time adaptive particle therapy is being
                      investigated as a means to maximize the treatment delivery
                      accuracy. To react to dosimetric errors, a system for fast
                      and reliable verification of the agreement between planned
                      and delivered doses is essential. This study presents a
                      clinically feasible, real-time 4D-dose reconstruction
                      system, synchronized with the treatment delivery and motion
                      of the patient, which can provide the necessary feedback on
                      the quality of the delivery.Approach. A GPU-based analytical
                      dose engine capable of millisecond dose calculation for
                      carbon ion therapy has been developed and interfaced with
                      the next generation of the dose delivery system (DDS) in use
                      at Centro Nazionale di Adroterapia Oncologica (CNAO). The
                      system receives the spot parameters and the motion
                      information of the patient during the treatment and performs
                      the reconstruction of the planned and delivered 4D-doses.
                      After each iso-energy layer, the results are displayed on a
                      graphical user interface by the end of the spill pause of
                      the synchrotron, permitting verification against the
                      reference dose. The framework has been verified
                      experimentally at CNAO for a lung cancer case based on a
                      virtual phantom 4DCT. The patient's motion was mimicked by a
                      moving Ionization Chamber (IC) 2D-array.Mainresults. For the
                      investigated static and 4D-optimized treatment delivery
                      cases, real-time dose reconstruction was achieved with an
                      average pencil beam dose calculation speed up to more than
                      one order of magnitude smaller than the spot delivery. The
                      reconstructed doses have been benchmarked against offline
                      log-file based dose reconstruction with the TRiP98 treatment
                      planning system, as well as QA measurements with the IC
                      2D-array, where an average gamma-index passing rate $(3\%/3$
                      mm) of $99.8\%$ and $98.3\%,$ respectively, were
                      achieved.Significance. This work provides the first
                      real-time 4D-dose reconstruction engine for carbon ion
                      therapy. The framework integration with the CNAO DDS paves
                      the way for a swift transition to the clinics.},
      keywords     = {Humans / Radiotherapy Dosage / Heavy Ion Radiotherapy:
                      methods / Time Factors / Radiotherapy Planning,
                      Computer-Assisted: methods / Movement / Radiation Dosage /
                      Four-Dimensional Computed Tomography / Phantoms, Imaging /
                      Lung Neoplasms: radiotherapy / Radiometry: methods /
                      adaptive therapy (Other) / moving targets (Other) / particle
                      therapy (Other) / real-time dose calculation (Other)},
      cin          = {BIO / BIO@FAIR},
      ddc          = {530},
      cid          = {I:(DE-Ds200)BIO-20160831OR354 / I:(DE-Ds200)Coll-FAIR-BIO},
      pnm          = {633 - Life Sciences – Building Blocks of Life: Structure
                      and Function (POF4-633) / SUC-GSI-Darmstadt - Strategic
                      university cooperation GSI-TU Darmstadt (SUC-GSI-DA) /
                      RAPTOR - Real-time Adaptive Particle Therapy of Cancer
                      (955956) / DFG project G:(GEPRIS)491382106 -
                      Open-Access-Publikationskosten / 2025-2027 / GSI
                      Helmholtzzentrum für Schwerionenforschung (491382106)},
      pid          = {G:(DE-HGF)POF4-633 / G:(DE-Ds200)SUC-GSI-DA /
                      G:(EU-Grant)955956 / G:(GEPRIS)491382106},
      experiment   = {$EXP:(DE-Ds200)no_experiment-20200803$},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39299266},
      UT           = {WOS:001322177000001},
      doi          = {10.1088/1361-6560/ad7d59},
      url          = {https://repository.gsi.de/record/353200},
}