CT Image Estimation for Calculation of Delivered Dose

描述（由申请人提供）：前列腺是一个移动的器官，其位置和形状会发生瞬间和日常变化，严重影响放射治疗的准确输送。出于这个原因，在现代技术上要求很高的前列腺癌放射治疗中，标准做法是在大多数治疗日定位前列腺，以帮助实现向前列腺递送高剂量同时保护附近放射敏感的正常组织的目标。I期研究确定了一种新方法的可行性，该方法使用一类统计学可训练的可变形形状模型的独特数学属性，通过基于植入前列腺的标记物的测量位置将参考CT图像数据映射到治疗空间来估计治疗图像数据。估计的图像在治疗期间捕获前列腺的姿态、位置和形状，并且适合于精确计算递送到前列腺和紧邻周围组织的剂量。这项II期研究的前两年将专注于基于这种创新技术的临床原型系统的设计和开发。第三年将在临床环境中对原型进行评估。设想的商业形式将接受来自多个设备的输入数据，包括治疗计划系统、治疗机和标记跟踪系统，并将输出数据传送到治疗计划系统。在几秒钟内，所提出的原型将使用输入数据自动计算估计的治疗图像并计算输送剂量。拟议的系统将利用目前正在进行的第二阶段项目（R44 CA 119571）完成的工作，该项目将允许原型与治疗中成像设备以及标记跟踪器一起使用。此外，所提出的方法可以实现一种称为同步动态剂量重建的剂量计算形式，这是ART的最准确形式所需的。 公共卫生相关性：前列腺是一个移动的器官，其位置和形状的瞬时和每日变化严重影响放射治疗的准确递送。出于这个原因，在现代技术上要求很高的前列腺癌放射治疗中，标准做法是在大多数治疗日定位前列腺，以帮助实现向前列腺递送高剂量同时保护附近放射敏感的正常组织的目标。I期研究确定了一种新方法的可行性，该方法使用一类统计学可训练的可变形形状模型的独特数学属性，通过基于植入前列腺的标记物的测量位置将参考CT图像数据映射到治疗空间来估计治疗图像数据。估计的图像在治疗期间捕获前列腺的姿态、位置和形状，并且适合于精确计算递送到前列腺和紧邻周围组织的剂量。这项II期研究的前两年将专注于基于这种创新技术的临床原型系统的设计和开发。第三年将在临床环境中对原型进行评估。设想的商业形式将接受来自多个设备的输入数据，包括治疗计划系统、治疗机和标记跟踪系统，并将输出数据传送到治疗计划系统。在几秒钟内，所提出的原型将使用输入数据自动计算估计的治疗图像并计算输送剂量。拟议的系统将利用目前正在进行的第二阶段项目（R44 CA 119571）完成的工作，该项目将允许原型与治疗中成像设备以及标记跟踪器一起使用。此外，所提出的方法可以实现一种称为同步动态剂量重建的剂量计算形式，这是最准确的ART形式所需的。该项目将在两个方面对公共健康做出贡献：1）它将允许称为自适应辐射计划的治疗内图像引导形式的治疗计划，确保计划和实际输送剂量之间的紧密匹配;和2）它将提供所需的但目前缺失的质量保证步骤，以确认每个治疗疗程的输送剂量的安全性。鉴于最近发生的一系列不当治疗，这一贡献尤其重要，这些不当治疗使许多人相信，新的计划和交付技术已经超过了独立验证安全计划和交付的临床实用方法的发展。

DESCRIPTION (provided by applicant): The prostate is a mobile organ that demonstrates momentary and daily changes in position and shape that critically affect accurate delivery of radiation therapy. For this reason, in modern technically demanding radiation therapy for prostate cancer, it is standard practice to localize the prostate on most days treatment as an aid to achieve the goal of delivering a high dose to the prostate while protecting nearby radiosensitive normal tissues. The Phase I study established the feasibility of a novel approach that uses unique mathematical properties of a class of statistically trainable deformable shape models to estimate treatment image data by mapping reference CT image data into the treatment space based on measured positions of markers implanted in the prostate. The estimated images capture the pose, position and shape of the prostate during treatment and are suitable for accurate calculation of dose delivered to the prostate and immediately surrounding tissues. The first two years of this Phase II study will focus on design and development of a clinical prototype system based on this creative technology. The prototype will be evaluated in the clinical setting during the third year. The envisioned commercial form will accept input data from multiple devices including the treatment planning system, treatment machine, and marker tracking system, and will communicate output data to the treatment planning system. Within a few seconds the proposed prototype will use input data to automatically compute the estimated treatment image and calculate delivered dose. The proposed system will leverage work accomplished under a currently active Phase II project (R44 CA119571) that will allow the prototype to be used with intra-treatment imaging devices as well as marker-trackers. Moreover the proposed approach may enable a form of dose computation, called synchronized dynamic dose reconstruction, needed for the most accurate form of ART. PUBLIC HEALTH RELEVANCE: The prostate is a mobile organ that demonstrates momentary and daily changes in position and shape that critically affect accurate delivery of radiation therapy. For this reason, in modern technically demanding radiation therapy for prostate cancer, it is standard practice to localize the prostate on most days treatment as an aid to achieve the goal of delivering a high dose to the prostate while protecting nearby radiosensitive normal tissues. The Phase I study established the feasibility of a novel approach that uses unique mathematical properties of a class of statistically trainable deformable shape models to estimate treatment image data by mapping reference CT image data into the treatment space based on measured positions of markers implanted in the prostate. The estimated images capture the pose, position and shape of the prostate during treatment and are suitable for accurate calculation of dose delivered to the prostate and immediately surrounding tissues. The first two years of this Phase II study will focus on design and development of a clinical prototype system based on this creative technology. The prototype will be evaluated in the clinical setting during the third year. The envisioned commercial form will accept input data from multiple devices including the treatment planning system, treatment machine, and marker tracking system, and will communicate output data to the treatment planning system. Within a few seconds the proposed prototype will use input data to automatically compute the estimated treatment image and calculate delivered dose. The proposed system will leverage work accomplished under a currently active Phase II project (R44 CA119571) that will allow the prototype to be used with intra-treatment imaging devices as well as marker-trackers. Moreover the proposed approach may enable a form of dose computation, called synchronized dynamic dose reconstruction, needed for the most accurate form of ART. This project will contribute to public health in two ways: 1) It will allow an intra-treatment-image-guided form of treatment planning called Adaptive Radiation Planning that assures a close match between the planned and actual delivered doses; and 2) It will provide a needed but currently missing quality assurance step to confirm the safety of the delivered dose for each treatment session. This contribution is especially significant in light of a series of recent mistreatments that have led many to believe that new planning and delivery technologies have outpaced the development of clinically practical methods to independently validate safe planning and delivery.