Quantification of Pediatric Abdominal Organ Motion With a 4-Dimensional Magnetic Resonance Imaging Method

Accepted Manuscript Quantification of Pediatric Abdominal Organ Motion with a 4-Dimensional Magnetic Resonance Imaging Method Jinsoo Uh, PhD, Matthew J. Krasin, MD, Yimei Li, PhD, Xingyu Li, MS, Christopher Tinkle, MD, PhD, John T. Lucas, Jr., MS, MD, Thomas E. Merchant, DO, PhD, Chiaho Hua, PhD PII:

S0360-3016(17)30960-4

DOI:

10.1016/j.ijrobp.2017.05.026

Reference:

ROB 24267

To appear in:

International Journal of Radiation Oncology • Biology • Physics

Received Date: 12 January 2017 Revised Date:

26 April 2017

Accepted Date: 17 May 2017

Please cite this article as: Uh J, Krasin MJ, Li Y, Li X, Tinkle C, Lucas Jr. JT, Merchant TE, Hua C, Quantification of Pediatric Abdominal Organ Motion with a 4-Dimensional Magnetic Resonance Imaging Method, International Journal of Radiation Oncology • Biology • Physics (2017), doi: 10.1016/ j.ijrobp.2017.05.026. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Quantification of Pediatric Abdominal Organ Motion with a 4-Dimensional Magnetic Resonance Imaging Method Jinsoo Uh, PhD,* Matthew J. Krasin, MD,* Yimei Li, PhD,† Xingyu Li, MS,† Christopher

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Tinkle, MD, PhD,* John T. Lucas, Jr., MS, MD,* Thomas E. Merchant, DO, PhD,* and Chiaho Hua, PhD*

Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis,

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*

Tennessee

Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis,

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Tennessee

Reprint requests to: Jinsoo Uh, PhD, Department of Radiation Oncology, St. Jude

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Children's Research Hospital, 262 Danny Thomas Place, MS-210, Memphis, TN 38105. Tel: (901) 595-6545; E-mail: [email protected].

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Short title: Pediatric organ motion with 4D MRI

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Conflict of interest: None.

Acknowledgements: This work was supported in part by the American Lebanese Syrian Associated Charities (ALSAC).

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Summary We quantified organ motion in 35 pediatric patients with a 4D MRI method and investigated the association between organ motion and specific patient characteristics.

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Organ motion was associated with patient age and anatomical site. Both inter-organ and intra-organ variations were apparent, and individual variation was greater in older

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predict organ motion in prospective patients.

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patients. We analyzed the organ motion data to determine whether they could be used to

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Abstract Purpose: To characterize respiration-induced abdominal organ motion in children

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receiving radiation treatment with a 4-dimensional magnetic resonance imaging (4D MRI) method.

Methods and Materials: We analyzed free-breathing coronal 4D MRI datasets acquired from 35 patients (aged 1–20 years) with abdominal tumors. A deformable image

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registration of the 4D MRI datasets was performed to derive motion trajectories of selected anatomical landmarks, from which organ motions were quantified. The

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association between organ motion and patient characteristics was investigated and compared with previous studies. The relation between patient height and organ motion was further investigated to predict organ motion in prospective patients. Results: Organ motion and its individual variation were reduced in younger patients (e.g.,

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kidney peak-to-peak motion < 5 mm for all but 1 patient < 8 years old), although special motion management may be warranted in some adolescent. The liver and spleen exhibited greater motion than did the kidneys, while intra-organ variation was present.

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The motions in the liver and kidneys agreed with those reported by the previous 4D CT studies. Individual variations of organ motion in younger patients were due, in part, to

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changes in respiration rate, which ostensibly reflected the effect of anesthesia. The prediction of organ motion was limited by large individual variations, particularly for older patients.

Conclusions: The 4D MRI acquisition method and motion analysis described in this study provide a non-ionizing approach to understand the age-associated organ motion, which aids in the planning of abdominal radiotherapy for pediatric patients. Use of 4D

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MRI facilitates monitoring of changes in target motion pattern during treatment courses

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and in various studies of the effect of organ motion on radiation treatment.

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Introduction Quantitative information describing respiration-induced organ motion is important for the

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planning of radiotherapy of abdominal tumors. Recent advances in conformal radiotherapy techniques, such as intensity-modulated radiotherapy and proton therapy,

necessitate the assessment of the uncertainties induced by organ motion (1,2). Pediatric

patients require additional and unique considerations because the pattern and amplitude

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of organ motion may depend on age-related factors, such as body size and respiration rate.

consideration for each treatment site.

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In addition, inter-organ and intra-organ variations in motion are important to take into

Abdominal irradiation is used to treat children with diverse tumors, such as neuroblastoma, Wilms’ tumor, rhabdomyosarcoma, lymphoma, and hepatic tumors (3).

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The anatomical locations of the tumors and adjacent organs at risk vary. Knowledge of organ-specific motion relative to age would help guide treatment planning and stratify patient groups by the need of potential motion management; however, such information

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in children is limited (4).

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Four-dimensional magnetic resonance imaging (4D MRI) is an emerging technique that can provide information on respiration-induced organ motion (5,6). Unlike 4D computed tomography (CT), 4D MRI does not use ionizing radiation and thus reduces risk to pediatric patients. The non-invasiveness of 4D MRI permits frequent monitoring of organ motion during treatment courses and facilitates healthy volunteer studies. Other advantages of 4D MRI include superior soft-tissue contrast, flexible image orientation,

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and the ability to acquire respiratory phase data with external sensors or internal surrogates.

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Previous studies of organ motion for treatment planning have largely relied on 4D CT (710). Such studies using 4D MRI (6) are not yet common, although dynamic 2D MRI (i.e., cine MRI) that covers only 1 or 2 image slices has been utilized (11-13). The primary

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aims of this study were to report 4D MRI-derived pediatric organ motion, determine its association with patient characteristics, and compare it with previous studies using 4D

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CT. We additionally investigated the feasibility of using the organ motion data for predicting organ motion in prospective patients.

