Triggered therapy system and method

Abstract

In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. Furthermore, a position of the target may be monitored. An occurrence of substantial alignment between the position of the target and the position of the target in the planning image may be calculated. Furthermore, after the calculation, a radiation beam may be triggered to deliver a dose to the target within a brief period of time (e.g., less than one second).

Description

[0001] This application is a divisional application with application number 201880035119.9 and invention name “Triggered therapy system and method”, which was filed on July 19, 2018, entered the Chinese national phase on November 27, 2019, and has the international application date of July 19, 2018. Background Art

[0002] The use of radiation therapy to treat cancer is well known. Typically, radiation therapy involves directing a beam of high-energy proton, photon, ion, or electron radiation ("therapeutic radiation") into a target or target volume (e.g., a tumor or lesion) within a patient's body.

[0003] Before a patient is treated with radiation, a treatment plan specific to that patient is developed. The plan uses simulations and optimization based on past experience to define various aspects of the therapy. Overall, the goal of the treatment plan is to deliver sufficient radiation to the target while minimizing exposure of surrounding normal healthy tissue to the radiation.

[0004] The planner's goal is to find the best solution for multiple clinical targets that may conflict in that improvements toward one target may have a detrimental effect on achieving another target. For example, a treatment plan that spares the liver from receiving a certain dose of radiation may result in the stomach receiving too much radiation. These types of trade-offs lead to an iterative process in which planners develop different plans to find the one that best achieves the desired outcome.

[0005] Recent radiation biology research has demonstrated the utility of delivering a full, relatively high therapeutic radiation dose to a target in a single, brief time period. This type of instruction is generally referred to herein as FLASH radiation therapy (FLASH RT). Evidence to date indicates that FLASH RT advantageously spares normal healthy tissue from damage when it is exposed to only a single irradiation burst for only a very brief time period. FLASH RT therefore introduces important constraints that are not considered or achieved in conventional radiation therapy plans.

[0006] For radiation therapy treatment, the patient usually first receives a CT (computed tomography) scan for simulating the patient's treatment. The simulated treatment plan defines the beam orientation and the corresponding particle fluence to generate a 3D (three-dimensional) dose distribution that best implements the physician's prescription and / or intention. Once the treatment plan is defined, treatment can begin. It should be noted that treatment uncertainty is due to the different appearance of the patient at each treatment fraction compared to the CT simulation from which the treatment plan was derived. In addition, organ motion related to large-scale patient movement, breathing, cardiac function, and changes in organ filling further exacerbates treatment uncertainty. Various techniques are currently used to manage organ motion in order to minimize the difference between the planned dose and the dose delivered to the patient, including breath holding, treatment gating, or abdominal compression. Each of these techniques has associated advantages and disadvantages, but all of these techniques are designed to manage motion when the treatment delivery time exceeds several minutes and may last up to 60 minutes.

[0007] For example, one of the disadvantages of breath holding is that many patients do not have the lung function to hold their breath for more than a few seconds; therefore, they are prevented from holding their breath for the entire duration of the treatment field. It should be noted that one of the disadvantages associated with treatment gating is that it requires continuous monitoring of the patient during a relatively long treatment period and shutting off the treatment beam whenever the target volume moves outside the predetermined volume of interest. In addition, treatment gating can significantly increase treatment time because the treatment beam remains off for a longer period of the respiratory cycle. It is important to note that abdominal compressions are generally not well tolerated by most patients because they are very uncomfortable for the patient and can limit critical functions associated with normal organ movement (such as breathing or defecation). Summary of the Invention

[0008] Various embodiments according to the present disclosure may address the above-mentioned disadvantages.

[0009] In various embodiments, the present disclosure provides triggered therapy, a new paradigm for image-guided radiation therapy that virtually eliminates organ motion during radiation delivery. In various embodiments, by delivering the entire treatment from each beam in a flash lasting a brief period of time (e.g., a fraction of a second), target and organ motion is relatively "frozen" in 3D space and treatment uncertainty caused by motion is minimized. Methods according to various embodiments involve monitoring the motion of a patient's target volume prior to treatment and selecting an appropriate time to trigger the flash of treatment. For each beam orientation, the region of interest can be monitored in real-time fluoroscopic projections through the patient. As the target moves within the patient, single or multiple synchronized fluoroscopic images can locate the target in three dimensions. When the target position matches its location in a pre-treatment simulation (e.g., CT (computed tomography), MRI (magnetic resonance imaging), or any medical imaging), the triggered therapy can be precisely delivered to the target in a nearly instantaneous flash.

