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

用于全乳腺放射治疗验证的实时切伦科夫成像系统

• 批准号: 9252220
• 负责人: Jacqueline Andreozzi
• 金额: $ 4.4万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2018-06-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9252220
• 关键词: Advisory Committees; Area; Beds; Breast; Cancer Patient; Clinic; Clinical; Clinical Trials; Collimator; Computer software; Data; Data Collection; Detection; Development; Doctor of Medicine; Doctor of Philosophy; Dose; Ensure; Evaluation; Feedback; Goals; Human; Image; Imagery; Intuition; Investigation; Lead; Life; Light; Measurement; Measures; Medical; Methods; Monitor; Nature; Oncologist; Operating System; Optics; Outcome; Output; Patients; Pattern; Physicians; Physics; Plant Leaves; Positioning Attribute; Process; Property; Quality of Care; Radiation; Radiation Monitoring; Radiation Oncologist; Radiation Oncology; Radiation Therapist; Radiation therapy; Real-Time Systems; Records; Recurrence; Reporting; Research; Research Project Grants; Risk; Safety; Savings; Scanning; Shapes; Skin; Statistical Data Interpretation; Stream; Suggestion; Surface; Surveys; System; Technology; Testing; Time; Tissues; Training; Trust; Validation; Variant; Visual; X-Ray Computed Tomography; base; career; cherenkov imaging; clinical imaging; cohort; design; disorder risk; imaging system; improved; in vivo; in vivo imaging; irradiation; light intensity; malignant breast neoplasm; novel; patient safety; prototype; public health relevance; quality assurance; radiation-induced injury; response; simulation; software development; tool; treatment planning; tumor

 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.

 描述（由申请人提供） 临床证明全乳房外照射放射治疗可以降低疾病复发的风险。虽然放射治疗的好处很多，而且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) 扫描开始，然后创建针对患者的治疗计划，使用静态或动态辐射束将规定剂量瞄准肿瘤，并最大限度地减少健康组织的剂量。每天进行分次治疗，持续数周；患者被小心翼翼地放置在治疗床上，尽可能靠近原始 CT 位置，并假设如果对齐准确，治疗将按计划进行。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，这些技术尚未提供物理观察患者表面上的光束的能力，从而消除通过直接观察到的证据暗示的假设。切伦科夫成像旨在填补“患者”剂量成像治疗工作流程中的这一空白。 在对 12 名患者进行试点临床试验后，首次记录了使用切伦科夫成像对患者皮肤辐射场的体内观察；目前正在进行第二次临床试验，涉及多达 70 名患者。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光束形状等特征的新颖信息，并最终提高患者的安全性。尽管如此，该方法目前仍存在局限性，需要对采集的临床图像进行耗时的后处理。该提案的推动力是构建一个实时操作和显示图像的切伦科夫成像系统原型，以便在治疗期间物理监测患者身上的光束。实时系统将有可能检测到治疗中可能被忽视的异常情况。这将通过多层使用进行评估，首先是医学物理评估，然后是放射治疗师的使用调查，然后是肿瘤学家对靶向的确认。为了在诊所中有效和高效地使用该系统，整个系统的开发将听取精心挑选的顾问团队的意见，该团队由 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。所提出的系统将允许对多叶准直器模式跟踪、患者对准以及切伦科夫强度和表面剂量之间的相关性等因素进行完全非侵入性、非破坏性的调查，以供医生进行相对量化和仔细监测。 在该项目期间，PI Jacqueline Andreozzi 将接受放射治疗、乳腺癌管理和结果统计分析等多个方面的培训，这些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强了尖端研究项目的能力。