Patients

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Methods and Materials

A total of 36 patients with abdominal tumors received free-breathing 4D MRI for radiation treatment planning in our institution from September 2015 to February 2017.

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All patients but 1 with severe voluntary motion artifacts (n=35) were included in this

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retrospective study after approval from our institutional review board. The characteristics of the patients are listed in Table 1. Patient ages ranged from 1 to 20 years.

4D MRI

The 4D MRI was performed according to a recently reported method (Fig. 1A) (14). We used a balanced steady-state free precession sequence to acquire slice-wise dynamic images with a sampling rate of 3 Hz. Other imaging parameters were as follows: typical 4

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field-of-view = 350 × 350 × 140 mm3, in-plane pixel size = 1.8 × 1.8 mm2, and coronal slice thickness = 4 or 5 mm. Scan times ranged from 11 to 20 minutes. The images were retrospectively sorted by an image-based internal respiratory surrogate. Image frames

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showing similar amplitude-percentiles in the surrogate signal were combined to

reconstruct image volumes at 10 temporally equidistant respiratory phases (i.e., each

volume corresponded to one-tenth of a respiratory cycle). Additional details of the 4D

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MRI method are available elsewhere (14). The MR imaging was performed with a 1.5T or 3T MRI scanner (MAGNETOM Avanto, Siemens Healthcare, Erlangen, Germany;

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Ingenia, Philips Healthcare, Best, The Netherlands). Patients younger than 8 years and a 12-year-old patient received intravenous propofol-based anesthesia without intubation under the supervision of an anesthesiologist during the imaging session. All patients were scanned in a supine position with positioning cushions (Vac-Lok, CIVCO Medical

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Solutions, Coralville, IA), as accommodated by the magnet aperture (60 or 70 cm). Average respiration rates were derived from image-based respiratory surrogate signals

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(Table 1).

Derivation of organ motion from 4D MRI

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Organ motion was automatically derived from the 4D MRI datasets by a cyclic DIR method (15) (Fig. 1A). This procedure created an implicit reference image volume and yielded the deformation fields between each phase volume and the reference. Using an implicit reference volume eliminated the need to choose a reference phase and the resultant bias towards the chosen phase. The reference image volume was defined as the geometric mean of the corresponding anatomical positions in the 10 image volumes of

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4D MRI. Because the respiratory phases were temporally equidistant, the reference image volumes yielded time-weighted mid-positions. We converted the deformation fields to motion vectors at each phase (referred to as “phase-wise motion”), which forms a closed-

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loop trajectory over the respiratory cycle (Fig. 1B).

Anatomical landmarks

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Organ motion information was available at any location within the image field-of-view, but we focused on major anatomical landmarks of interest. These landmarks included the

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center of mass (COM) of gross tumor volume (GTV), dome of the right hemidiaphragm (i.e., the right liver dome), gallbladder, and COM and superior edge (SE) of the liver, spleen, and kidneys. The gallbladder was a surrogate landmark for the porta hepatis,

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where lymph nodes are occasionally targeted for radiotherapy.

Organ SEs were manually identified for each reference MR image. The COM was determined by calculating the mean coordinates of all voxels within the anatomical

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structure. The anatomical structures were adopted from those delineated on a CT for clinical use. We used MIM software (MIM Software Inc., Cleveland, OH) to semi-

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automatically register the CT to the reference MR image and applied the transformation to the structures. The registered structures were manually adjusted as necessary. Representative registered 4D MRIs with propagated contours are presented in Fig. 1C.

Statistical analysis on peak-to-peak motion

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We quantified peak-to-peak motion (i.e., the maximum extent of phase-wise motion) in 3 spatial dimensions (anteroposterior [AP], mediolateral [ML], and superoinferior [SI]) for each anatomical landmark. The associations between peak-to-peak motion and patient

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characteristics (i.e., age, gender, height, body weight, and respiration rate) were examined by simple or multiple linear regressions with R software (The R Foundation for Statistical

distribution uniformity of the characteristics.

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Computing, Vienna, Austria). Kolmogorov-Smirnov tests were used to evaluate the

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A group-wise analysis was performed to compare the peak-to-peak motion with those reported by a previous study that analyzed 4D CT data from a different pediatric cohort (4). For consistency with that study, we divided the patients into 2 age groups (younger, 1–8 years and older, 9–20 years) and performed statistical analyses of the peak-to-peak

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motion for each group. The 2 studies were compared by a 2-sample t-test. This comparison was limited to the right liver dome and kidneys that were commonly reported

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by the 2 studies.

Standard deviation of phase-wise motion

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Phase-wise motion provides additional information besides peak-to-peak extent. We also calculated the standard deviation of the phase-wise motion, ߪ௠ . This standard deviation corresponds to motion-induced targeting error during radiation treatment, which has been utilized in determining appropriate margins of planning target volume (PTV) (16,17) or organ at risk (OAR) (18,19).

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We investigated predicting ߪ௠ of prospective patients using the existing database of patient height and organ motion. This prediction could be useful for determining the need of 4D imaging and motion management before simulation for treatment planning. When

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the tumor or tumor bed are inside an OAR or immediately adjacent to it (e.g., Wilms’ tumors or sarcomas of the diaphragm) and especially tumor beds are not clearly

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discernible, OAR motion may serve as a surrogate to target motion.

We selected height rather than age as the predictor variable because body size is

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potentially more relevant to the magnitude of respiratory motion. Figure 2 illustrates the procedure of predicting ߪ௠ for the right liver dome. Such plots for all anatomical landmarks are provided in Appendices A and B. The phase-wise linear regression of all motion and height data gives the fitted motion, ܻ௜ , at each phase ݅ as a function of height.

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For a given height, the standard deviation of ܻ௜ over all phases yields ߪ௠ . This prediction was evaluated by a leave-one-out approach. Specifically, a relation between height and ߪ௠ was first established by using the present motion data excluding 1 patient. Then, the

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predicted ߪ௠ for that patient by using this relation was compared with the actual ߪ௠ . This

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procedure was repeated for all patients.

