Real-time Cherenkov imaging system for whole-breast radiotherapy verification

 描述（由申请人提供） 全乳外照射放射治疗已被临床证明可以降低疾病复发的风险。虽然放射治疗的好处很多，相关的风险率也很低，但这些风险的影响可能很严重。典型的治疗工作流程从计算机断层扫描（CT）开始，然后创建患者特定的治疗计划，该治疗计划使用静态或动态放射束以肿瘤处的处方剂量为目标，并最大限度地减少对健康组织的剂量。每天进行分次治疗，持续数周;患者在治疗床上被精心定位，尽可能接近原始CT位置，以便在假设治疗将按计划进行的情况下进行操作，如果这种对准是准确的。放射肿瘤学团队使用许多工具来确保高水平的质量保证，然而，这些技术中还没有一种能够物理地观察患者表面上的射束，从而消除直接观察证据的隐含假设。切伦科夫成像试图填补这一空白的治疗工作流程中的'对病人'剂量成像。 在对12名患者进行试点临床试验后，记录了使用切伦科夫成像对患者皮肤上辐射场的首次体内观察;目前正在进行多达70名患者的第二次临床试验。切伦科夫成像为新的治疗验证过程提供了机会，该过程将为临床医生提供有关目标区域表面剂量和精确射束形状等特征的新信息，并最终提高患者安全性。尽管如此，目前对该方法存在限制，其需要对所采集的临床图像进行耗时的后处理。该提案的推动力是建立一个原型切伦科夫成像系统，该系统实时操作和显示图像，以便在治疗期间物理监测患者的光束。实时系统将有可能检测到治疗中的异常，否则这些异常将被忽视。这将通过几个层次的使用进行评估，首先是医学物理学评估，然后是放射治疗师的使用调查，然后是肿瘤学家的靶向确认。为了在诊所中有效和高效地使用该系统，整个系统将在由Jarvis博士（放射肿瘤学家）、Gladstone博士（首席医学物理学家）和Craig Hansen先生（首席放射治疗技术专家）组成的精心挑选的咨询团队的投入下开发。拟议的系统将允许一个完全非侵入性的，非破坏性的调查因素，如多叶准直器模式跟踪，患者对齐，切伦科夫强度和表面剂量之间的相关性，相对量化和仔细监测的医生。 在此项目期间，PI Jacqueline Andreozzi将接受放射治疗，乳腺癌管理和结果统计分析等多方面的培训，这些都是该项目及其职业目标的关键组成部分。每周，每月和每年的培训目标增加了一个尖端的研究项目。

 DESCRIPTION (provided by applicant) Whole-breast external beam radiotherapy has been clinically demonstrated to reduce the risk of disease recurrence. While the benefits of radiotherapy are many and the associated rates of risk are low, the effects of those risks can be severe. Typical treatment workflow begins with computed tomography (CT) scan, followed by the creation of a patient-specific treatment plan that uses static or dynamic radiation beams to target a prescribed dose at the tumor and minimize dose to healthy tissues. Fractionated therapy is delivered on a daily basis for up to several weeks; the patient is meticulously positioned on the treatment bed as close to the original CT position as possible, to operate under the assumption that the treatment will be delivered as planned if this alignment is accurate. The radiation oncology team uses many tools to ensure high levels of quality assurance, however, none of these technologies have yet provided the ability to physically view the beam on the surface of the patient, and thereby eliminate the implied assumption with directly observed evidence. Cherenkov imaging seeks to fill this gap in the treatment workflow of 'on patient' dosimetric imaging. The first in vivo observations of the radiation field on the skin of patients using Cherenkov imaging were documented after a pilot clinical trial of 12 patients; a second clinical trial of up to 70 patient is currently underway. Cherenkov imaging provides the opportunity for a new treatment verification process that will offer novel information to clinicians about features such as surface dose over the targeted region and precise beam shape, and could ultimately improve patient safety. Still, there is a current limitation on the method which requires time-consuming post-processing of the acquired clinical images. The impetus of this proposal is to build a prototype Cherenkov imaging system that operates and displays images in real-time, in order to physically monitor the beam on the patient during treatment as it is being administered. The real-time system will have the potential to detect abnormalities in the treatment which would otherwise go unnoticed. This will be evaluated by several layers of use, starting with medical physics evaluation, then radiation therapist survey of use, and then oncologist confirmation of targeting. To allow effective and efficient use of the system in the clinic, the entire system will be developed with input from a carefully selected advisory team consisting of Dr. Jarvis (Radiation Oncologist), Dr. Gladstone (Chief Medical Physicist), and Mr. Craig Hansen (Chief Radiation Therapy Technologist). The proposed system will allow for a completely non-invasive, non-disruptive investigation of factors such as multi-leaf collimator pattern tracking, patient alignment, and correlation between Cherenkov intensity and surface dose for relative quantification and careful monitoring by physicians. During this project, the PI Jacqueline Andreozzi will be trained in many aspects of radiation therapy, breast cancer management, and statistical analysis of outcomes, which make up key components of this project and her career goals. Weekly, monthly and annual goals on training augment a cutting edge research project.