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Han H, Geng C, Deng X, Li J, Shu D, Tang X. A preliminary study of multispectral Cherenkov imaging and a Fricke-xylenol orange gel film (MCIFF) for online, absolute dose measurement. Med Phys 2024; 51:3734-3745. [PMID: 38224326 DOI: 10.1002/mp.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/17/2023] [Accepted: 01/03/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Cherenkov luminescence imaging has shown potential for relative dose distribution and field verification in radiation therapy. However, to date, limited research utilizing Cherenkov luminescence for absolute dose calibration has been conducted owing to uncertainties arising from camera positioning and tissue surface optical properties. PURPOSE This paper introduces a novel approach to multispectral Cherenkov luminescence imaging combined with Fricke-xylenol orange gel (FXG) film, termed MCIFF, which can enable online full-field absolute dose measurement. By integrating these two approaches, MCIFF allows for calibration of the ratio between two spectral intensities with absorbed dose, thereby enabling absolute dose measurement. METHODS All experiments are conducted on a Varian Clinac 23EX, utilizing an electron multiplying charge-coupled device (EMCCD) camera and a two-way image splitter for simultaneous capture of two-spectral Cherenkov imaging. In the first part of this study, the absorbance curves of the prepared FXG film, which receives different doses, are measured using a fluorescence spectrophotometer to verify the correlation between absorbance and dose. In the second part, the FXG film is positioned directly under the radiation beam to corroborate the dose measurement capacity of MCIFF across various beams. In the third part, the feasibility of MCIFF is tested in actual radiotherapy settings via a humanoid model, demonstrating its versatility with various radiotherapy materials. RESULTS The results of this study indicate that the logarithmic ratios of spectral intensities at wavelengths of 550 ± 50 and 700 ± 100 nm accurately reflect variations in radiation dose (R2 > 0.96) across different radiation beams, particle energies, and dose rates. The slopes of the fitting lines remain consistent under varying beam conditions, with discrepancies of less than 8%. The optical profiles obtained using the MCIFF exhibit a satisfactory level of agreement with the measured results derived from the treatment planning system (TPS) and EBT3 films. Specifically, for photon beams, the lateral distances between the 80% and 20% isodose lines, referred to as the penumbra (P80-20) values, obtained through TPS, EBT3 films, and MCIFF, are determined as 0.537, 0.664, and 0.848 cm, respectively. Similarly, for electron beams, the P80-20 values obtained through TPS, EBT3 films, and MCIFF are found to be 0.432, 0.561, and 0.634 cm, respectively. Furthermore, imaging of the anthropomorphic phantom demonstrates the practical application of MCIFF in real radiotherapy environments. CONCLUSION By combining an FXG film with Cherenkov luminescence imaging, MCIFF can calibrate Cherenkov luminescence to absorbed dose, filling the gap in online 2D absolute dose measurement methods in clinical practice, and providing a new direction for the clinical application of optical imaging to radiation therapy.