Results

Representative motion trajectory A representative motion trajectory of the right kidney COM from a 12-year-old patient is depicted in Fig. 1B. Hysteresis (i.e., different paths between inhalation and exhalation) and varying speeds throughout the respiratory cycle were evident in the trajectory. A

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longer arrow indicates a faster motion because the time between adjacent phases was the same. It was apparent that the kidney COM moved faster near end-inhalation than at endexhalation. Consequently, the time-weighted mid-position at the origin was located

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towards end-exhalation. The phase-wise fitted motion (Fig. 2B) also demonstrated that the standard deviation (ߪ௠ ) was shifted towards end-exhalation because of the slower motion at this respiratory phase. We observed such features in other anatomical

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landmarks as well.

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Peak-to-peak motion relative to anatomical sites and patient characteristics The peak-to-peak SI motions of the anatomical landmarks for all patients are listed in Table 1. The magnitude of organ motion and its individual variation were generally greater for older patients. The variation across different organs was also apparent. The

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kidneys displayed smaller motion than did the liver and spleen. All but 1 patient younger than 8 years exhibited kidney motion less than 5 mm. In contrast, liver and spleen motion was often greater than 10 mm particularly in older patients. The tumor motion depended

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on the treatment site, as well as age. GTV motion greater than 5 mm occurred in 5 older patients who received radiation to the spleen, lung base, diaphragm, liver, and upper

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abdomen (11.7, 6.0, 5.5, 7.9, and 6.6 mm for Patients 20, 26, 27, 28, and 31, respectively), which often exhibited greater motion than did other sites.

The group-wise statistics further showed the intra-organ variation of the motion (Table 2). The COM of liver and spleen demonstrated significantly less motion (paired t-test, P<0.001) than did the right liver dome and spleen SE, respectively, indicative of elastic

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changes during respiration. The magnitude of motion in different directions occurred generally in the order of SI > AP > ML. The upper 95% confidence interval was ≤ 4 mm

focused on the SI motion for regression analysis.

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for all AP and ML motions regardless of age and anatomy. Therefore, we specifically

The peak-to-peak SI motion was significantly correlated with age and height (P <.05) for

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all anatomical landmarks. Both age and height correlated with the motion equally. A high correlation between age and height (P <.001) indicated that they were equivalent

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covariates for the present cohort. The correlation of the organ motion with body weight or respiration rate was relatively moderate and it did not reach statistical significance for a few landmarks. However, analysis of variance (ANOVA) on multiple regressions revealed that using respiration rate as an additional covariate to age or height improved

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the regression, particularly for the liver and spleen. The ANOVA also indicated that the gender of the patient did not improve the regression, which is indicative of similar organ

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motion between male and female patients in the cohort.

The peak-to-peak organ motion quantified in this study was comparable with that

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described in the previous pediatric 4D CT study (4). A 2-sample t-test revealed that no significant difference (P >.05) was present between the 2 studies for the SI motions of the right liver dome and kidneys.

Prediction of the standard deviation of phase-wise motion (σm)

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The height and age of the present cohort were uniformly distributed (i.e., the nullhypothesis of uniformity could not be rejected, P = .13 and P = .18, respectively), supporting the characteristic-based prediction of ߪ௠ . The predicted ߪ௠ at a given height

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is listed in Table 3 for each anatomical landmark. The liver and spleen showed larger ߪ௠ values than kidneys in accordance with the larger peak-to-peak motions. The errors of the predicted ߪ௠ evaluated by the leave-one-out approach (Fig. 3) were sub-millimeters for

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kidneys in patients younger than 8 years (i.e., shorter than 125 cm). However, errors

larger than 1mm and 2 mm were respectively found in 89% and 17% of the patients older

Discussion Comparison with previous studies

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than 8 years (16 and 3 of 18 patients, respectively).

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Our findings demonstrate that respiration-induced pediatric organ motion is associated with age and varies with anatomical location. Organ motion was relatively small in younger patients, which is consistent with previous reports (4,20-22). The peak-to-peak

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motion of the kidneys of patients younger than 8 years was mostly below the magnitude that may warrant respiratory management (i.e., < 5 mm) (23). In contrast, organ motion in

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older patients was comparable with that of adults (9,24). Similar findings between this study and the previous 4D CT study on pediatric patients (4) support the use of 4D MRI, rather than 4D CT, for monitoring organ motion.

Individual variation of organ motion

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Table 1 suggests that factors other than age likely contributed to individual variation of organ motion. Height, body weight, and gender did not yield more information than did age to account for the individual variations. This was possibly due to the limited cohort

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size and large variations within the same characteristics. The selection of height rather

than age for the predictor variable was based on its potential advantage, although our data

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did not reveal any evidence.

We observed a large variation of respiration rate in the patients who received anesthesia.

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The organ motion tended to be greater in the patients showing slower respiration as confirmed by the ANOVA of multiple regressions. These observations imply that anesthesia affects respiration rate and, in turn, organ motion. The anesthesia effect appeared to be dependent on patient-specific co-induction agents accompanied with

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propofol. Among the younger patients, those adjunctively receiving opioids (Patients 3 and 16) exhibited the lowest respiration rates (9.2 and 15.0 breaths/min).

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Other factors such as anatomical differences, pathology, and surgery may also contribute to the individual variations in respiration and organ motion. We noted that pulmonary

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function tests suggested restrictive lung physiology and air-trapping for 2 patients (Patients 21 and 33) who displayed smaller organ motions than those of similar ages. The 2 patients with Wilms’ tumor who received right nephrectomy (Patients 14 and 28) and another patient with metastatic osteosarcoma who underwent right thoracotomy with en bloc resection (Patient 27) displayed greater motion in their left organs.

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The errors in predicted ߪ௠ (Fig. 3) also reflected the individual variations of organ motion. The large errors for some young adults indicated that relying only on body size may not be feasible for predicting the organ motion for such patients and warranted

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patient-specific 4D imaging.

