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First online real-time motion-including prostate and bladder dose reconstruction during prostate radiotherapy.

Karolina Klucznik1, Thomas Ravkilde2, Simon Skouboe3

  • 1Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|November 24, 2025
PubMed
Summary

This study introduces real-time dose reconstruction during prostate radiotherapy, accurately calculating motion-induced dose distortions. This method enables real-time assessment of motion mitigation techniques, improving treatment accuracy.

Keywords:
Intrafraction image-guidanceIntrafraction motionProstate radiotherapyReal-time dose reconstruction

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Image-Guided Therapy

Background:

  • Prostate radiotherapy doses can be distorted by organ motion.
  • Real-time calculation of motion-induced dose distortions during treatment is a significant challenge.

Purpose of the Study:

  • To present the first real-time, motion-including dose reconstruction during prostate radiotherapy.
  • To validate the accuracy and speed of the developed in-house software for online dose calculation.
  • To assess the effectiveness of intrafractional image guidance in mitigating dose distortions.

Main Methods:

  • Twenty patients underwent stereotactic prostate radiotherapy with intrafractional image guidance.
  • In-house software performed real-time dose reconstruction, accounting for organ motion.
  • Reconstructed doses were validated against a clinical treatment planning system (TPS).
  • Hypothetical doses without repositioning were reconstructed to demonstrate the benefit of motion mitigation.

Main Results:

  • Real-time dose calculations showed high agreement with TPS (e.g., 0.1% difference for CTV D95%).
  • Online dose reconstruction averaged 336 ms, proving real-time applicability.
  • Intrafractional image guidance minimized average dose distortions to 0.0% for CTV and +0.1% for bladder.
  • Without repositioning, dose deviations could reach clinically unacceptable levels (up to -42.5% for CTV D95%).

Conclusions:

  • This study achieved the first clinical real-time motion-including dose reconstruction for target and organs at risk.
  • The developed method paves the way for real-time dose-guided radiotherapy.
  • Accurate online dose reconstruction enhances treatment precision and patient safety.