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Dong Y, Yang F, Wen J, Cai J, Zeng F, Liu M, Li S, Wang J, Ford JC, Portelance L, Yang Y. Improvement of 2D cine image quality using 3D priors and cycle generative adversarial network for low field MRI-guided radiation therapy. Med Phys 2024; 51:3495-3509. [PMID: 38043123 DOI: 10.1002/mp.16860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/12/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Cine magnetic resonance (MR) images have been used for real-time MR guided radiation therapy (MRgRT). However, the onboard MR systems with low-field strength face the problem of limited image quality. PURPOSE To improve the quality of cine MR images in MRgRT using prior image information provided by the patient planning and positioning MR images. METHODS This study employed MR images from 18 pancreatic cancer patients who received MR-guided stereotactic body radiation therapy. Planning 3D MR images were acquired during the patient simulation, and positioning 3D MR images and 2D sagittal cine MR images were acquired before and during the beam delivery, respectively. A deep learning-based framework consisting of two cycle generative adversarial networks (CycleGAN), Denoising CycleGAN and Enhancement CycleGAN, was developed to establish the mapping between the 3D and 2D MR images. The Denoising CycleGAN was trained to first denoise the cine images using the time domain cine image series, and the Enhancement CycleGAN was trained to enhance the spatial resolution and contrast by taking advantage of the prior image information from the planning and positioning images. The denoising performance was assessed by signal-to-noise ratio (SNR), structural similarity index measure, peak SNR, blind/reference-less image spatial quality evaluator (BRISQUE), natural image quality evaluator, and perception-based image quality evaluator scores. The quality enhancement performance was assessed by the BRISQUE and physician visual scores. In addition, the target contouring was evaluated on the original and processed images. RESULTS Significant differences were found for all evaluation metrics after Denoising CycleGAN processing. The BRISQUE and visual scores were also significantly improved after sequential Denoising and Enhancement CycleGAN processing. In target contouring evaluation, Dice similarity coefficient, centroid distance, Hausdorff distance, and average surface distance values were significantly improved on the enhanced images. The whole processing time was within 20 ms for a typical input image size of 512 × 512. CONCLUSION Taking advantage of the prior high-quality positioning and planning MR images, the deep learning-based framework enhanced the cine MR image quality significantly, leading to improved accuracy in automatic target contouring. With the merits of both high computational efficiency and considerable image quality enhancement, the proposed method may hold important clinical implication for real-time MRgRT.
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Affiliation(s)
- Yuyan Dong
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, China
| | - Fei Yang
- The Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Jie Wen
- Department of Radiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Feiyan Zeng
- Department of Radiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Mengqiu Liu
- Department of Radiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Shuang Li
- Department of Radiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jiangtao Wang
- Cancer Center, Sichuan Academy of Medical Sciences Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - John Chetley Ford
- The Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | - Yidong Yang
- Department of Engineering and Applied Physics, University of Science and Technology of China, Hefei, Anhui, China
- Department of Radiation Oncology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
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Fast MF, Cao M, Parikh P, Sonke JJ. Intrafraction Motion Management With MR-Guided Radiation Therapy. Semin Radiat Oncol 2024; 34:92-106. [PMID: 38105098 DOI: 10.1016/j.semradonc.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
High quality radiation therapy requires highly accurate and precise dose delivery. MR-guided radiotherapy (MRgRT), integrating an MRI scanner with a linear accelerator, offers excellent quality images in the treatment room without subjecting patient to ionizing radiation. MRgRT therefore provides a powerful tool for intrafraction motion management. This paper summarizes different sources of intrafraction motion for different disease sites and describes the MR imaging techniques available to visualize and quantify intrafraction motion. It provides an overview of MR guided motion management strategies and of the current technical capabilities of the commercially available MRgRT systems. It describes how these motion management capabilities are currently being used in clinical studies, protocols and provides a future outlook.
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Affiliation(s)
- Martin F Fast
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, CA
| | - Parag Parikh
- Department of Radiation Oncology, Henry Ford Health - Cancer, Detroit, MI
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Lombardo E, Dhont J, Page D, Garibaldi C, Künzel LA, Hurkmans C, Tijssen RHN, Paganelli C, Liu PZY, Keall PJ, Riboldi M, Kurz C, Landry G, Cusumano D, Fusella M, Placidi L. Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects. Radiother Oncol 2024; 190:109970. [PMID: 37898437 DOI: 10.1016/j.radonc.2023.109970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
MRI-guided radiotherapy (MRIgRT) is a highly complex treatment modality, allowing adaptation to anatomical changes occurring from one treatment day to the other (inter-fractional), but also to motion occurring during a treatment fraction (intra-fractional). In this vision paper, we describe the different steps of intra-fractional motion management during MRIgRT, from imaging to beam adaptation, and the solutions currently available both clinically and at a research level. Furthermore, considering the latest developments in the literature, a workflow is foreseen in which motion-induced over- and/or under-dosage is compensated in 3D, with minimal impact to the radiotherapy treatment time. Considering the time constraints of real-time adaptation, a particular focus is put on artificial intelligence (AI) solutions as a fast and accurate alternative to conventional algorithms.