Other implications

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Age-associated respiratory motion fields are also useful for studying respiratory motion models for pediatric patients (25). Such models are essential to derive full 4D motion

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from on-board cine images produced by MRI-teletherapy systems (26). Respiratory motion fields are also required to evaluate the interplay effect in spot scanning proton therapy (27). Previous interplay effect studies relied on 4D CT, but 4D MRI would be

Study limitations

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advantageous for accurate measurement of motion fields, particularly in small targets.

Our results should be interpreted in light of a few limitations. Because just one 4D MRI

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dataset was acquired per patient, this study did not address any intra-patient reproducibility or variation (i.e., intra-fractional irregularities or inter-fractional variation).

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This limitation will be addressed in future studies, as repetitive 4D MRI datasets become mature.

Appropriate organ motion quantification is subject to the accuracies of 4D MRI, DIR, and landmark positioning. The voxel size of the coronal imaging (1.8 mm in the SI and ML directions; 4 or 5 mm in the AP direction) was somewhat greater than the peak-to-

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peak motions presented in Tables 1 and 2. However, DIR-based quantification is based on the fact that organ motion is continuous and smooth (15,28). For example, SE and COM motions exhibit only millimeter differences, although they are separated by

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centimeter distances. Such motions can be detected, despite coarse resolution, by

representing them as continuous B-spline functions. Our quantification focused on the

dominant motion in the SI direction, in which the effect of limited resolution is minimal.

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The smooth feature of organ motion also makes the quantification insensitive to

mispositioning of the landmarks. We found that intentionally shifting of the landmark by

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a few millimeters mostly resulted in submillimeter differences in the quantified motion. The accuracy of the quantification was further supported by the previous study (14) reporting spatial errors of the 4D MRI that were, on average, smaller than voxel. The evaluation of the DIR method on CT and MR images also showed sub-voxel accuracy

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(15,29). New techniques to enhance image quality and scan efficiency (30-33) are

4D MRI.

Conclusions

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expected to provide opportunities for more accurate quantification of organ motion using

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This study characterized respiration-induced organ motion in a pediatric cohort by using an advanced 4D MRI method. The association of organ motion with age and anatomical site was apparent and comparable with previous 4D CT studies of the liver and kidneys. The effect of anesthesia on organ motion also appeared to present. Despite such associations, characteristic-based prediction of organ motion was limited for older patients because of large individual variations in organ motion. The non-ionizing imaging

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modality of 4D MRI, coupled with superior soft tissue discrimination, facilitates

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monitoring changes in target motion pattern during treatment courses.

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Figure Captions Fig. 1. A 4D MRI method to determine organ motion. (A) Acquisition of 4D MRI and

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post-processing. Slice-wise dynamic 2D images were sorted by an image-based respiratory surrogate signal to reconstruct 3D image volumes at 10 respiratory phases.

The deformable registration fields between the volumes were converted to motion vectors for each voxel. (B) A representative motion trajectory of the right kidney center of mass

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of a 12-year-old patient. A 3D plot (top left) and 2D plots in orthogonal planes are

depicted. Each plot shows the phase-wise motion (open blue circles) with reference to the

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time-weighted mid-position (closed red circle). The arrows connecting open circles indicate the direction of motion. (C) Examples of 4D MR images in coronal, sagittal, and transverse views (from left to right) overlaid with the propagated contours for 2 representative patients with neuroblastoma (top and bottom rows). The red, blue, yellow,

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and orange contours indicate GTV, liver, right kidney, and left kidney, respectively. Abbreviations: AP = anteroposterior; GTV = gross tumor volume; ML = mediolateral; SI

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= superoinferior.

Fig. 2. Prediction of the standard deviation of phase-wise motion (ߪ௠ ) illustrated with the

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right liver dome. (A) Phase-wise linear regression of the superoinferior (SI) motion with height, including fitted line (black solid line) and 95% prediction interval (dashed red line). Only the plots of phases 1 and 5 are shown for simplicity. Positive numbers indicate motion in the superior direction. (B) For a given height, the fitted motions (ܻ௜ ) of all phases were used to calculate ߪ௠ which is indicated by horizontal black dot-dashed lines. The phase indices (݅ = 1, 2, …,10) were assigned so that phase 1 indicated end-

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exhalation and phases 4 through 6 fell on end-inhalation depending on the individual breathing pattern.

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Fig. 3. Evaluation of the predicted standard deviation of phase-wise motion (ߪ௠ ). The plot for each anatomical landmark compares individual superoinferior motions (blue

squares) with corresponding predictions (red circles) that were derived by the leave-one-

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out approach. Abbreviations: COM=center of mass; L=left; R=right; SE=superior edge.

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M AN U

SC

RI PT

33.

20

ACCEPTED MANUSCRIPT

The purpose of this appendix is to provide the complete data of this study which have been partly presented in the manuscript due to the limited space. Note that this file is prepared with a very high resolution. The figures and table may be zoomed in as much as needed.

SC

RI PT

Appendix A: Linear regression of the phase-wise organ motion with height The regression on phase-wise motion for all phases and heights are in Figs. A1-A10 which are extensions of Fig. 2A. The 10 figures correspond to the 10 respiratory phases and each figure has 10  3 plots for the motions of 10 anatomical landmarks in 3 dimensions. The motion towards right, anterior, or superior is indicated by positive number. The phase-wise motion (blue circle marker) is presented with the fitted line (black solid line) and 95% prediction (red dashed line) as in Fig. 2A. Abbreviations: AP = anteroposterior; COM= center of mass; L = left; ML= mediolateral; R = right; SE = superior edge; SI = superoinferior

AC C

EP

TE D

M AN U

Appendix B: Prediction of standard deviation of phase-wise organ motion The Figs. B1-B21 are extensions of Fig. 2B where the standard deviation of phase-wise organ motion was derived. The 21 figures correspond to the 21 heights and each figure has 9  3 plots for the motions of 9 anatomical landmarks in 3 dimensions. Each plot shows the fitted value of the phasewise motion (blue circle marker) at each respiratory phase. The black dot-dashed horizontal line indicates the standard deviation ( of the motion. Abbreviations: AP = anteroposterior; COM= center of mass; L = left; ML= mediolateral; R = right; SE = superior edge; SI = superoinferior