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Affiliation(s)
- Haonan Han
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Changran Geng
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
- Key Laboratory of Nuclear Technology Application and Radiation Protection in Astronautic, Nanjing University of Aeronautics and Astronautics, Ministry of Industry and Information Technology, Nanjing, People's Republic of China
- Joint International Research Laboratory on Advanced Particle Therapy, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xinping Deng
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Jun Li
- Radiotherapy Center, Subei People's Hospital of Jiangsu Province, Yangzhou, People's Republic of China
| | - Diyun Shu
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
- Joint International Research Laboratory on Advanced Particle Therapy, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xiaobin Tang
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
- Key Laboratory of Nuclear Technology Application and Radiation Protection in Astronautic, Nanjing University of Aeronautics and Astronautics, Ministry of Industry and Information Technology, Nanjing, People's Republic of China
- Joint International Research Laboratory on Advanced Particle Therapy, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
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Di X, Geng C, Guo C, Shang Y, Fu H, Han H, Tang X. Enhanced Cherenkov imaging for real-time beam visualization by applying a novel carbon quantum dot sheeting in radiotherapy. Med Phys 2023; 50:1215-1227. [PMID: 36433734 DOI: 10.1002/mp.16121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cherenkov imaging can be used to visualize the placement of the beam directly on the patient's surface tissue and evaluate the accuracy of treatment planning. However, Cherenkov emission intensity is lower than ambient light. At present, time gating is the only way to realize Cherenkov imaging with ambient light. PURPOSE This study proposes preparing a novel carbon quantum dot (cQD) sheeting to adjust the wavelength of Cherenkov emission to obtain the optimal wavelength meeting the sensitive detection region of the camera, meanwhile the total optical signal is also increased. By combining a specific filter, this approach might help in using lower-cost camera systems without intensifier-coupled to accomplish in vivo monitoring of the surface beam profile on patients with ambient light. METHODS The cQD sheetings were prepared by spin coating and UV curing with different concentrations. All experiments were performed on the Varian VitalBeam system and optical emission was captured using an electron multiplying charge-coupled device (EMCCD) camera. To quantify the optical characteristics and certify the improvement of light intensity as well as signal-to-noise ratio (SNR) of cQD sheeting, the first part of the study was carried out on solid water with 6 and 10 MV photon beams. The second part was carried out on an anthropomorphic phantom to explore the applicability of sheeting when using different radiotherapy materials and the imaging effect of sheeting with the impact of ambient light sources. Additionally, thanks to the narrow emission spectrum of the cQD, a band-pass filter was tested to reduce the effect from environmental lights. RESULTS The experimental results show that the optical intensity collected with sheeting has an excellent linear relationship (R2 > 0.99) with the dose for 6 and 10 MV photons. The full-width half maximum (FWHM) in x and y axis matched with the measured EBT film image, with accuracy in the range of ±1.2 and ±2.7 mm standard deviation, respectively. CQD sheeting can significantly improve the light intensity and SNR of optical images. Using 0.1 mg/ml sheeting as an example, the signal intensity is increased by 209%, and the SNR is increased by 147.71% at 6 MV photons. The imaging on the anthropomorphic phantom verified that cQD sheeting could be applied to different radiotherapy materials. The average optical intensity increased by about 69.25%, 63.72%, and 61.78%, respectively, after adding cQD sheeting to bolus, mask sample and the combination of bolus and mask. Corresponding SNR is improved by about 62.78%, 56.77%, and 68.80%, respectively. Through the sheeting, optical images with SNR > 5 can be obtained in the presence of ambient light and it can be improved through combining with a band-pass filter. When red ambient lights are on, the SNR is increased by about 98.85% after adding a specific filter. CONCLUSION Through a combination of cQD sheeting and corresponding filter, light intensity and SNR of optical images can be increased significantly, and it shed new light on the promotion of the clinical application of optical imaging to visualize the beam in radiotherapy.
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Affiliation(s)
- Xing Di
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Changran Geng
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China.,Joint International Research Laboratory on Advanced Particle Therapy, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Chang Guo
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Yufen Shang
- Department of Radiation Physics, Dezhou Second People's Hospital, Dezhou, People's Republic of China
| | - Hongtao Fu
- Department of Radiation Physics, Dezhou Second People's Hospital, Dezhou, People's Republic of China
| | - Haonan Han
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xiaobin Tang
- Department of Nuclear Science and Technology, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China.,Joint International Research Laboratory on Advanced Particle Therapy, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
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Bianfei S, Fang L, Zhongzheng X, Yuanyuan Z, Tian Y, Tao H, Jiachun M, Xiran W, Siting Y, Lei L. Application of Cherenkov radiation in tumor imaging and treatment. Future Oncol 2022; 18:3101-3118. [PMID: 36065976 DOI: 10.2217/fon-2022-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cherenkov radiation (CR) is the characteristic blue glow that is generated during radiotherapy or radioisotope decay. Its distribution and intensity naturally reflect the actual dose and field of radiotherapy and the location of radioisotope imaging agents in vivo. Therefore, CR can represent a potential in situ light source for radiotherapy monitoring and radioisotope-based tumor imaging. When used in combination with new imaging techniques, molecular probes or nanomedicine, CR imaging exhibits unique advantages (accuracy, low cost, convenience and fast) in tumor radiotherapy monitoring and imaging. Furthermore, photosensitive nanomaterials can be used for CR photodynamic therapy, providing new approaches for integrating tumor imaging and treatment. Here the authors review the latest developments in the use of CR in tumor research and discuss current challenges and new directions for future studies.