[0010] In various embodiments, the triggered treatments of the present disclosure may include real-time monitoring of patient motion using fluoroscopic imaging (or alternative methods), which allows the patient to breathe freely or hold their breath when instructed. Furthermore, this preserves patient comfort, ultimately leading to a more positive patient experience. Furthermore, it should be noted that due to the ultra-short triggered treatment flash, the treatment margin that contributes to motion uncertainty can be significantly reduced, meaning that significantly less healthy tissue is irradiated, which results in fewer side effects and less late toxicity from the treatment.

[0011] In various embodiments, triggered therapy of the present disclosure may include continuously monitoring the patient's surface and triggering a series of radiographic images to be acquired to confirm the location of the target before triggering therapy.

[0012] In various embodiments, triggered therapy of the present disclosure may include any method of continuously tracking patient motion and / or respiration in conjunction with some form of visualization of internal anatomy, fiducial markers, or surrogates of internal anatomy.

[0013] In various embodiments, the triggered therapy of the present disclosure can be implemented with any particle or wave radiation delivered at a FLASH dose rate (eg, greater than 40 Gy (Gray) / second), but is not limited thereto.

[0014] In various embodiments, in accordance with the present disclosure, it should be noted that fluoroscopy (eg, ionizing radiation) doses can be used along with standard dose rates to reconstruct doses for inter-fraction dose tracking.

[0015] In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. Furthermore, a four-dimensional (4D) real-time video image of the target may be generated. Substantial alignment between the target in the 4D real-time video image and the target in the planning image may be calculated. Furthermore, after the calculation, a radiation beam may be triggered to deliver a dose to the target within a brief period of time (e.g., less than one second).

[0016] In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. Furthermore, a 4D real-time video image of the target may be generated. Mapping may be performed on the target in both the 4D real-time video image and the planning image. Substantial alignment between the target in the 4D real-time video image and the target in the planning image may be calculated. Furthermore, after the calculation, a radiation beam may be triggered to deliver a fraction of a dose to the target within a brief period of time (e.g., less than one second).

[0017] In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. A 4D real-time video image of the target may be generated. Furthermore, the occurrence of substantial alignment between the target in the 4D real-time video image and the target in the planning image may be calculated. Following the calculation, a radiation beam may be triggered to deliver a dose to the target within a brief period of time (e.g., less than one second). Furthermore, after the triggering, quality assurance may be performed using imaging information associated with the 4D real-time video image.

[0018] In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. Furthermore, a position of the target may be monitored. An occurrence of substantial alignment between the position of the target and the position of the target in the planning image may be calculated. Furthermore, after the calculation, a radiation beam may be triggered to deliver a dose to the target in less than one second.

[0019] In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. Furthermore, a position of the target may be monitored. Mapping may be performed on the target in both the monitoring and planning images. An occurrence of substantial alignment between the position of the target and the position of the target in the planning image may be calculated. Furthermore, after the calculation, a radiation beam may be triggered to deliver a fraction of a dose to the target in less than one second.

[0020] In various embodiments, a method of radiation therapy may include loading a planning image of a target within a human body. A position of the target may be monitored. Furthermore, occurrence of substantial alignment between the position of the target and the position of the target in the planning image may be calculated. Following the calculation, a radiation beam may be triggered to deliver a dose to the target in less than one second. Furthermore, after the triggering, quality assurance may be performed using information associated with the monitoring.

[0021] While various embodiments according to the present disclosure have been described in detail within this Summary, it should be noted that claimed subject matter is not limited in any way to these various embodiments. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] In the accompanying drawings, there is shown by way of example and not limitation, various embodiments according to the present disclosure.It should be noted that throughout the drawings, like reference numerals designate similar elements.

[0023] Figure 1 is a block diagram of an example of a computing system on which various embodiments described herein can be implemented according to various embodiments of the present disclosure.

[0024] Figure 2 is a block diagram illustrating an example of an automated radiation therapy treatment planning system according to various embodiments of the present disclosure.

[0025] Figure 3 A knowledge-based planning system according to various embodiments of the present disclosure is shown.

[0026] Figure 4A is a block diagram illustrating selected components of a radiation therapy system on which various embodiments may be implemented according to various embodiments of the present disclosure.

[0027] Figure 4B is a block diagram illustrating a non-coplanar arrangement of a gantry and nozzles relative to a patient support according to various embodiments of the present disclosure.

[0028] Figure 4C is a block diagram illustrating a coplanar arrangement of a gantry and nozzles relative to a patient support according to various embodiments of the present disclosure.

[0029] Figure 4D is a block diagram illustrating movement of a gantry and nozzles about a patient support according to various disclosed embodiments.

