Real-time dose-guidance in radiotherapy: Proof of principle

Highlights: • Real-time motion-including tumor dose reconstruction during simulated liver SBRT. • Continuous estimation of end-of-fraction dose with and without couch correction. • Dose-guided couch correction triggered based on estimated gain in tumor dose. • Real-time dose-guidance shown to be superior to geometry guidance. The outcome of radiotherapy is a direct consequence of the dose delivered to the patient. Yet image-guidance and motion management to date focus on geometrical considerations as a practical surrogate for dose. Here, we propose real-time dose-guidance realized through continuous motion-including dose reconstructions and demonstrate this new concept in simulated liver stereotactic body radiotherapy (SBRT) delivery.