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Affiliation(s)
- Shao Bianfei
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Liu Fang
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiation Oncology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiang Zhongzheng
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Zeng Yuanyuan
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Tian
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - He Tao
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Ma Jiachun
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Wang Xiran
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Siting
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Liu Lei
- Department of Head and Neck Oncology, West China Hospital, Sichuan University, Chengdu, China
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Cloutier E, Archambault L, Beaulieu L. Accurate dose measurements using cherenkov emission polarization imaging. Med Phys 2022; 49:5417-5422. [PMID: 35502867 DOI: 10.1002/mp.15693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/21/2022] [Accepted: 05/02/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Cherenkov radiation carries the potential of direct in-water dose measurements, but its precision is currently limited by a strong anisotropy. Taking advantage of polarization imaging, this work proposes a new approach for high accuracy Cherenkov emission dose measurements. METHODS Cherenkov radiation produced in a 15 × 15 × 20 cm3 water tank is imaged with a cooled CCD camera from four polarizer transmission axes [0°, 45°, 90°, 135°]. The water tank is positioned at the isocenter of a 5 × 5 cm2 , 6 MV and 18 MV photon beam. Using Malus' law, the polarized portion of the signal is extracted. Corrections are applied to the polarized signal following azimuthal and polar Cherenkov emission angular distributions extracted from Monte Carlo simulations. Projected percent depth dose and beam profiles are measured and compared with the prediction from a treatment planning system (TPS). RESULTS Corrected polarized signals on the central axis reduced deviations at depth (mean ± std) from 8±5% to 0.8 ±1% at 6 MV and 8±7% to 1±3% at 18 MV. For the profile measurement, differences between the corrected polarized signal and the TPS calculations are 1±3% and 2±3% on the central axis at 6 MV and 18 MV respectively. In these conditions, Cherenkov emission is shown to be partly polarized. CONCLUSIONS This work proposes a novel polarization imaging approach enabling high precision water-based dose measurements using Cherenkov radiation. The method allows correction of the Cherenkov emission anisotropy within 4% on the beam central axis and in depth. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Emily Cloutier
- Physics, physical engineering and optics department and Cancer Research Center, Universite Laval, Quebec, Canada.,CHU de Quebec - Universite Laval, CHU de Quebec, Quebec, Canada
| | - Louis Archambault
- Physics, physical engineering and optics department and Cancer Research Center, Universite Laval, Quebec, Canada.,CHU de Quebec - Universite Laval, CHU de Quebec, Quebec, Canada
| | - Luc Beaulieu
- Physics, physical engineering and optics department and Cancer Research Center, Universite Laval, Quebec, Canada.,CHU de Quebec - Universite Laval, CHU de Quebec, Quebec, Canada
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Hachadorian RL, Bruza P, Jermyn M, Gladstone DJ, Zhang R, Jarvis LA, Pogue BW. Remote dose imaging from cherenkov light using spatially-resolved CT calibration in breast radiotherapy. Med Phys 2022; 49:4018-4025. [PMID: 35304768 DOI: 10.1002/mp.15614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Imaging Cherenkov light during radiotherapy allows the visualization and recording of frame-by-frame relative maps of the dose being delivered to the tissue at each control point used throughout treatment, providing one of the most complete real-time means of treatment quality assurance. In non-turbid media, the intensity of Cherenkov light is linear with surface dose deposited, however the emission from patient tissue is well-known to be reduced by absorbing tissue components such as hemoglobin, fat, water and melanin, and diffused by the scattering components of tissue. Earlier studies have shown that bulk correction could be achieved by using the patient planning CT scan for attenuation correction. METHODS In this study, CT maps were used for correction of spatial variations in emissivity. Testing was completed on Cherenkov images from radiotherapy treatments of post-lumpectomy breast cancer patients (n = 13), combined with