ACCEPTED MANUSCRIPT Phase−wise motion (phase 1) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A1. Linear regression of phase−wise organ motion with height (phase 1).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 2) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A2. Linear regression of phase−wise organ motion with height (phase 2).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 3) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A3. Linear regression of phase−wise organ motion with height (phase 3).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 4) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A4. Linear regression of phase−wise organ motion with height (phase 4).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 5) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A5. Linear regression of phase−wise organ motion with height (phase 5).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 6) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A6. Linear regression of phase−wise organ motion with height (phase 6).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 7) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A7. Linear regression of phase−wise organ motion with height (phase 7).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 8) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A8. Linear regression of phase−wise organ motion with height (phase 8).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 9) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A9. Linear regression of phase−wise organ motion with height (phase 9).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT Phase−wise motion (phase 10) R liver dome 6

6

6

6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

1.2 1.4 1.6 1.8 Height (m)

−6

−8 0.6 0.8

2

1

Liver COM

1.2 1.4 1.6 1.8 Height (m) Liver COM

8

6

6

6

6

−2 −4 −6

−2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

2 0 −2 −4 −6

1

Gallbladder

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0 −2 −4 −6

4 2 0 −2 −4 −6

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

1

4 2 0 −2 −4

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −8 0.6 0.8

2

1

2

8

6

6 AP Motion (mm)

8 4 2 0 −2 −4 −6

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−4

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

1

1.2 1.4 1.6 1.8 Height (m)

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1

10 8 6 4 2 0 −2 −4 −6 −8 −10 −12 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

1.2 1.4 1.6 1.8 Height (m)

−2 −4

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

R Kidney COM 8

6

6

4 2 0

−2 −4

2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

6

6

0

−2 −4

1

1.2 1.4 1.6 1.8 Height (m)

4 2 0 −2 −4 −6 −8 0.6 0.8

2

2 0 −2 −4

1

1.2 1.4 1.6 1.8 Height (m)

−8 0.6 0.8

2

8

8

6

6

6

0 −2 −4

2

Fig. A10. Linear regression of phase−wise organ motion with height (phase 10).

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

1

2

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

2

R Kidney SE

8

2

2

4

R Kidney SE

4

1.2 1.4 1.6 1.8 Height (m)

−6

R Kidney SE

−8 0.6 0.8

1

L Kidney SE

6 2

2

4

8

4

1.2 1.4 1.6 1.8 Height (m)

R Kidney COM

8

−8 0.6 0.8

1

L Kidney SE

−6 2

0

8

Spleen COM

1

1

L Kidney SE

2

2

8

−8 0.6 0.8

2

4

−6

−6

−6

Spleen COM

SI Motion (mm)

Spleen COM

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m)

0

Spleen SE

−6 1

−2

AC C

−6

0

−8 0.6 0.8

2

SI Motion (mm)

6 AP Motion (mm)

6

−8 0.6 0.8

1.2 1.4 1.6 1.8 Height (m) Spleen SE

8

2

−6

Spleen SE 8

4

EP

1

2

−8 0.6 0.8

2

TE D

2

SI Motion (mm)

6 AP Motion (mm)

8

4

1.2 1.4 1.6 1.8 Height (m) Gallbladder

8

−8 0.6 0.8

1

Gallbladder

8

4

−6

ML Motion (mm)

−8 0.6 0.8

0

4

ML Motion (mm)

0

2

1

M AN U

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−4

R Kidney COM

8 4

−2 −6

−8 0.6 0.8

2

0

SI Motion (mm)

1

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8 0.6 0.8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1

1.2 1.4 1.6 1.8 Height (m)

2

−8 0.6 0.8

1

1.2 1.4 1.6 1.8 Height (m)

2

ACCEPTED MANUSCRIPT 80 cm tall (1 year old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B1. Derivation of the standard deviation of phase−wise organ motion (80 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 85 cm tall (1 year old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B2. Derivation of the standard deviation of phase−wise organ motion (85 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 90 cm tall (2 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B3. Derivation of the standard deviation of phase−wise organ motion (90 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 95 cm tall (3 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B4. Derivation of the standard deviation of phase−wise organ motion (95 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 100 cm tall (4 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B5. Derivation of the standard deviation of phase−wise organ motion (100 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 105 cm tall (5 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B6. Derivation of the standard deviation of phase−wise organ motion (105 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 110 cm tall (6 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B7. Derivation of the standard deviation of phase−wise organ motion (110 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 115 cm tall (7 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B8. Derivation of the standard deviation of phase−wise organ motion (115 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 120 cm tall (8 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B9. Derivation of the standard deviation of phase−wise organ motion (120 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 125 cm tall (8 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B10. Derivation of the standard deviation of phase−wise organ motion (125 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 130 cm tall (9 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B11. Derivation of the standard deviation of phase−wise organ motion (130 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 135 cm tall (10 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B12. Derivation of the standard deviation of phase−wise organ motion (135 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 140 cm tall (11 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B13. Derivation of the standard deviation of phase−wise organ motion (140 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 145 cm tall (12 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B14. Derivation of the standard deviation of phase−wise organ motion (145 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 150 cm tall (13 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B15. Derivation of the standard deviation of phase−wise organ motion (150 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 155 cm tall (14 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B16. Derivation of the standard deviation of phase−wise organ motion (155 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 160 cm tall (15 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B17. Derivation of the standard deviation of phase−wise organ motion (160 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 165 cm tall (15 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B18. Derivation of the standard deviation of phase−wise organ motion (165 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 170 cm tall (16 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B19. Derivation of the standard deviation of phase−wise organ motion (170 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 175 cm tall (17 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B20. Derivation of the standard deviation of phase−wise organ motion (175 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT 180 cm tall (18 years old) R liver dome 6

6

6

6

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Liver COM

Liver COM 8

6

6

6

6

−6 −8

−4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Gallbladder

0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

6

6

6

4 2 0 −2 −4 −6 −8

SI Motion (mm)

8

AP Motion (mm)

8 4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen SE

6

6

6

0 −2 −4

−2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase Spleen COM

6

6 AP Motion (mm)

8

2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase

4 2 0 −2

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase

−2 −4 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

6

6

4 2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

6

6

6

2 0

−2 −4 −8

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

4 2 0 −2 −4 −6 −8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8

8

6

6

6

2 0 −2 −4 −6 −8

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

Spleen COM

2 0

−2 −4

1 2 3 4 5 6 7 8 9 10 Phase

Fig. B21. Derivation of the standard deviation of phase−wise organ motion (180 cm tall).

