Uncertainty-driven determination of target measurement times for indirect tracking validation in adaptive radiotherapy.

. Hybrid indirect tumor tracking strategies combine continuous monitoring of surrogate signals with episodic radiographic imaging of the target to check and update their models during the treatment. This validation process is traditionally performed at predetermined and fixed-rate time intervals. This study investigates a new validation procedure based on the real-time uncertainty associated with the predicted target positions.. An adaptive version of a Bayesian method for indirect tracking is developed to simulate different validation processes within a single framework: no validation, regular validation and uncertainty-based validation. While regular validation involves measuring targets at fixed intervals, uncertainty-based validation takes advantage of a key Bayesian feature, which is the real-time confidence information associated with predictions. The validation processes are applied to ground truth breathing signals consisting of a lung target and two different surrogates (one internal, one external). Their impact on prediction accuracy is evaluated with root-mean-square error (RMSE) and incidence of large errors. The number of validation measurements triggered is also examined.. When using the internal surrogate and compared to regular validation, uncertainty-based validation results in significantly better prediction accuracy while using fewer validation measurements: RMSE and fraction of large errors are reduced on average by 12% and 26% respectively, with 36% fewer validation measurements. With the external surrogate, whose correlation with the target is less stable over time, more validation measurements are automatically triggered, which leads to a substantial reduction of prediction errors: RMSE and fraction of large errors are reduced on average by 17% and 28% respectively compared to regular validation. It is also observed that depending on the initial instant, regular validation can result in worse prediction accuracy compared to no validation.. Uncertainty-based validation has the potential to be more efficient and effective than a validation process performed at prescheduled and fixed-rate time intervals.