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Affiliation(s)
- Elia Lombardo
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium; Université Libre De Bruxelles (ULB), Radiophysics and MRI Physics Laboratory, Brussels, Belgium
| | - Denis Page
- University of Manchester, Division of Cancer Sciences, Manchester, United Kingdom
| | - Cristina Garibaldi
- IEO, Unit of Radiation Research, European Institute of Oncology IRCCS, Milan, Italy
| | - Luise A Künzel
- National Center for Tumor Diseases (NCT), Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Rob H N Tijssen
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Chiara Paganelli
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Paul Z Y Liu
- Image X Institute, University of Sydney Central Clinical School, Sydney, NSW, Australia; Department of Medical Physics, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Paul J Keall
- Image X Institute, University of Sydney Central Clinical School, Sydney, NSW, Australia; Department of Medical Physics, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Marco Riboldi
- Department of Medical Physics, Faculty of Physics, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, a Partnership between DKFZ and LMU University Hospital Munich, Germany; Bavarian Cancer Research Center (BZKF), Partner Site Munich, Munich, Germany
| | | | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy.
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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Dong Y, Hu P, Li X, Liu W, Yan B, Yang F, Ford JC, Portelance L, Yang Y. Dosimetry impact of distinct gating strategies in cine MR image-guided breath-hold pancreatic cancer radiotherapy. J Appl Clin Med Phys 2023; 24:e14078. [PMID: 37335543 PMCID: PMC10562039 DOI: 10.1002/acm2.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
PURPOSE To investigate the dosimetry effects of different gating strategies in cine magnetic resonance imaging (MRI)-guided breath-hold pancreatic cancer radiotherapy. METHODS Two cine MRI-based gating strategies were investigated: a tumor contour-based gating strategy at a gating threshold of 0-5% and a tumor displacement-based gating strategy at a gating threshold of 3-5 mm. The cine MRI videos were obtained from 17 pancreatic cancer patients who received MRI-guided radiation therapy. We calculated the tumor displacement in each cine MR frame that satisfied the gating threshold and obtained the proportion of frames with different displacements. We generated IMRT and VMAT plans using a 33 Gy prescription, and motion plans were generated by adding up all isocenter-shift plans corresponding to different tumor displacements. The dose parameters of GTV, PTV, and organs at risk (OAR) were compared between the original and motion plans. RESULTS In both gating strategies, the difference was significant in PTV coverage but not in GTV coverage between the original and motion plans. OAR dose parameters deteriorate with increasing gating threshold. The beam duty cycle increased from 19.5±14.3% (median 18.0%) to 60.8±15.6% (61.1%) for gating thresholds from 0% to 5% in tumor contour-based gating and from 51.7±11.5% (49.7%) to 67.3±12.4% (67.1%) for gating thresholds from 3 to 5 mm in tumor displacement-based gating. CONCLUSION In tumor contour-based gating strategy, the dose delivery accuracy deteriorates while the dose delivery efficiency improves with increasing gating thresholds. To ensure treatment efficiency, the gating threshold might be no less than 3%. A threshold up to 5% may be acceptable in terms of the GTV coverage. The displacement-based gating strategy may serve as a potential alternative to the tumor contour based gating strategy, in which the gating threshold of approximately 4 mm might be a good choice for reasonably balancing the dose delivery accuracy and efficiency.
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Affiliation(s)
- Yuyan Dong
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Panpan Hu
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Xiaoyang Li
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Wei Liu
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Bing Yan
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
| | - Fei Yang
- The Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Yidong Yang
- Department of Engineering and Applied PhysicsUniversity of Science and Technology of ChinaHefeiAnhuiChina
- Department of Radiation Oncologythe First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of ChinaHefeiAnhuiChina
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Bernchou U, Schytte T, Bertelsen A, Lorenzen EL, Brink C, Mahmood F. Impact of abdominal compression on intra-fractional motion and delivered dose in magnetic resonance image-guided adaptive radiation ablation of adrenal gland metastases. Phys Med 2023; 114:102682. [PMID: 37717398 DOI: 10.1016/j.ejmp.2023.102682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
PURPOSE The current study investigated the impact of abdominal compression on motion and the delivered dose during non-gated, magnetic resonance image (MRI)-guided radiation ablation of adrenal gland metastases. METHODS Thirty-one patients with adrenal gland metastases treated to 45-60 Gy in 3-8 fractions on a 1.5 T MRI-linac were included in the study. The patients were breathing freely (n = 14) or with motion restricted by using an abdominal compression belt (n = 17). The time-resolved position of the target in online 2D cine MR images acquired during treatment was assessed and used to estimate the dose delivered to the GTV and abutting luminal organs at risk (OAR). RESULTS The median (range) 3D root-mean-square target position error was significantly higher in patients treated without a compression belt [2.9 (1.9-5.6) mm] compared to patients using the belt [2.1 (1.2-3.5) mm] (P < 0.01). The median (range) GTV V95% was significantly reduced from planned 98.6 (65.9-100) % to delivered 96.5 (64.5-99.9) % due to motion (P < 0.01). Most prominent dose reductions were found in patients showing either large target drift or respiration motion and were mainly treated without abdominal compression. Motion did not lead to an increased number of constraint violations for luminal OAR. CONCLUSIONS Acceptable target coverage and dose to OAR was observed in the vast majority of patients despite intra-fractional motion during adaptive MRI-guided radiation ablation. The use of abdominal compression significantly reduced the target position error and prevented the most prominent target coverage degradations and is, therefore, recommended as motion management at MRI-linacs.