[0030] Figure 5 is a flow chart of a method according to various embodiments of the present disclosure.

[0031] Figure 6Visual representations of various embodiments according to the present disclosure are shown.

[0032] Figure 7 is a flow chart of a method according to various embodiments of the present disclosure. DETAILED DESCRIPTION

[0033] Reference will now be made in detail to various embodiments according to the present disclosure, examples of which are illustrated in the accompanying drawings. Although described in conjunction with various embodiments, it should be understood that these various embodiments are not intended to limit the present disclosure. On the contrary, the present disclosure is intended to cover alternatives, modifications and equivalents, which may be included within the scope of the present disclosure as interpreted according to the claims. In addition, in the following detailed description of various embodiments according to the present disclosure, numerous specific details are set forth in order to provide a thorough understanding of the present disclosure. However, it will be apparent to those of ordinary skill in the art that the present disclosure can be practiced without these specific details or their equivalents. In other cases, well-known methods, procedures, components and circuits are not described in detail to avoid unnecessarily confusing various aspects of the present disclosure.

[0034] Some portions of the following detailed description are presented in terms of procedures, logic blocks, processes, and other symbolic representations of operations on data bits within a computer memory. These descriptions and representations are the means by which those skilled in the art of data processing can most effectively convey the essence of their work to others skilled in the art. In this application, procedures, logic blocks, processes, and the like are conceived as a self-consistent sequence of steps or instructions leading to a desired result. These steps are steps utilizing physical manipulations of physical quantities. Typically, although not necessarily, these quantities take the form of electrical or magnetic signals that can be stored, transferred, combined, compared, and otherwise manipulated in a computing system. It has proven convenient, primarily for common usage, to refer to these signals as transactions, bits, values, elements, symbols, characters, samples, pixels, and the like.

[0035] It should be borne in mind, however, that all of these terms and similar terms are to be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities. Unless specifically stated otherwise, as will be clear from the following discussion, it should be understood that throughout this disclosure, discussions utilizing terms such as "determine," "access," "direct," "control," "define," "arrange," "generate," "acquire," "trigger," "compute," "load," and the like refer to a computing system or similar electronic computing device or processor (e.g., Figure 1The actions and processes of a computing system 100 (e.g., a computer system or similar electronic computing device) manipulate and transform data represented as physical (electronic) quantities within a computing system memory, registers, or other such information storage, transmission, or display device. Terms such as "dose" or "fluence" generally refer to dose or fluence values; the use of such terms will be clear from the context of the surrounding discussion.

[0036] The following detailed description is presented and discussed in terms of methods. Although steps and their ordering are disclosed in the figures herein that illustrate the operation of such methods, such steps and ordering are exemplary. Any method is well suited to performing various other steps or variations of the steps listed in the flowcharts of the figures herein, and in an order different from that depicted and described herein.

[0037] The various embodiments described herein may be discussed in the general context of computer-executable instructions residing on some form of computer-readable storage medium (such as program modules) executed by one or more computers or other devices. By way of example and not limitation, computer-readable storage media may include non-transitory computer storage media and communication media. In general, program modules include routine programs, procedures, objects, components, data structures, etc. that perform specific tasks or implement specific abstract data types. In various embodiments, the functionality of program modules may be combined or distributed as needed.

[0038] Computer storage media includes volatile and nonvolatile, removable and non-removable media implemented in any information storage method or technology, such as computer-readable instructions, data structures, program modules or other data. Computer storage media includes, but is not limited to, random access memory (RAM), read-only memory (ROM), electrically erasable programmable ROM (EEPROM), flash memory or other memory technology, compact disc ROM (CD-ROM), digital versatile disc (DVD) or other optical storage devices, magnetic cassettes, magnetic tape, magnetic disk storage devices or other magnetic storage devices, or any other medium that can be used to store the desired information and can be accessed to retrieve the information.

[0039] Communication media may embody computer-executable instructions, data structures, and program modules, and include any information delivery media. By way of example, and not limitation, communication media include wired media (such as a wired network or direct-wired connection) and wireless media (such as acoustic, radio frequency (RF), infrared, and other wireless media). Combinations of any of the above may also be included within the scope of computer-readable media.

[0040] Figure 1A block diagram illustrating an example of a computing system 100 on which various embodiments described herein may be implemented according to various embodiments of the present disclosure is shown. In the most basic configuration of system 100, system 100 includes at least one processing unit 102 and memory 104. This most basic configuration is Figure 1 106. The system 100 may also have additional features and / or functionality. For example, the system 100 may also include additional storage devices (removable and / or non-removable) including, but not limited to, magnetic or optical disks or tapes. Such additional storage devices may be stored in a manner similar to that described in the preceding text. Figure 1 1 and 2. The system 100 is shown in FIG. 1 by removable storage 108 and non-removable storage 120. The system 100 may also include one or more communication connections 122 that allow the device to communicate with other devices, such as in a networking environment using logical connections to one or more remote computers.