−8

1 2 3 4 5 6 7 8 9 10 Phase R Kidney SE

8 4

1 2 3 4 5 6 7 8 9 10 Phase L Kidney SE

8

4

1 2 3 4 5 6 7 8 9 10 Phase R Kidney COM

8

4

−8

0

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

2

−6

−6

1 2 3 4 5 6 7 8 9 10 Phase

6

−4 −8

−4

8

−6 1 2 3 4 5 6 7 8 9 10 Phase

0

Spleen COM

8 4

2

−6

SI Motion (mm)

−8

0

−2

4

8

L Kidney SE

1 2 3 4 5 6 7 8 9 10 Phase

AC C

−6

2

4

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

EP

2

SI Motion (mm)

8

AP Motion (mm)

8 4

0

Spleen SE

8 4

2

−8

1 2 3 4 5 6 7 8 9 10 Phase

Gallbladder

8

4

−6

ML Motion (mm)

−4

−2

2

ML Motion (mm)

−2

0

−4 −6

M AN U

0

2

4

TE D

2

ML Motion (mm)

8 SI Motion (mm)

8 4

−2

R Kidney COM

8 4

0

SI Motion (mm)

−8

1 2 3 4 5 6 7 8 9 10 Phase

−6

−4

2

SI Motion (mm)

−6

−4

−2

4

SI Motion (mm)

−4

−2

0

AP Motion (mm)

−4

−2

0

2

AP Motion (mm)

−2

0

2

4

AP Motion (mm)

0

2

4

RI PT

2

4

SC

4

SI Motion (mm)

6

AP Motion (mm)

6

ML Motion (mm)

8

SI Motion (mm)

8

AP Motion (mm)

ML Motion (mm)

L Kidney COM

8

Liver COM

ML Motion (mm)

L Kidney COM

8

−8

ML Motion (mm)

L Kidney COM

8

−6

ML Motion (mm)

R liver dome

8 AP Motion (mm)

ML Motion (mm)

R liver dome

4 2 0 −2 −4 −6

1 2 3 4 5 6 7 8 9 10 Phase

−8

1 2 3 4 5 6 7 8 9 10 Phase

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

Table 1 Patient characteristics and superoinferior peak-to-peak motion (mm) of anatomical landmarks* Patient Age Height Weight Respiration rate General Gender Tumor type Treatment site number (years) (cm) (kg) (breath/min) anesthesia 1 1 78 M 11.1 47.3 Yes Neuroblastoma Renal, retrocrural 2 2 83 M 12.0 49.0 Yes Neuroblastoma Left abdomen 3 2 85 F 12.0 9.2 Yes Neuroblastoma Left abdomen 4 2 87 M 11.9 36.8 Yes Neuroblastoma Left adrenal 5 3 95 M 14.0 20.7 Yes Neuroblastoma Right adrenal 6 3 94 F 14.0 25.1 Yes Neuroblastoma Right adrenal 7 3 99 F 14.0 20.7 Yes Neuroblastoma Left adrenal 8 4 100 F 17.6 34.4 Yes Neuroblastoma Right adrenal 9 4 102 M 14.7 25.0 Yes Neuroblastoma Right abdomen 10 4 99 M 14.4 21.5 Yes Rhabdomyosarcoma Retroperitoneum 11 5 101 F 13.7 29.1 Yes Neuroblastoma Left adrenal 12 5 109 F 17.0 34.5 Yes Neuroblastoma Left abdomen 13 5 108 M 16.2 27.3 Yes Neuroblastoma Thoracoabdominal 14 5 104 M 15.7 17.0 Yes Wilms’ tumor Inferior lung 15 6 109 M 18.6 18.1 Yes Neuroblastoma Right abdomen 16 6 116 M 19.0 15.0 Yes Neuroblastoma Abdomen 17 7 123 F 21.0 24.4 Yes Neuroblastoma Left adrenal 18 9 127 M 19.9 29.5 No Neuroblastoma Right perirenal 19 11 154 F 51.0 19.2 No Ewing's sarcoma Whole lung 20 11 143 M 32.0 21.5 No Hodgkin lymphoma Spleen 21 12 154 F 50.0 28.0 Yes Neuroblastoma Left abdomen paraspinal 22 12 170 F 77.6 19.6 No Rhabdomyosarcoma Whole abdomen 23 12 153 M 40.0 21.3 No DSRCT Whole abdomen 24 13 152 M 47.0 23.3 No Hepatoblastoma Liver/Upper abdomen 25 15 167 F 61.2 31.6 No Rhabdomyosarcoma Left chestwall 26 15 157 M 92.0 24.9 No Hodgkin lymphoma Right lung base 27 15 165 F 44.0 20.1 No Osteosarcoma Right diaphragm 28 15 172 M 56.3 17.8 No Wilms’ tumor Liver 29 17 158 F 43.4 22.5 No Fibrosarcoma Whole abdomen 30 17 179 M 93.0 17.7 No Hodgkin lymphoma Anterior mediastinum 31 18 168 F 79.0 19.3 No Hodgkin lymphoma Liver/Upper abdomen 32 19 161 F 88.0 18.0 No Hodgkin lymphoma Mediastinum 33 19 182 M 61.3 14.0 No DSRCT Whole abdomen 34 19 160 F 65.4 17.2 No Hodgkin lymphoma Left mediastinum 35 20 179 M 81.0 15.3 No Hodgkin lymphoma Right axilla