spatial renderings of the patient radiodensity (CT number) from their planning CT scan. RESULTS The correction technique was shown to provide a pixel-by-pixel correction that suppressed many of the inter- and intra-patient differences in the Cherenkov light emitted per unit dose. This correction was established from a calibration curve that correlated Cherenkov light intensity to surface-rendered CT number (R6MV 2 = 0.70 and R10MV 2 = 0.72). The corrected Cherenkov intensity per unit dose standard error was reduced by nearly half (from ∼30% to ∼17%). CONCLUSIONS This approach provides evidence that the planning CT scan can mitigate some of the tissue-specific attenuation in Cherenkov images, allowing them to be translated into near surface dose images. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Petr Bruza
- Thayer School of Engineering at Dartmouth, Dartmouth College, Hanover, NH.,DoseOptics LLC, NH, Lebanon
| | - Michael Jermyn
- Thayer School of Engineering at Dartmouth, Dartmouth College, Hanover, NH.,DoseOptics LLC, NH, Lebanon
| | - David J Gladstone
- Thayer School of Engineering at Dartmouth, Dartmouth College, Hanover, NH.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Rongxiao Zhang
- Thayer School of Engineering at Dartmouth, Dartmouth College, Hanover, NH.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Lesley A Jarvis
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Brian W Pogue
- Thayer School of Engineering at Dartmouth, Dartmouth College, Hanover, NH.,DoseOptics LLC, NH, Lebanon
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Li Y, Liu H, Huang N, Wang Z, Zhang C. The Measurement of the Surface Dose in Regular and Small Radiation Therapy Fields Using Cherenkov Imaging. Technol Cancer Res Treat 2022; 21:15330338211073432. [PMID: 35119327 PMCID: PMC8819764 DOI: 10.1177/15330338211073432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study is to measure the output factor (OF)
and profile of surface dose in regular and small radiation therapy fields using
Cherenkov imaging (CI). Methods: A medical linear accelerator
(linac) was employed to generate radiation fields, including regular open photon
field (ROPF), regular wedge photon field (RWPF), regular electron field (REF)
and small photon field (SPF). The photon beams consisted of two filter modes
including flattening filter (FF) and flattening filter free (FFF). All fields
were delivered to a solid water phantom. Cherenkov light was captured using a
charge-coupled device system during phantom irradiation. The OF and profile of
surface dose measured by CI were compared with those determined by film
measurement, ionization chamber measurement and treatment planning system
calculation in order to examine the feasibility of measuring surface dose OF and
profile using CI. Results: The discrepancy between surface dose OF
measured by CI and that determined by other methods is less than 6% in ROPFs
with size less than 10 × 10 cm2, REFs with size less than 10 × 10
cm2, and SPFs except for 1 × 1 cm2 field. In the flat
profile region, the discrepancy between surface dose profile measured by CI and
that determined by other methods is less than 4% in REFs and less than 3% in
ROPFs, RWPFs, and SPFs except for 1 × 1 cm2 field. The discrepancy of the
surface dose profile is in compliance with the recommendation by IAEA TRS 430
reports. The discrepancy between field width measured by CI and that determined
by film measurement is equal to or less than 2 mm, which is within the tolerance
recommend by the guidelines of linac quality assurance in regular open FF photon
fields, SPFs, and REFs with cone size of 10 × 10 cm2 in area.
Conclusion: CI can be used to quantitatively measure the OF and
profile of surface dose. It is feasible to use CI to measure the surface dose
profile and field width in regular open FF photon fields and SPFs except for
1 × 1 cm2 field.
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Affiliation(s)
- Yi Li
- State Key Laboratory of Transient Optics and Photonics, Xi’an
Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi’an
710119, China
- School of Physics, Xi’an Jiaotong University, Xi’an 710049, China
- University of Chinese Academy of Sciences, Beijing 100049,
China
| | - HongJun Liu
- State Key Laboratory of Transient Optics and Photonics, Xi’an
Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi’an
710119, China
- Collaborative Innovation Center of Extreme Optics, Shanxi
University, Taiyuan 030006, China
- Hongjun Liu, PhD, State Key Laboratory of
Transient Optics and Photonics, Xi’an Institute of Optics and Precision
Mechanics, Chinese Academy of Sciences, Xi’an 710119, China.
