Lesley A Jarvis1, Rachael L Hachadorian2, Michael Jermyn2, Petr Bruza2, Daniel A Alexander2, Irwin I Tendler2, Benjamin B Williams3, David J Gladstone3, Philip E Schaner4, Bassem I Zaki4, Brian W Pogue2. 1. Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. Electronic address: lesley.a.jarvis@hitchcock.org. 2. Thayer School of Engineering at Dartmouth, Hanover, New Hampshire. 3. 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. 4. Department of Medicine, Section of Radiation Oncology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
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.
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.
Authors: Rachael L Hachadorian; Petr Bruza; Michael Jermyn; David J Gladstone; Rongxiao Zhang; Lesley A Jarvis; Brian W Pogue Journal: Med Phys Date: 2022-03-28 Impact factor: 4.506
Authors: Rachael Hachadorian; J Cedar Farwell; Petr Bruza; Michael Jermyn; David J Gladstone; Brian W Pogue; Lesley A Jarvis Journal: Radiother Oncol Date: 2021-05-01 Impact factor: 6.901
Authors: Erli Chen; Brian W Pogue; Petr Bruza; Daniel A Alexander; Nancy L Andino; Savannah M Decker; Danielle M Gaudet; David J Gladstone; Melinda J Lake; Steven R Levene; Jennifer L Michelson; Hila L Robinson; Debra N Stallings; John E Starkey; Lesley A Jarvis Journal: Tech Innov Patient Support Radiat Oncol Date: 2022-09-09