ACCEPTED MANUSCRIPT

AC C

EP

TE D

M AN U

SC

RI PT

Table 1 (continued) Patient characteristics and superoinferior peak-to-peak motion (mm) of anatomical landmarks* Patient Age Height GTV R Liver Liver Gall- Spleen Spleen L Kidney R Kidney L Kidney R Kidney number (years) (cm) COM dome COM bladder SE COM COM COM SE SE 1 1 78 1.0 1.9 1.1 0.8 2.6 1.8 1.2 1.2 1.0 1.0 2 2 83 0.7 1.2 0.8 0.5 1.7 0.6 0.6 1.2 0.5 1.4 3 2 85 2.4 5.8 6.6 3.7 5.7 5.5 0.8 2.7 0.9 2.7 4 2 87 2.1 5.0 3.4 2.3 2.9 1.5 1.3 2.6 1.0 2.4 5 3 95 2.1 4.9 2.5 1.2 5.5 3.6 1.9 1.5 1.9 1.3 6 3 94 1.0 5.4 1.6 1.3 4.4 3.0 1.9 1.3 1.7 1.7 7 3 99 0.8 3.3 2.7 5.2 2.8 1.8 0.9 1.9 0.7 1.7 8 4 100 2.0 3.0 1.7 1.0 2.8 2.5 0.9 1.3 0.9 1.9 9 4 102 1.6 3.7 1.7 1.2 4.4 3.6 2.8 1.5 2.4 1.3 10 4 99 2.5 7.6 6.2 5.6 3.2 2.0 1.9 3.8 2.0 2.6 11 5 101 0.6 5.1 3.6 2.7 1.9 1.2 1.0 3.4 0.4 2.2 12 5 109 1.1 3.0 2.2 0.7 3.0 2.2 1.4 2.2 1.4 2.2 13 5 108 1.2 4.1 2.1 1.6 2.5 1.7 1.1 1.9 1.1 1.8 14 5 104 2.1 3.3 0.9 1.1 5.7 4.2 1.6 1.6 15 6 109 2.6 7.9 4.9 4.1 4.2 3.9 2.5 2.5 2.8 1.8 16 6 116 3.3 9.0 7.7 4.8 10.2 10.8 4.5 4.0 5.3 3.0 17 7 123 0.9 6.4 4.1 2.8 2.1 1.8 1.0 3.3 0.6 2.8 18 9 127 2.3 7.0 6.8 5.9 6.5 6.2 4.5 3.2 3.1 3.2 19 11 154 9.3 8.9 8.2 7.9 5.3 3.5 4.3 2.9 1.9 20 11 143 11.7 9.6 10.2 8.7 12.7 11.2 8.2 7.7 9.9 9.0 21 12 154 1.0 2.5 1.8 5.7 1.6 1.6 0.9 1.3 1.2 1.4 22 12 170 4.5 7.7 10.4 8.2 7.2 4.4 3.6 4.7 3.5 23 12 153 8.0 7.5 5.7 10.1 9.2 4.7 6.0 3.5 7.3 24 13 152 3.8 6.0 3.8 3.7 4.3 6.1 2.8 2.7 5.3 2.9 25 15 167 1.2 6.5 5.1 4.6 2.9 1.5 1.6 3.6 1.9 2.8 26 15 157 6.0 4.2 2.9 2.6 6.9 3.4 2.8 2.6 2.8 3.0 27 15 165 5.5 9.8 7.8 9.7 16.1 19.5 13.0 6.2 13.1 4.3 28 15 172 7.9 6.0 5.5 4.1 12.4 9.4 7.8 6.7 29 17 158 9.3 5.8 6.8 8.2 9.1 5.3 7.3 4.8 5.6 30 17 179 3.7 9.2 6.5 8.0 8.0 5.1 2.7 2.8 31 18 168 6.6 9.9 9.6 11.6 9.2 6.4 5.7 9.1 4.5 7.6 32 19 161 4.8 8.8 9.8 6.3 9.2 7.5 3.7 5.1 4.2 2.8 33 19 182 3.9 3.5 1.8 5.8 1.9 2.9 1.8 5.9 1.6 34 19 160 4.1 9.7 7.9 6.0 8.4 7.2 6.0 6.8 4.5 5.2 35 20 179 2.1 9.7 11.0 12.3 5.8 6.9 2.8 3.7 4.7 2.4 Abbreviations: DSRCT = Desmoplastic Small Round Cell Tumor; F = female; M = male. *A few landmarks for some cases were not available because GTV was not defined for 5 patients who received radiation to whole abdomen (n=4) or whole lung (n=1); 2 patients underwent right nephrectomy before receiving 4D MRI; and 4D MRI did not cover the center of kidneys for one patients.

ACCEPTED MANUSCRIPT

0.7 1.1 0.9 1.0 1.0 1.4 0.5 0.5 0.6 0.6

0.5 0.8 0.6 0.6 0.6 0.9 0.4 0.3 0.4 0.4

0.8 1.5 1.2 1.4 1.5 1.8 0.7 0.6 0.8 0.8

0.9 2.6 1.2 1.4 1.9 1.0 0.6 0.8 0.7 1.0

0.6 1.8 0.9 0.8 1.3 0.7 0.5 0.6 0.6 0.7

1.2 3.4 1.6 2.0 2.4 1.3 0.7 1.0 0.9 1.4

1.6 4.7 3.2 2.4 3.9 3.0 1.6 2.3 1.5 2.0

SI Lower Upper 95% CI 95% CI 1.2 3.6 2.1 1.5 2.8 1.8 1.1 1.8 0.9 1.7

RI PT

Younger (1-8 years, n=17)

GTV COM* R liver dome Liver COM Gall Bladder Spleen SE Spleen COM L Kidney COM R Kidney COM L Kidney SE R Kidney SE

