Integrated 3D X-Ray/ultrasound guided radiation therapy of soft tissue targets

描述（由申请人提供）：低分割高剂量放射治疗是一种日益重要的治疗方法。图像引导对于确保准确的患者定位和允许使用高剂量输送的紧治疗裕度是必要的。目前，流行的引导方法采用X射线成像来提供3D体积和/或2D投影信息。不幸的是，该方法被发现在与周围组织的低放射对比度下对肿瘤有需求。这些包括重要的腹部部位，如前列腺、胰腺和肝脏。因此，已采用植入标记物的检测作为替代方案。然而，由于缺乏解剖信息和手术的侵入性，这些替代物也不太理想。为了响应PAR 10 -169，约翰霍普金斯大学（JHU）、Elekta-Resonant和克利夫兰诊所（CC）之间建立了学术-工业合作伙伴关系，以开发集成的3D X射线/超声成像系统，为大分割放射治疗提供机载指导。该合作伙伴关系在X射线和超声成像、机器人工程和放射治疗方面具有重要的专业知识。我们有三个具体目标。具体目标1是设计和构建系统。3D超声成像系统将对接到配备机载X射线锥束CT（CBCT）成像的医疗加速器上。超声成像克服了X射线成像检测低对比度软组织目标的障碍，而CBCT提供了解剖信息，用于在机器参考系中设置患者，并在必要时重新计算剂量。将采用带有力传感器的机器人控制来自动定位超声系统，该系统将在整个治疗过程中保持在患者身上，以提供实时监测。手术是非侵入性的。该监测是非电离的，适合儿科患者的应用。具体目标2侧重于优化IGRT工作流程，以避免成像和辐照程序相互干扰。对于特定目标3，我们将在JHU和CC验证集成成像系统的性能。我们将通过证明目标定义的可重复性更高且用户依赖性更低来检验使用集成机器人系统的引导上级CBCT或单独超声成像的假设。合作伙伴的专业知识非常适合满足PAR 10 -169的期望。将建造两个商业级系统。JHU和CC代表最终用户对这些系统进行现场验证。Elekta-Resonant也是一个理想的工业合作伙伴，可以在社区中进行商业化传播。

DESCRIPTION (provided by applicant): Hypofractionated high dose radiation therapy is an increasingly important treatment approach. Image guidance is imperative to ensure accurate patient positioning and to allow the use of tight treatment margin for high dose delivery. At present, the prevailing guidance method employs x- ray imaging to provide 3D volumetric and/or 2D projection information. Unfortunately, the approach is found wanting for tumors at low radiographic contrast with the surrounding tissue. These include important abdominal sites such as prostate, pancreas and liver. Consequently, detection of implanted markers has been employed as an alternative. However, these surrogates are also less than ideal due to the lack of anatomic information and the invasive nature of the procedure. In response to PAR10-169, an academic-industrial partnership is formed between Johns Hopkins University (JHU), Elekta-Resonant and Cleveland Clinic (CC), to develop an integrated 3D x-ray/ultrasound imaging system to provide on-board guidance for hypofractionated radiation therapy. The partnership has significant expertise in x-ray and ultrasound imaging, robotic engineering and radiation therapy. We have 3 specific aims. Specific Aim 1 is to design and construct the system. A 3D ultrasound imaging system will be docked onto a medical accelerator equipped with on-board x-ray cone-beam CT (CBCT) imaging. Ultrasound imaging overcomes the hurdle of detecting low contrast soft tissue target with x-ray imaging, while CBCT provides the anatomic information for setting up the patient in the machine frame of reference and for dose re-calculation if necessary. Robotic control with force sensors will be employed to automate the positioning of the ultrasound system which will remain on the patient throughout the treatment session to provide real-time monitoring. The procedure is non-invasive. The monitoring is non-ionizing and desirable for applications with pediatric patients. Specific Aim 2 focuses on optimizing the IGRT workflow for planning, radiation delivery to avoid the interference of imaging and irradiation procedures with each other. For Specific Aim 3, we will validate the performance of the integrated imaging system at JHU and CC. We will test the hypothesis that guidance using the integrated robotic system is superior to CBCT or ultrasound imaging alone by demonstrating that the target definition is more reproducible and less user-dependent. The expertise of partners is well suited to fulfill the expectations of PAR10-169. Two commercial grade systems will be constructed. JHU and CC represent the end-users to conduct in-field validation of these systems. Elekta-Resonant is also an ideal industrial partner to pursue commercialization for dissemination in the community.