Precision breast radiotherapy with the soft robot and supine CT

项目总结/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 经过几十年的成像和放射治疗技术的研究和发展，乳腺放射治疗仍然是 由于缺乏可行的方法来准确地分离、定位、定位和靶向乳房， 随后，肿瘤控制的成功是以急性和慢性毒性为代价的， 患者的生活质量，并可能在治疗后数十年内引起危及生命的并发症 治疗提供准确的乳腺成像和治疗的挑战是由于独特的生物力学特性， 乳房是一个没有内部骨骼支撑的外部器官。因此，它的形状各不相同 基本上与患者的姿势一致。在仰卧位，这是最稳定和常见的立场， 放疗时，乳房靠在胸壁上，导致其与胸壁、肺、心脏非常接近， 其他重要器官，这产生了用于放射治疗的不期望的几何形状。然而，现有的仰卧装置 乳房设置不仅提供差的支撑和固定， 治疗X光片在俯卧位治疗的患者会遇到新的问题，包括较低的设置 可重复性，由于心脏下降导致的心脏剂量增加，难以耐受，以及与 淋巴结治疗为了获得期望的俯卧乳房几何形状并避免与该姿势相关联的缺点， 从胸壁提起乳房并在仰卧位对乳房成像的更有效的方法是 精确的图像引导乳腺放射治疗的迫切需要。为了实现第一个目标， 一个动力多步态软机器人，BreastBot，将被开发和优化，以支持和支撑乳房 仰卧位。BreastBot将以几种通用的形式制造，以最大限度地降低成本， 通过个性化的致动序列为每个乳房个性化。BreastBot的可行性已经被 在志愿者和幻影上使用单一步态原型进行演示。为了实现第二个目标， 对BreastBot固定的乳房进行图像引导放射治疗，避免对患者身体的成像剂量， 并获得更高的图像质量，将开发一种新型仰卧顶置式乳腺CT。以下 提出了图像引导仰卧乳房放射治疗的四个目标。目的1：乳房设置软件的优化 机器人（BreastBot）用于仰卧乳房设置。目标2：开发用于乳腺成像的顶置式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 study.

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.