SC

Patient group

Statistics of peak-to-peak organ motion (mm) in the pediatric patients grouped by age ML AP Anatomical Lower Upper Lower Upper landmark Mean Mean Mean 95% CI 95% CI 95% CI 95% CI

M AN U

Table 2

2.1 5.8 4.3 3.3 4.9 4.2 2.1 2.8 2.2 2.3

AC C

EP

TE D

GTVCOM* 1.4 1.0 1.8 2.4 1.6 3.3 4.7 2.9 6.5 R liver dome 1.4 1.1 1.6 2.6 2.1 3.0 7.4 6.2 8.6 1.2 0.7 1.6 2.2 1.6 2.8 6.8 5.5 8.1 Liver COM Gall Bladder 1.9 1.2 2.6 2.3 1.9 2.7 6.8 5.3 8.3 Older Spleen SE 1.6 1.2 1.9 3.3 2.6 4.0 8.0 6.3 9.8 (9-20 2.0 1.2 2.8 2.0 1.6 2.3 6.9 4.9 9.0 Spleen COM years, L Kidney COM 0.9 0.6 1.2 1.0 0.8 1.3 4.8 3.3 6.2 n=18) R Kidney COM 1.0 0.6 1.3 1.5 1.1 1.9 4.7 3.5 5.9 L Kidney SE 0.9 0.7 1.2 1.8 1.3 2.3 4.8 3.4 6.2 R Kidney SE 1.1 0.7 1.5 1.2 0.9 1.5 4.0 2.8 5.1 Abbreviations: AP=anteroposterior; CI=confidence interval; ML=mediolateral; L = left; R = right; SE = superior edge; SI = superoinferior. *The statistics of tumor motion reflect variation across different tumor sites as well as individual variation.

ACCEPTED MANUSCRIPT

Table 3 Height (cm)

Estimated standard deviation (ߪ௠ ) of phase-wise superoinferior motion (mm) Age (years)*

R liver dome

Liver COM

Gallbladder

Spleen SE

Spleen COM

L Kidney COM

R Kidney COM

L Kidney SE

0.5 0.5 0.6 0.6 0.6 0.7 0.7 0.8 0.8 0.9 0.9 1.0 1.0 1.1 1.1 1.2 1.2 1.3 1.3 1.3 1.4

AC C

EP

TE D

M AN U

SC

RI PT

80 1 1.0 0.4 0.1 0.6 0.5 0.2 0.4 0.2 85 1 1.1 0.5 0.1 0.8 0.6 0.3 0.5 0.2 90 2 1.2 0.6 0.2 0.9 0.7 0.3 0.6 0.3 95 3 1.3 0.7 0.3 1.0 0.8 0.4 0.6 0.4 100 4 1.3 0.8 0.4 1.1 0.9 0.5 0.7 0.5 105 5 1.4 0.9 0.5 1.2 1.0 0.6 0.8 0.6 110 6 1.5 1.0 0.7 1.3 1.1 0.7 0.8 0.6 115 7 1.6 1.1 0.8 1.4 1.2 0.7 0.9 0.7 120 8 1.7 1.3 1.0 1.5 1.3 0.8 1.0 0.8 125 8 1.8 1.4 1.1 1.7 1.4 0.9 1.0 0.9 130 9 1.8 1.5 1.2 1.8 1.5 1.0 1.1 1.0 135 10 1.9 1.6 1.4 1.9 1.6 1.0 1.2 1.0 140 11 2.0 1.7 1.5 2.0 1.7 1.1 1.2 1.1 145 12 2.1 1.8 1.6 2.1 1.8 1.2 1.3 1.2 150 13 2.2 1.9 1.8 2.2 1.9 1.3 1.3 1.3 155 14 2.3 2.0 1.9 2.3 2.0 1.4 1.4 1.4 160 15 2.3 2.1 2.0 2.5 2.1 1.4 1.5 1.4 165 15 2.4 2.2 2.2 2.6 2.2 1.5 1.5 1.5 170 16 2.5 2.3 2.3 2.7 2.3 1.6 1.6 1.6 175 17 2.6 2.4 2.4 2.8 2.4 1.7 1.7 1.7 180 18 2.7 2.5 2.6 2.9 2.5 1.8 1.7 1.8 Abbreviations: COM=center of mass; L = left; R = right; SE = superior edge. *Approximate age corresponding to the height given by the linear regression: age = 0.175 × height - 13.4.

R Kidney SE

A

Slice 1

Slice 2

...

ACCEPTED MANUSCRIPT Slice N

B

2

1

1.5 1 0.5

0.5 AP (mm)

SI (mm)

0 -0.5 -1 -1.5 -2

0

anterior

-0.5

right

-2.5

-1

2

... Retrospective sorting

-0.5

0

0.5

1

ML (mm)

end-exhalation

1.5

-1

-1.5

-2

superior

TE D

EP AC C

C

end-exhalation

0 -0.5 -1 -1.5

-0.5 0 0.5 AP (mm)

superior

endinhalation

-2.5

anterior

Deformable image registration

1

0.5

-2

-2.5

-3 -1

-0.5 0 0.5 ML (mm)

1

M AN U

Phase 2 . . . Phase 10

SI (mm)

0

-0.5

2

1 0.5

-1

SI (mm)

1.5

Phase 1

0 -0.5

RI PT

AP (mm)

peak-to-peak motion in SI

Derivation of internal respiratory surrogate by dimensionality reduction

-1 -1

SC

64 frames

-3 1 0.5

right

1

-3 -1

-0.5 0 0.5 ML (mm)

1

ACCEPTED MANUSCRIPT

A

RI PT

End-inhalation (phase 5)

M AN U

SC

End-exhalation (phase 1)

EP

TE D

80 cm tall (1 year old)

AC C

B

inhalation

exhalation

180 cm tall (18 years old)

AC C

EP

TE D

M AN U

SC

RI PT

ACCEPTED MANUSCRIPT