Chunmin Zhang, PhD, School of Physics,
Xi’an Jiaotong University, Xi’an 710049, China.
| | - Nan Huang
- State Key Laboratory of Transient Optics and Photonics, Xi’an
Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi’an
710119, China
| | - Zhaolu Wang
- State Key Laboratory of Transient Optics and Photonics, Xi’an
Institute of Optics and Precision Mechanics, Chinese Academy of Sciences, Xi’an
710119, China
| | - Chunmin Zhang
- School of Physics, Xi’an Jiaotong University, Xi’an 710049, China
- Hongjun Liu, PhD, State Key Laboratory of
Transient Optics and Photonics, Xi’an Institute of Optics and Precision
Mechanics, Chinese Academy of Sciences, Xi’an 710119, China.
Chunmin Zhang, PhD, School of Physics,
Xi’an Jiaotong University, Xi’an 710049, China.
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Decker SM, Alexander DA, Hachadorian RL, Zhang R, Gladstone DJ, Bruza P, Pogue BW. Estimation of diffuse Cherenkov optical emission from external beam radiation build-up in tissue. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210129RR. [PMID: 34545714 PMCID: PMC8451315 DOI: 10.1117/1.jbo.26.9.098003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE Optical imaging of Cherenkov emission during radiation therapy could be used to verify dose delivery in real-time if a more comprehensive quantitative understanding of the factors affecting emission intensity could be developed. AIM This study aims to explore the change in diffuse Cherenkov emission intensity with x-ray beam energy from irradiated tissue, both theoretically and experimentally. APPROACH Derivation of the emitted Cherenkov signal was achieved using diffusion theory, and experimental studies with 6 to 18 MV energy x-rays were performed in tissue phantoms to confirm the model predictions as related to the radiation build-up factor with depth into tissue. RESULTS Irradiation at lower x-ray energies results in a greater surface dose and higher build-up slope, which results in a ∼46 % greater diffusely emitted Cherenkov signal per unit dose at 6 MV relative to 18 MV x-rays. However, this phenomenon competes with a decrease in signal from less Cherenkov photons being generated at lower energies, a ∼44 % reduction at 6 versus 18 MV. The result is an emitted Cherenkov signal that is nearly constant with beam energy. CONCLUSIONS This study explains why the observed Cherenkov emission from tissue is not a strong function of beam energy, despite the known strong correlation between Cherenkov intensity and particle energy in the absence of build-up and scattering effects.
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Affiliation(s)
- Savannah M. Decker
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Daniel A. Alexander
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | | | - Rongxiao Zhang
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth–Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - David J. Gladstone
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth–Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Petr Bruza
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- DoseOptics LLC, Lebanon, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
- Dartmouth College, Geisel School of Medicine, Department of Medicine, Hanover, New Hampshire, United States
- DoseOptics LLC, Lebanon, New Hampshire, United States
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Hachadorian R, Farwell JC, Bruza P, Jermyn M, Gladstone DJ, Pogue BW, Jarvis LA. Verification of field match lines in whole breast radiation therapy using Cherenkov imaging. Radiother Oncol 2021; 160:90-96. [PMID: 33892022 DOI: 10.1016/j.radonc.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/17/2021] [Accepted: 04/09/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE In mono-isocentric radiation therapy treatment plans designed to treat the whole breast and supraclavicular lymph nodes, the fields meet at isocenter, forming the match line. Insufficient coverage at the match line can lead to recurrence, and overlap over weeks of treatment can lead to increased risk of healthy tissue toxicity. Cherenkov imaging was used to assess the accuracy of delivery at the match line and identify potential incidents during patient treatments. METHODS AND MATERIALS A controlled calibration was constructed from the deconvolved Cherenkov images from the delivery of a modified patient treatment plan to an anthropomorphic phantom with introduced separation and overlap. The trend from this calibration was then used to evaluate the field match line for accuracy and inter-fraction consistency for two patients. RESULTS The intersection point between matching field profiles was directly correlated to the distance (gap/overlap) between the fields (anthropomorphic phantom R2 = 0.994 "breath hold" and R2 = 0.990 "free breathing"). The profile intersection points from two patients' imaging sessions yielded an average of +1.40 mm offset (overlap) and -1.32 mm offset (gap), thereby introducing roughly a 25.0% over-dose and a -23.6% under-dose (R2 = 0.994). CONCLUSIONS This study shows that field match regions can be detected and quantified by taking deconvolved Cherenkov images and using their product image to create steep intensity gradients, causing match lines to stand out. These regions can then be quantitatively translated into a dose consequence. This approach offers a high sensitivity detection method which can quantify match line variability and errors in vivo.
