Enabling remote medical physics services for medical accelerator quality assurance through a novel, table-top imaging device

执行摘要 放射治疗是癌症患者治疗策略的有效组成部分 癌症。调强放射治疗(IMRT)、图像引导放射治疗(IGRT)、 立体定向体部放疗(SBRT)和立体定向放射外科(SRS)可改善结果，并使用 医用直线加速器(即“直线加速器”)。SBRT特别吸引人，因为精确的治疗是 每天提供1-5次治疗，而不是常规治疗所需的20-40次 技巧。在农村环境中提供SBRT可以通过管理这些精确的、缩写的 对前往大型地区性医疗中心有困难的患者进行治疗。此外，通过 质量控制和增强的远程剂量测量的自动化技术可以支持同行审查，改进 质量，减少对(当地)专业知识的依赖，并降低运营成本。 医学物理学家提供的质量保证(QA)对安全的治疗至关重要，但有一个 美国和全球都缺乏合格的医学物理学家(QMP)。与此同时，更多的中心 正在引入更精确的现代技术，但由于高剂量，本质上有更大的风险 并要求几何精度。存在广泛的不符合行业标准QA协议的情况 美国和国际上。现有的质量保证设备还没有发展到足以提供精确度、多功能性 以及高精度RT所需的效率。鉴于这些加剧的安全风险，市场需要一个 现代RT中QA执行方式的范式转变。 野狗物理(WDP)建议设计和测试新一代QA设备，以解决这些问题 未得到满足的医疗需求。完成后，它将比任何QA更精确、更高效、更全面 目前市场上已有解决方案。拟议的项目旨在开发一个临床原型，以便在 肯塔基大学放射治疗诊所，以及位于 农村，服务不足的地区。原型将使用以下里程碑进行开发：设计和构建i) 一种新型的小形状因数光隧道(SFFOT)，II)具有闪烁荧光粉的叠层侧壁 屏幕和‘可切换的薄膜’外层，以便于环境光抑制和iii)，混合光束质量/ 紧凑型CT模型。该项目将以建造一个综合原型而告终，该原型将 经过技术和临床性能测试。 为此，该项目的具体目标是： 具体目标1：构建和测试集成设备的3个主子组件；a)能够 采集整个有用内表面的图像(S)，将图像(S)传输到电子相机传感器 通过小形状因数(直径5厘米)的无源光链；b)由 外部电子偏振光学层和内部射电发光层，以及c)混合剂量 被集成到设备的一侧，该设备将用作组织等效的体模，从而 光束质量度量可以被监控并托管CT图像质量测试对象。 具体目标2：构建和测试临床原型；该系统在 临床环境将得到验证。对探测相对和绝对辐射输出的变化的敏感性，如 将测量现场边缘定位，成功标准定义为0.5%和0.5 mm。数据 将衡量每月QA测试的获取时间，并将成功定义为少于30分钟。 将多种设备功能与易用性和测量结合在一起 精确度使医疗物理服务和质量保证的提供方式发生了范式转变。稀疏 但高效的日常QA协议将被全面的数据收集和自动化分析所取代，网址为 没有额外的时间或人员成本。高精度的放射治疗可以安全地带到农村和 服务不足的地区，使用这项创新的任何中心都可以提高安全性、效率和精确度。 到目前为止，我们已经确定了构建一种能够获得 在不到60分钟的时间内提供全面的QA指标。目前，已对所有子系统进行了测试，发现 按要求执行。我们已经建立了一个三维样机，并正在进行临床验证 英国放射医学部的合伙人。WDP正在寻求SBIR第二阶段资金，以 进一步将该技术开发到商业化的程度。

Executive Summary Radiation Therapy is an effective component of the treatment strategy for patients suffering from cancer. Advanced techniques such as intensity modulated radiation therapy (IMRT), image-guided RT (IGRT), stereotactic body RT (SBRT) and stereotactic radiosurgery (SRS) improve outcomes and are delivered using medical linear accelerators (i.e., ‘linacs”). SBRT is especially appealing given that the precise treatments are delivered in 1-5 daily treatment fractions, as opposed to the 20-40 fractions required for conventional techniques. Providing SBRT in rural settings can improve access by administering these precise, abbreviated treatments to patients who have difficulty traveling to large, regional medical centers. Further, adoption of automated techniques for quality control and enhanced tele-dosimetry can support peer review, improve quality, reduce dependence on (local) expertise and reduce operating costs. The quality assurance (QA) that medical physicists provide is critical for safe treatments, yet there is a shortage of qualified medical physicists (QMPs), both in the US and globally. At the same time, more centers are introducing modern techniques that are more precise but intrinsically have more risk, due the high doses and geometric precision required. There is widespread noncompliance with industry standard QA protocols in the US and internationally. Existing QA devices have not evolved sufficiently to provide the precision, versatility and efficiency that is needed for high precision RT. Given these exacerbated safety risks, the market needs a paradigm shift in how QA is performed in modern RT. Wild Dog Physics (WDP) proposes to design and test a new-generation QA device that addresses these unmet medical needs. When complete, it will be more precise, efficient, and comprehensive than any QA solution currently on the market. The proposed project seeks to develop a clinical prototype to be tested in the Radiation Therapy clinic at the University of Kentucky, as well as regional partner organizations located in rural, underserved areas. The prototype will be developed using the following milestones: Design and build i) a novel, a small-form-factor optical tunnel (SFFOT), ii) a laminated side wall with a scintillating phosphor screen and ‘switchable film’ outer layer to facilitate ambient light rejection and iii), a hybrid beam quality / compact CT phantom. The project will culminate with the construction of an integrated prototype that will be tested for technical and clinical performance. Towards this end, the specific aims of this project are: Specific Aim 1: Build and test the 3 primary subcomponents of an integrated device; a) a SFFOT that can collect an image(s) of the entire useful interior surface, transmit the image(s) to an electronic camera sensor through a small form-factor (< 5 cm diameter) passive optical chain; b) a laminated side wall consisting of an outer, electronically polarizing optical layer, and an inner radio-luminescent layer, and c) a hybrid ‘dose phantom’ to be integrated onto one side of the device which will serve as a tissue-equivalent phantom so that beam quality metrics can be monitored and to host CT image quality test objects. Specific Aim 2: Construct and test a clinical prototype; The system’s ability to monitor machine performance in a clinical setting will be validated. Sensitivity to detecting changes in relative and absolute radiation output, as well as field edge positioning will be measured, with success criteria defined as 0.5% and 0.5 mm. Data acquisition time for monthly QA tests will be measured and success defined as less than 30 minutes. The consolidation of multiple device functions combined with the ease of use and measurement precision enable a paradigm shift in how medical physics services and quality assurance are rendered. Sparse but efficient daily QA protocols will be replaced with comprehensive data collection and automated analysis, at no additional cost in time or staffing. High precision radiation treatments can be safely brought to rural and underserved areas, with safety, efficiency and precision improved in any center using the innovation. To date, we have established the feasibility of constructing a single device that can acquire comprehensive QA metrics in less than 60 minutes. Presently, all subsystems have been tested and found to perform as required. A three-dimensional prototype has been built and is being validated by our clinical partner at the UK Radiation Medicine department. WDP is in the process of seeking SBIR Phase 2 funding to further develop the technology to the point of commercialization.