Real-time energy/mass transfer mapping for online 4D dose reconstruction.

In this work we describe an ultra-fast, low-latency implementation of the energy/mass transfer (EMT) mapping method to accumulate dose on deforming geometries such as lung using the central processing unit (CPU). It enables the computation of the actually delivered dose for intensity-modulated radiation therapy on 4D image data in real-time at 25 Hz. In order to accumulate the delivered dose onto a reference phase a pre-calculated deformable vector field is used. The aim of this study is to present an online dose accumulation technique that can be carried out in less than 40 ms to accommodate the machine log update rate of our research linac. Three speed optimisation strategies for the CPU are discussed: single-core optimisation, parallelisation for multiple cores and vectorisation. The single-core implementation accumulates dose in about 1.1 s on a typical high resolution grid for a lung stereotactic body radiation therapy case. Adding parallelisation decreased the runtime to about 50 ms while adding vectorisation satisfied our real-time constraint by further reducing the dose accumulation time to 15 ms without compromising on resolution or accuracy. The presented method allows real-time dose accumulation on deforming patient geometries and has the potential to enable online dose evaluation and re-planning scenarios.