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Affiliation(s)
| | | | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, United States
| | - Michael Jermyn
- Thayer School of Engineering, Dartmouth College, Hanover, United States; DoseOptics LLC, Lebanon, United States
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, United States; Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center, Lebanon, United States; Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, United States; DoseOptics LLC, Lebanon, United States; Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center, Lebanon, United States; Geisel School of Medicine, Dartmouth College, Hanover, United States
| | - Lesley A Jarvis
- Norris Cotton Cancer Center at Dartmouth Hitchcock Medical Center, Lebanon, United States; Geisel School of Medicine, Dartmouth College, Hanover, United States.
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Jarvis LA, Hachadorian RL, Jermyn M, Bruza P, Alexander DA, Tendler II, Williams BB, Gladstone DJ, Schaner PE, Zaki BI, Pogue BW. Initial Clinical Experience of Cherenkov Imaging in External Beam Radiation Therapy Identifies Opportunities to Improve Treatment Delivery. Int J Radiat Oncol Biol Phys 2021; 109:1627-1637. [PMID: 33227443 PMCID: PMC10544920 DOI: 10.1016/j.ijrobp.2020.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/05/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The value of Cherenkov imaging as an on-patient, real-time, treatment delivery verification system was examined in a 64-patient cohort during routine radiation treatments in a single-center study. METHODS AND MATERIALS Cherenkov cameras were mounted in treatment rooms and used to image patients during their standard radiation therapy regimen for various sites, predominantly for whole breast and total skin electron therapy. For most patients, multiple fractions were imaged, with some involving bolus or scintillators on the skin. Measures of repeatability were calculated with a mean distance to conformity (MDC) for breast irradiation images. RESULTS In breast treatments, Cherenkov images identified fractions when treatment delivery resulted in dose on the contralateral breast, the arm, or the chin and found nonideal bolus positioning. In sarcoma treatments, safe positioning of the contralateral leg was monitored. For all 199 imaged breast treatment fields, the interfraction MDC was within 7 mm compared with the first day of treatment (with only 7.5% of treatments exceeding 3 mm), and all but 1 fell within 7 mm relative to the treatment plan. The value of imaging dose through clear bolus or quantifying surface dose with scintillator dots was examined. Cherenkov imaging also was able to assess field match lines in cerebral-spinal and breast irradiation with nodes. Treatment imaging of other anatomic sites confirmed the value of surface dose imaging more broadly. CONCLUSIONS Daily radiation therapy can be imaged routinely via Cherenkov emissions. Both the real-time images and the posttreatment, cumulative images provide surrogate maps of surface dose delivery that can be used for incident discovery and/or continuous improvement in many delivery techniques. In this initial 64-patient cohort, we discovered 6 minor incidents using Cherenkov imaging; these otherwise would have gone undetected. In addition, imaging provides automated, quantitative metrics useful for determining the quality of radiation therapy delivery.