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Affiliation(s)
- Uffe Bernchou
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark.
| | - Tine Schytte
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark; Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Anders Bertelsen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Ebbe Laugaard Lorenzen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Carsten Brink
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark.
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19 3., 5000 Odense C, Denmark.
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Huang X, Hooshangnejad H, China D, Feng Z, Lee J, Bell MAL, Ding K. Ultrasound Imaging with Flexible Array Transducer for Pancreatic Cancer Radiation Therapy. Cancers (Basel) 2023; 15:3294. [PMID: 37444403 DOI: 10.3390/cancers15133294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Pancreatic cancer with less than 10% 3-year survival rate is one of deadliest cancer types and greatly benefits from enhanced radiotherapy. Organ motion monitoring helps spare the normal tissue from high radiation and, in turn, enables the dose escalation to the target that has been shown to improve the effectiveness of RT by doubling and tripling post-RT survival rate. The flexible array transducer is a novel and promising solution to address the limitation of conventional US probes. We proposed a novel shape estimation for flexible array transducer using two sequential algorithms: (i) an optical tracking-based system that uses the optical markers coordinates attached to the probe at specific positions to estimate the array shape in real-time and (ii) a fully automatic shape optimization algorithm that automatically searches for the optimal array shape that results in the highest quality reconstructed image. We conducted phantom and in vivo experiments to evaluate the estimated array shapes and the accuracy of reconstructed US images. The proposed method reconstructed US images with low full-width-at-half-maximum (FWHM) of the point scatters, correct aspect ratio of the cyst, and high-matching score with the ground truth. Our results demonstrated that the proposed methods reconstruct high-quality ultrasound images with significantly less defocusing and distortion compared with those without any correction. Specifically, the automatic optimization method reduced the array shape estimation error to less than half-wavelength of transmitted wave, resulting in a high-quality reconstructed image.
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Affiliation(s)
- Xinyue Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Hamed Hooshangnejad
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Debarghya China
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Ziwei Feng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Muyinatu A Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA
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Bessieres I, Lorenzo O, Bertaut A, Petitfils A, Aubignac L, Boudet J. Online adaptive radiotherapy and dose delivery accuracy: A retrospective analysis. J Appl Clin Med Phys 2023:e14005. [PMID: 37097765 PMCID: PMC10402677 DOI: 10.1002/acm2.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/16/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023] Open
Abstract
PURPOSE With online adaptive radiotherapy (ART), patient-specific quality assurance (PSQA) testing cannot be performed prior to delivery of the adapted treatment plan. Consequently, the dose delivery accuracy of adapted plans (i.e., the ability of the system to interpret and deliver the treatment as planned) are not initially verified. We investigated the variation in dose delivery accuracy of ART on the MRIdian 0.35 T MR-linac (Viewray Inc., Oakwood, USA) between initial plans and their respective adapted plans, by analyzing PSQA results. METHODS We considered the two main digestive localizations treated with ART (liver and pancreas). A total of 124 PSQA results acquired with the ArcCHECK (Sun Nuclear Corporation, Melbourne, USA) multidetector system were analyzed. PSQA result variations between the initial plans and their respective adapted plans were statistically investigated and compared with the variation in MU number. RESULTS For the liver, limited deterioration in PSQA results was observed, and was within the limits of clinical tolerance (Initial = 98.2%, Adapted = 98.2%, p = 0.4503). For pancreas plans, only a few significant deteriorations extending beyond the limits of clinical tolerance were observed and were due to specific, complex anatomical configurations (Initial = 97.3%, Adapted = 96.5%, p = 0.0721). In parallel, we observed an influence of the increase in MU number on the PSQA results. CONCLUSION We show that the dose delivery accuracy of adapted plans, in terms of PSQA results, is preserved in ART processes on the 0.35 T MR-linac. Respecting good practices, and minimizing the increase in MU number can help to preserve the accuracy of delivery of adapted plans as compared to their respective initial plans.
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Affiliation(s)
- Igor Bessieres
- Department of Medical Physics, Centre Georges François Leclerc, Dijon, France
| | - Olivier Lorenzo
- Department of Medical Physics, Centre Georges François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Methodology, Data-Management and Biostatistics Unit, Centre Georges-François Leclerc, Dijon, France
| | - Aurélie Petitfils
- Department of Medical Physics, Centre Georges François Leclerc, Dijon, France
| | - Léone Aubignac
- Department of Medical Physics, Centre Georges François Leclerc, Dijon, France
| | - Julien Boudet
- Department of Medical Physics, Centre Georges François Leclerc, Dijon, France
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