[0041] The system 100 also includes one or more input devices 124 , such as a keyboard, mouse, pen, voice input device, touch input device, etc. The system 100 also includes one or more output devices 126 , such as a display device, speaker, printer, etc.

[0042] exist Figure 1 In the example of , the memory 104 includes computer-readable instructions, data structures, program modules, etc. associated with an "optimizer" model 150. However, the optimizer model 150 may alternatively reside in any computer storage medium used by the system 100, or may be distributed across some combination of computer storage media, or may be distributed across some combination of networked computers. The functionality of the optimizer model 150 is described below.

[0043] It should be noted that computing system 100 may not include all Figure 1 Furthermore, the computing system 100 may be implemented to include Figure 1 One or more elements not shown. It should be noted that the computing system 100 may be utilized or implemented in any manner similar to that described and / or illustrated in this disclosure, but is not limited thereto.

[0044] Figure 2 1 is a block diagram illustrating an example of an automated radiation therapy treatment planning system 200 according to various embodiments of the present disclosure. The system 200 includes an input interface 210 for receiving patient-specific information (data) 201, a data processing component 220 that implements the optimizer model 150, and an output interface 230. The system 200 may be implemented in whole or in part on the computing system 100 ( Figure 1 ) is implemented on / using the computing system 100 as a software program, hardware logic, or a combination thereof.

[0045] exist Figure 2In the example of FIG, patient-specific information is provided to and processed by the optimizer model 150. The optimizer model 150 generates a prediction result. A treatment plan based on the prediction result can then be generated.

[0046] It should be noted that the computing system 200 may not include all Figure 2 Additionally, the computing system 200 may be implemented to include Figure 2 One or more elements not shown. It should be noted that the system 200 may be utilized or implemented in any manner similar to that described and / or illustrated in this disclosure, but is not limited thereto.

[0047] Figure 3 A knowledge-based planning system 300 is shown according to various embodiments of the present disclosure. Figure 3 In the example of , system 300 includes a knowledge base 302 and a treatment planning toolset 310. Knowledge base 302 includes patient records 304 (e.g., radiation therapy plans), treatment types 306, and statistical models 308. Figure 3 In the example of , the treatment planning toolset 310 includes a current patient record 312 , a treatment type 314 , a medical image processing module 316 , an optimizer model (module) 150 , a dose allocation module 320 , and a final radiation treatment plan 322 .

[0048] Treatment planning toolset 310 searches knowledge base 302 (and patient records 304) for previous patient records similar to current patient record 312. Statistical model 308 can be used to compare current patient record 312 with predicted outcomes for statistical patients. Using current patient record 312, selected treatment type 306, and selected statistical model 308, toolset 310 generates radiation therapy plan 322.

[0049] More specifically, in Figure 3 In the present invention, based on past clinical experience, there may be the most commonly used treatment types when patients present with a specific diagnosis, stage, age, weight, sex, co-morbidities, etc. The first stage treatment type 314 can be selected by selecting the treatment type that the planner has used in the past for similar patients. The medical image processing module 316 provides automatic delineation and automatic segmentation of two-dimensional cross-sectional slides (e.g., from computed tomography (CT), magnetic resonance imaging (MRI), or other medical imaging) to form a three-dimensional (3D) image using the medical images in the current patient record 312. The dose allocation module 320 of the optimizer model 150 can be used to calculate the dose allocation map.

[0050] In various embodiments according to the present disclosure, the optimizer model 150 uses a dose prediction model to help shape the dose distribution.The optimizer model 150 may provide, for example, a 3D dose distribution, fluence, and an associated dose-volume histogram for the current patient.

[0051] It should be noted that system 300 may not include all Figure 3 Furthermore, the system 300 may be implemented to include Figure 3 One or more components not shown. Note that system 300 may be utilized or implemented in any manner similar to that described and / or illustrated in this disclosure, but is not limited thereto.

[0052] Figure 4A is a block diagram illustrating selected components of a radiation therapy system 400 on which various embodiments may be implemented according to various embodiments of the present disclosure. Figure 4A In the example of , system 400 includes an accelerometer and beam delivery system 404 and a nozzle 406 .

