Precision breast radiotherapy with the soft robot and supine CT

项目摘要/摘要 放射治疗对于乳腺癌患者实现持久的疾病控制至关重要。然而，尽管有几个 在几十年的成像和放射治疗技术的研究和发展中，乳房放射治疗仍然 由于缺乏可行的方法来准确地隔离、固定、定位和定位乳房，因此乳房变得粗糙。 随后，肿瘤控制的成功是以急性和慢性毒性为代价的，这些毒性对 患者的生活质量，并可能在治愈后几十年出现危及生命的并发症 治疗。提供准确的乳房成像和治疗的挑战是由于独特的生物力学 乳房是一种外部器官，没有内部骨骼支撑。因此，它的形状各不相同 基本上与病人的姿势相吻合。在仰卧位，这是最稳定和最常见的姿势 在放射治疗中，乳房靠在胸壁上，因此它非常接近胸壁、肺、心脏和 其他重要器官，这为放射治疗创造了一个不受欢迎的几何形状。然而，现有的仰卧设备 乳房设置不仅支撑和固定效果差，而且还对成像和 治疗X光。接受俯卧位治疗的患者会遇到新的问题，包括体位较低。 重复性、心脏下降导致的心脏剂量增加、耐受性困难以及与 结节疗法。为了获得所需的俯卧乳房几何形状并避免与该姿势相关的缺点， 将乳房从胸壁上抬起并以仰卧位成像的更有效的方法是 高精度影像引导下的乳腺放射治疗急需。为了实现第一个目标，气动 将开发和优化动力多步态软机器人BreastBot，以支持和固定乳房 以仰卧的姿势。BreastBot将以几种通用的形式制造，以最大限度地降低成本，但 通过个性化的驱动序列为每个乳房个性化。BreastBot的可行性已经被证明 在志愿者和幻影上使用单一步态原型进行了演示。为了实现第二个目标，那就是 将BreastBot固定的乳房成像进行图像引导放射治疗，避免了对患者身体的成像剂量， 并实现更高的图像质量，将开发一种新型的仰卧式天花板安装的乳腺CT。以下是 提出了影像引导仰卧位乳房放射治疗的四个目标。目标1：优化丰胸软体 用于仰卧乳房设置的机器人(BreastBot)。目标2：研制用于乳房成像的天花板CBCT- 引导放射治疗。目标3：具体目标3：端到端集成、验证和观察患者 学习。

Project Summary/Abstract Radiotherapy is essential to achieve durable disease control for breast cancer patients. However, despite several decades of research and development in imaging and radiotherapy techniques, breast radiotherapy remains crude due to the lack of viable methods to accurately isolate, immobilize, localize and target the breast. Subsequently, the success of tumor control is at the cost of both acute and chronic toxicities that adversely affect the patients’ quality of life and potentially introduce life-threatening complications decades after the curative treatment. The challenge in providing accurate breast imaging and therapy is due to the unique biomechanical properties of the breast, which is an external organ with no internal skeletal support. As a result, its shape varies substantially with the patient's posture. In the supine position, which is the most stable and common position for radiotherapy, the breast rests on the chest wall, resulting in its close proximity to the chest wall, lung, heart, and other vital organs, which creates an undesirable geometry for radiotherapy. Yet, existing devices for supine breast setup not only provide poor support and immobilization but also adversely interfere with imaging and therapy X-rays. Patients treated in the prone position experience new problems, including the lower setup reproducibility, increased cardiac dose due to heart descending, the difficulty to tolerate, and incompatibility with nodal treatment. To attain the desirable prone breast geometry and avoid drawbacks associated with this posture, a more effective method to lift the breast from the chest wall and to image the breast in the supine position is urgently needed for precision image-guided breast radiotherapy. To achieve the first goal, a pneumatically powered multi-gait soft robot, BreastBot, will be developed and optimized to support and immobilize the breast in the supine position. The BreastBot will be fabricated in several generic form factors to minimize the cost but personalized for each breast via an individualized actuation sequence. The feasibility of BreastBot has been demonstrated using single gait prototypes on volunteers and phantoms. To achieve the second goal, which is to image the BreastBot immobilized breast for image-guided radiotherapy, avoid imaging dose to the patient's body, and achieve a higher image quality, a novel supine ceiling-mounted breast CT will be developed. The following four aims are proposed for image-guided supine breast radiotherapy. Aim 1: Optimization of a breast setup soft robot (BreastBot) for supine breast setup. Aim 2: Development of a ceiling-mounted CBCT for breast image- guided radiation therapy. Aim 3: Specific Aim 3: End-to-end integration, validation, and observational patient study.