Bringing 4π radiation therapy to the clinic

意义/创新：在放射治疗中使用非共面射束可以显著提高 更好地保留正常器官和肿瘤靶向。然而，这种治疗的最佳效果需要广泛的 以及有效利用与现有放射治疗平台不兼容的非共面射束。这个 广泛使用的C形臂龙门系统容易碰撞、笨重，并且需要不受欢迎的患者沙发 运动实现了非共面角度。现有的机器人系统缺乏后梁和规划 系统，以整体优化束流方向和注量，使其在可实现的剂量学中受到极大限制， 目标大小、适用的疾病部位和吞吐量。 在这些临床和市场需求的推动下，加州大学洛杉矶分校和RadiaBeam正在开发一种新的机器人 名为Polaris的放射治疗平台，克服了现有放射治疗系统的限制，具有 以下创新优势：1.超紧凑的6 MV直线加速器可让您畅通无阻地 4π立体角，包括后梁。2.用于综合波束定向的数学框架， 源到肿瘤的距离和通量图优化，可以有效地创建更好的计划 而不是临床上最先进的技术。3.3D图像制导系统将首次在 不阻碍非共面投放自由度的机器人放射治疗系统。4. 硬件和软件的组合允许将卓越的剂量测量有效地提供给所有目标 尺寸，使我们的系统成为所有C形臂龙门系统和现有机器人的卓越替代品 放射治疗系统作为一种通用的放射治疗机。 在SBIR项目(NIH第二阶段5R44CA183390-04)期间，天文肿瘤公司成立，以带来 北极星系统推向市场，并在2020年获得了600万美元的首轮投资。这座NIH SBIR IIB期大桥 项目将加快完成实现以下目标所需的最后技术、法规和临床步骤 把救命治疗带到诊所。我们提出以下目标： 目标：1A：对X射线源和探测器机器人进行机械同步。1B.收集圆形的投影 以及用于CBCT重建的螺旋轨迹。1C。集成用于端到端IGRT的成像组件 准确性验证。2A。完成临床系统的设计、制造、验证和确认。 2B。提交美国市场清关申请。2C。建立并认证质量管理体系。3A.安装 以及加州大学洛杉矶分校的4π放射治疗系统的验收测试。3B.早期临床研究。 影响：北极星将成为所有通用机器的卓越替代品，在剂量上具有优势 合规性、自动化和吞吐量。这些优势将推动快速采用。这件事的成功 项目将清除当前技术开发水平与需要达到的水平之间的最后障碍 在商业和临床上都做好了准备。

Significance/Innovation: Utilizing non-coplanar beams in radiotherapy can significantly improve dosimetry for better normal organ sparing and tumor targeting. However, the optimality of such therapy requires extensive and efficient utilization of non-coplanar beams that are incompatible with existing radiotherapy platforms. The widely available C-arm gantry systems are collision prone, cumbersome, and require undesirable patient couch motion to achieve the non-coplanar angles. The existing robotic system lacks posterior beams and a planning system to integrally optimize beam orientation and fluence, making it extremely limited in achievable dosimetry, target sizes, applicable disease sites, and throughput. Motivated by these clinical and market needs UCLA and RadiaBeam are developing a new robotic radiotherapy platform called Polaris that overcomes the limitations of existing radiotherapy systems, with the following innovative advantages: 1. A super compact 6MV linear accelerator enables unobstructed access to 4π solid angle, including posterior beams. 2. A mathematical framework for integrated beam orientation, source-to-tumor distance, and fluence map optimization, which can efficiently create substantially better plans than the clinical state-of-the-art. 3. A 3D image guidance system will be implemented for the first time on a robotic radiotherapy system without impeding the degrees of freedom in non-coplanar delivery. 4. The combination of hardware and software allows superior dosimetry to be efficiently delivered to targets of all sizes, making our system a superior replacement of all C-arm gantry systems and the existing robotic radiotherapy system as a general-purpose radiotherapy machine. During the SBIR project (NIH Phase II 5R44CA183390-04), Celestial Oncology Inc. was founded to bring the Polaris system to market, and received a $6M series A investment in 2020. This NIH SBIR Phase IIB bridge project will accelerate the completion of the last technical, regulatory, and clinical steps required to bring this life-saving therapy to the clinic. We propose the following aims: Aims: 1a: Mechanically synchronize the X-ray source and detector robots. 1b. Collect projections for circular and helical trajectories for CBCT reconstruction. 1c. Integrate the imaging component for end-to-end IGRT accuracy validation. 2a. Complete the design, manufacturing, verification, and validation of the clinical system. 2b. Submit for US market clearance. 2c. Establish and certify a Quality Management System. 3a. Installation and acceptance tests of the 4π radiotherapy system at UCLA. 3b. Early phase clinical study. Impact: Polaris will serve as a superior replacement of all general-purpose machines with advantages in dose conformity, automation, and throughput. These advantages will drive rapid adoption. The success of this project will clear the last hurdles between the current level of technical development and what is needed to be commercially and clinically ready.