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@ARTICLE{Galeone:362217,
      author       = {Galeone, Cosimo and Nakas, A. and Donetti, M. and Martire,
                      Maria Chiara and Milian, F. M. and Pella, A. and Paganelli,
                      C. and Sacchi, R. and Vignati, A. and Durante, Marco and
                      Baroni, G. and Giordanengo, S. and Graeff, Christian},
      title        = {{R}eal-time motion modeling and treatment verification for
                      irregular motion in carbon ion therapy: a feasibility study},
      journal      = {Physics in medicine and biology},
      volume       = {70},
      number       = {16},
      issn         = {0031-9155},
      address      = {Bristol},
      publisher    = {IOP Publ.},
      reportid     = {GSI-2025-01090},
      pages        = {165009},
      year         = {2025},
      note         = {Original content from this work may be used under the terms
                      of the Creative Commons Attribution 4.0 licence.},
      abstract     = {Objective.Irregular motion impacts treatment accuracy and
                      can be compensated by larger margins or online adaptive
                      approaches. A seamless workflow for fast and accurate
                      4D-dose reconstruction allows dosimetric monitoring intra-
                      and inter-fractionally, as a basis for adaptive therapy.
                      This study presents a real-time, motion-adaptive framework
                      that combines motion modeling and treatment verification,
                      integrated into the dose delivery and monitoring systems to
                      enable continuous assessment of the delivered
                      4D-dose.Approach.The framework includes a GPU-based
                      analytical algorithm for real-time dose reconstruction in
                      carbon ion therapy, interfaced with the dose delivery and
                      optical tracking systems at the Centro Nazionale di
                      Adroterapia Oncologica (CNAO). A motion model, driven by
                      external surrogate tracking, generates a virtual CT every
                      150 ms, used for 4D-dose reconstruction with measured spot
                      parameters. Planned and delivered doses are compared after
                      each iso-energy slice. The framework was validated at CNAO
                      using a geometric target and a 4D lung tumor phantom with a
                      moving 2D ionization chamber array, under regular and
                      irregular motion patterns.Main results.The framework
                      successfully generated real-time CT images of the lung
                      phantom, showing strong agreement with ground-truth images.
                      Dose reconstructions were performed within inter-spill times
                      during delivery, ensuring rapid assessment. Comparisons
                      against detector measurements yielded an average gamma-index
                      passing rate of $99\%$ $(3\%/3$ mm), confirming the accuracy
                      of both the motion model and the integrated treatment
                      verification system.Significance.This work presents the
                      first real-time framework for carbon ion therapy,
                      integrating motion modeling and dose reconstruction to
                      handle irregular motion, fully embedded in a clinic-like
                      setup.},
      keywords     = {Heavy Ion Radiotherapy: methods / Feasibility Studies /
                      Humans / Movement / Phantoms, Imaging / Time Factors /
                      Radiotherapy Planning, Computer-Assisted: methods /
                      Radiotherapy Dosage / Four-Dimensional Computed Tomography /
                      Lung Neoplasms: radiotherapy / Lung Neoplasms: diagnostic
                      imaging / Lung Neoplasms: physiopathology / adaptive therapy
                      (Other) / irregular motion (Other) / motion model (Other) /
                      particle therapy (Other) / real-time dose calculation
                      (Other)},
      cin          = {BIO},
      ddc          = {530},
      cid          = {I:(DE-Ds200)BIO-20160831OR354},
      pnm          = {633 - Life Sciences – Building Blocks of Life: Structure
                      and Function (POF4-633) / RAPTOR - Real-time Adaptive
                      Particle Therapy of Cancer (955956) / SUC-GSI-Darmstadt -
                      Strategic university cooperation GSI-TU Darmstadt
                      (SUC-GSI-DA)},
      pid          = {G:(DE-HGF)POF4-633 / G:(EU-Grant)955956 /
                      G:(DE-Ds200)SUC-GSI-DA},
      experiment   = {$EXP:(DE-Ds200)External_experiment-20200803$},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40730202},
      UT           = {WOS:001548428600001},
      doi          = {10.1088/1361-6560/adf592},
      url          = {https://repository.gsi.de/record/362217},
}