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Affiliation(s)
- Lesley A Jarvis
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | | | - Michael Jermyn
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Petr Bruza
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | | | - Irwin I Tendler
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Benjamin B Williams
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - David J Gladstone
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Philip E Schaner
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Bassem I Zaki
- Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Brian W Pogue
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
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Li Y, Liu H, Huang N, Wang Z, Zhang C. Using Cherenkov imaging to monitor the match line between photon and electron radiation therapy fields on biological tissue phantoms. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200268RR. [PMID: 33300317 PMCID: PMC7725107 DOI: 10.1117/1.jbo.25.12.125001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
SIGNIFICANCE Due to patients' respiratory movement or involuntary body movements during breast cancer radiotherapy, the mismatched adjacent fields in surface exposure regions could result in insufficient dosage or overdose in these regions, which would lead to tissue injury, excessive skin burns, and potential death. Cherenkov luminescence imaging (CLI) could be used to effectively detect the matching information of adjacent radiation fields without extra radiation or invasive imaging. AIM Our objective was to provide a biological experimental basis for monitoring matching of adjacent radiation fields between photon and electron fields due to introduced shifts during radiotherapy by CLI technique. APPROACH A medical accelerator was used to generate photon and electron fields. An industrial camera system was adopted to image the excited CLI signal during irradiation of chicken tissue with yellow (group A and group C experiments) or black color (group B experiment). The following introduced shifts were tested: 10, 5, 2, and 0 mm toward superior or inferior direction. A model was introduced to deal with matching error analysis of adjacent radiation fields due to introduced shifts with adapted plans used to treat neoplasms of the right breast with supraclavicular nodes or internal mammary lymph node. RESULTS The matching values between photon and electron fields were consistent with the tested introduced shifts during yellow chicken irradiation. In group A, average discrepancies were 0.59 ± 0.35 mm and 0.68 ± 0.37 mm for photon fields and electron fields in anterior/posterior (AP) direction, with 87% and 75% of measurement within 1 mm, respectively. In group C, average discrepancies were 0.80 ± 0.65 mm and 1.07 ± 0.57 mm for oblique photon field with gantry angles of 330 deg and 150 deg, with 66% and 65% of measurement within 1 mm, respectively. The average discrepancies were 0.44 ± 0.30 mm for electron field in the AP direction, with 94% of measurement within 1 mm. The matching error introduced by the proposed method was less than 1.5 mm for AP fields and 2 mm for oblique incidence fields. However, the field matching could not be monitored with black chicken tissue irradiation due to a weak CLI signal that could hardly be extracted from background noise in group B. CONCLUSIONS CLI is demonstrated for the quantitative monitoring of the field match line on light biological tissue phantoms and has potential for monitoring of field matching in surface tissue during breast cancer radiotherapy.
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Affiliation(s)
- Yi Li
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
- Xi’an Jiaotong University, School of Physics, Xi’an, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Hongjun Liu
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
- Shanxi University, Collaborative Innovation Center of Extreme Optics, Taiyuan, China
| | - Nan Huang
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
| | - Zhaolu Wang
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
| | - Chunmin Zhang
- Xi’an Jiaotong University, School of Physics, Xi’an, China
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11
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Rickard AG, Yoshikawa H, Palmer GM, Liu HQ, Dewhirst MW, Nolan MW, Zhang X. Cherenkov emissions for studying tumor changes during radiation therapy: An exploratory study in domesticated dogs with naturally-occurring cancer. PLoS One 2020; 15:e0238106. [PMID: 32845905 PMCID: PMC7449466 DOI: 10.1371/journal.pone.0238106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Real-time monitoring of physiological changes of tumor tissue during radiation therapy (RT) could improve therapeutic efficacy and predict therapeutic outcomes. Cherenkov radiation is a normal byproduct of radiation deposited in tissue. Previous studies in rat tumors have confirmed a correlation between Cherenkov emission spectra and optical measurements of blood-oxygen saturation based on the tissue absorption coefficients. The purpose of this study is to determine if it is feasible to image Cherenkov emissions during radiation therapy in larger human-sized tumors of pet dogs with cancer. We also wished to validate the prior work in rats, to determine if Cherenkov emissions have the potential to act an indicator of blood-oxygen saturation or water-content changes in the tumor tissue-both of which have been correlated with patient prognosis. METHODS A DoseOptics camera, built to image the low-intensity emission of Cherenkov radiation, was used to measure Cherenkov intensities in a cohort of cancer-bearing pet dogs during clinical irradiation. Tumor type and location varied, as did the radiation fractionation scheme and beam arrangement, each planned according to institutional standard-of-care. Unmodulated radiation was delivered using multiple 6 MV X-ray beams from a clinical linear accelerator. Each dog was treated with a minimum of 16 Gy total, in ≥3 fractions. Each fraction was split into at least three subfractions per gantry angle. During each subfraction, Cherenkov emissions were imaged. RESULTS We documented significant intra-subfraction differences between the Cherenkov intensities for normal tissue, whole-tumor tissue, tissue at the edge of the tumor and tissue at the center of the tumor (p<0.05). Additionally, intra-subfraction changes suggest that Cherenkov emissions may have captured fluctuating absorption properties within the tumor. CONCLUSION Here we demonstrate that it is possible to obtain Cherenkov emissions from canine cancers within a fraction of radiotherapy. The entire optical spectrum was obtained which includes the window for imaging changes in water and hemoglobin saturation. This lends credence to the goal of using this method during radiotherapy in human patients and client-owned pets.
