Everyday Use of Optical Cherenkov Imaging Identifies Adverse Events and Opportunities for Improved Radiation Treatment

摘要 放射治疗是一种辅助治疗，与大多数手术和化疗一起使用， 每四个人中就有一个在他们的一生中被传递。外照射治疗通常 分次给药（即每天给药25-40天）。虽然它通常被认为是安全和有效的，但许多 相信这样会更安全如果不给予每日高剂量，可能会发生主要的潜在副作用 精确度，包括毫米级患者对准和护理，以保持正常组织剂量足够低。 然而，这种治疗的继发性癌症发生率已证实为1-5%。这一点尤其重要 在乳房放射治疗中，即使对侧乳房的剂量为1%，也已被证明会导致较高的 继发性癌症的可能性。事实上，没有一家诊所真正知道他们的真实发病率，因为没有系统 存在可视化作为常规临床实践的一部分的每个治疗。BeamSiteTM系统的发明， 用于切伦科夫光发射的时间选通单光子成像，提供了第一个直接的视频成像， 辐射剂量传递。该系统以真实的时间捕获递送事件的直接可视化， 从而治疗师可以进行直观的观察，并且可以根据需要进行日常校正。在 在本申请中，我们将开展一项多中心临床研究，以研究切伦科夫成像的能力 来探测迄今为止未被发现的事件我们还将推进系统的工作流程， 自动化事件检测工具，使治疗团队能够轻松使用BeamSiteTM。最后，系统将 还可以扩展剂量估计算法，以估计长期继发性癌症风险。该项目 基于先前NIH支持的硬件，该硬件已获得FDA 510（k）批准上市，并将部署 通过这里提出的工具的增强。本提案为以下目标提供资源： 量化在多种放射治疗临床设置中患者的总体治疗中的错误率，以及（ii）量化 非靶组织的计划外剂量，包括全乳放疗中的对侧乳腺。 这项工作包括软件支持和光学闪烁体剂量测定开发，将用于 这些目标。事件发生率的前瞻性人体研究将在 达特茅斯-希区柯克健康医疗中心。该系统产生的数据将证明， 治疗的可视化可以改变跟踪日常放射治疗的方式，并提供一种工具， 改善每个参与中心，从而降低脱靶辐射的继发性发病率。 存在财务偿还，随着外地转向基于质量而不是基于数量的偿还， 切伦科夫成像将成为所有领先的放射治疗单位的主食。

ABSTRACT Radiation therapy is a supplementary curative treatment used adjuvant with most surgery and chemotherapy, being delivered to nearly 1 out of every 4 people in their lifetime. External beam treatment is commonly fractionated (i.e. delivered every day for 25-40 days). While it is generally considered safe and effective, many in the field believe it could be safer. Major potential side effects can occur if not administered with high daily accuracy, including millimeter level patient alignment and care to keep normal tissue doses sufficiently low. However, there is a proven 1-5% incidence of secondary cancer from this treatment. This is particularly relevant in breast radiotherapy, where even a 1% dose to the contralateral breast has been proven to lead to a high probability for a secondary cancer. In reality, no clinic actually knows their true incident rate, because no system exists to visualize every treatment as part of routine clinical practice. The invention of the BeamSiteTM system, for time-gated single photon imaging of Cherenkov light emissions, provides the first direct video imaging of the radiation dose delivery as it happens. The system captures a direct visualization of delivery incidents in real time, so that intuitive observations can be made by the therapists and daily corrections can be made as needed. In this application, we will carry out a multicenter clinical study to investigate the capability of Cherenkov imaging to detect events which, heretofore, would go undetected. We will also advance the workflow of the system with automated incident detection tools to make BeamSiteTM easily used by the therapy team. Finally, the system will also be expanded with dose estimation algorithms to estimate long term secondary cancer risk. The project is based upon previous NIH supported hardware that is FDA 510(k) cleared for marketing and will be deployed with augmentation from the tools proposed here. The current proposal provides resources for the goals of: (i) quantifying error rates in the overall treatment of patients in multiple radiotherapy clinical settings, and (ii) quantify the unplanned dose delivered to non-target tissues, including contralateral breast in whole breast radiotherapy. The work includes software support and optical scintillator dosimetry development, to be leveraged towards these goals. The prospective human study of the incident rates will be carried out as a multisite effort within the Dartmouth-Hitchcock Health medical centers. The data produced with this system will demonstrate that visualization of treatment can change the way that daily radiotherapy is tracked and provide a tool for continuous improvement for each participating center, thereby reducing the secondary morbidity of off-target radiation. Financial reimbursement exists and as the field shifts to quality-based reimbursement versus quantity-based, Cherenkov imaging will become a staple of all leading radiotherapy units.