Quantitative assessment of dose accumulation uncertainty using a commercial deformable image registration algorithm in adaptive intensity-modulated proton therapy for prostate cancer

•The impact of DIR error on prostate proton dose accumulation was evaluated.•A well-regularized DIR algorithm was used as a reference.•The geometric and dosimetric DIR error was assessed on a structure-basis.•Dose variation due to anatomical change exceeded the DIR uncertainties.•The structure-guide...

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