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Affiliation(s)
- Ashlyn G. Rickard
- Department of Radiation Oncology, Program of Medical Physics, Duke University School of Medicine, Durham, NC, United States of America
| | - Hiroto Yoshikawa
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC, United States of America
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
| | - Gregory M. Palmer
- Department of Radiation Oncology, Program of Medical Physics, Duke University School of Medicine, Durham, NC, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC, United States of America
| | - Harrison Q. Liu
- Program of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Mark W. Dewhirst
- Department of Radiation Oncology, Program of Medical Physics, Duke University School of Medicine, Durham, NC, United States of America
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC, United States of America
| | - Michael W. Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, NC State University, Raleigh, NC, United States of America
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
- Duke Cancer Institute, Duke University, Durham, NC, United States of America
| | - Xiaofeng Zhang
- Artificial Intelligence, Marchex Inc., Seattle, WA, United States of America
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12
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Miao T, Bruza P, Pogue BW, Jermyn M, Krishnaswamy V, Ware W, Rafie F, Gladstone DJ, Williams BB. Cherenkov imaging for linac beam shape analysis as a remote electronic quality assessment verification tool. Med Phys 2018; 46:811-821. [PMID: 30471126 DOI: 10.1002/mp.13303] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE A remote imaging system tracking Cherenkov emission was analyzed to verify that the linear accelerator (linac) beam shape could be quantitatively measured at the irradiation surface for Quality Audit (QA). METHODS The Cherenkov camera recorded 2D dose images delivered on a solid acrylonitrile butadiene styrene (ABS) plastic phantom surface for a range of square beam sizes, and 6 MV photons. Imaging was done at source to surface distance (SSD) of 100 cm and compared to GaF film images and linac light fields of the same beam sizes, ranging over 5 × 5 cm2 up to 20 × 20 cm2 . Line profiles of each field were compared in both X and Y jaw directions. Each measurement was repeated on two different Clinac2100 machines. An interreader comparison of the beam width interpretation was completed using procedures commonly employed for beam to light field coincidence verification. Cherenkov measurements are also done for beams of complex treatment plan and isocenter QA. RESULTS The Cherenkov image widths matched with the measured GaF images and light field images, with accuracy in the range of ±1 mm standard deviation. The differences between the measurements were minor and within tolerance of geometrical requirement of standard linac QA procedures conducted by human setup verification, which had a similar error range. The measurement made by the remote imaging system allowed for beam shape extraction of radiation fields at the SSD location of the beam. CONCLUSIONS The proposed Cherenkov image acquisition system provides a valid way to remotely confirm radiation field sizes and provides similar information to that obtained from the linac light field or GaF film estimates of the beam size. The major benefit of this approach is that with a fixed installation of the camera, testing could be done completely under software control with automated image analysis, potentially simplifying conventional QA procedures with appropriate calibration of boundary definitions, and the natural extension to capturing dynamic treatment beamlets at SSD could have future value, such as verification of beam plans with complex beam shapes, like IMRT or "star-shot" QA for the isocenter.
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Affiliation(s)
- Tianshun Miao
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,DoseOptics LLC, Lebanon, NH, 03766, USA
| | - Michael Jermyn
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,DoseOptics LLC, Lebanon, NH, 03766, USA
| | | | | | - Frank Rafie
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
| | - Benjamin B Williams
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
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