[0053] The accelerometer and beam delivery system 404 generates and accelerates a beam of charged particles, such as electrons, protons, and ions (e.g., heavy ions), and contains the particles in a well-defined beam. In various embodiments, the accelerometer is an isochronous cyclotron capable of continuous wave output. The accelerator (e.g., a cyclotron) extracts particles with a specified energy. This provides a high continuous wave beam current at a high dose rate per shot. Other types of radio frequency accelerometers can be used, such as pulsed proton accelerometers (e.g., synchrocyclotrons, synchrotrons), coupled cavity linear accelerometers (e.g., constant field) in addition to non-radio frequency accelerometers, and laser-based accelerometers. The accelerometer (e.g., a cyclotron) can be a low-power output cyclotron, such as a cyclotron that accelerates particles to a range of 70-300 megaelectronvolts (MeV).

[0054] exist Figure 4AIn the embodiment of the present invention, the accelerometer and beam delivery system 404 includes components (e.g., dipole magnets, also known as bending magnets) that direct (e.g., bend, turn, or steer) the beam through the accelerometer and beam delivery system in a direction toward and into the nozzle 406. The accelerometer and beam delivery system 404 may include one or more multi-leaf collimators (MLCs); each MLC leaf may be independently moved back and forth by the control system 410 to dynamically shape the aperture through which the beam may pass, so as to block or unblock portions of the beam and thereby control the beam shape and exposure time. The accelerometer and beam delivery system 404 may also include components for adjusting the energy of the beam entering the nozzle 406 so that it is different from the energy of the beam extracted from the accelerometer. In various embodiments, multiple sets of quadrupole magnets are positioned in the accelerometer and beam delivery system 404 along the beam path.

[0055] In various embodiments, it should be noted that the accelerometer and beam delivery system 404 of the therapy system 400 can be implemented to generate any type of particle beam. For example, in various embodiments, the accelerometer and beam delivery system 404 can be implemented to generate any type of charged particle beam or uncharged particle beam. It should be noted that in various embodiments, the accelerometer and beam delivery system 404 can generate, but is not limited to, the following particle beams: electrons, protons, photons, carbon, carbon ions, neutrons, helium, alpha particles, oxygen, helium nuclei, or X-rays. Additionally, in various embodiments, the accelerometer and beam delivery system 404 can be implemented to generate an ultrasound output.

[0056] The nozzle 406 is used to aim the beam toward various locations (targets) within a subject (e.g., a patient) supported on a patient support 408 (e.g., a chair or table) in the treatment room. The target can be an organ, a portion of an organ (e.g., a volume or region within an organ), a tumor, diseased tissue, or a patient's external shape. In various embodiments, the nozzle 406 also includes components (e.g., XY scanning magnets) that steer (e.g., direct, deflect, or scan) the beam particles in the X and Y directions to scan the target within the patient on the patient support 408.

[0057] exist Figure 4A In the embodiment, the nozzle 406 can be mounted on the frame or a part thereof (e.g., Figure 4B 、 Figure 4C and Figure 4D ), the gantry is movable relative to the patient support 408, which is also movable. In various embodiments, the accelerometer and beam delivery system 404 are also mounted on or part of the gantry; in various embodiments, the accelerometer and beam delivery system are separate from (but in communication with) the gantry.

[0058] Figure 4A The control system 410 receives and implements the prescribed treatment plan. In various embodiments, the control system 410 comprises a computer system having a processor, memory, an input device (e.g., a keyboard), and possibly a display, in a well-known manner. The control system 410 can receive data regarding the operation of the system 400. Based on the data it receives and in accordance with the prescribed treatment plan, the control system 410 can control the accelerometer and parameters of the beam delivery system 404, the nozzle 406, and the patient support device 408, including parameters such as the energy, intensity, direction, size, and / or shape of the beam.

[0059] As noted above, the particles entering the nozzle 406 have a specified energy. Thus, in various embodiments according to the present disclosure, the nozzle 406 includes one or more components that affect (e.g., reduce, modulate) the energy, intensity, or both energy and intensity of the particles in the beam. The term "beam energy modulator" is used herein as a general term for one or more components that affect the energy, intensity, or both energy and intensity of the particles in the beam in order to control the range of the beam (e.g., the extent to which the beam penetrates into the target) and / or control the depth dose curve of the beam (e.g., the location of the maximum dose value in the target). In various embodiments, the beam modulator 407 includes: a range modulator, a range shifter, an intensity modulator, or any combination thereof (e.g., a range modulator and a range shifter, a range and intensity modulator, etc.). That is, when the term "beam modulator" is used, the element in question can be a range modulator, an intensity modulator, a range shifter, or both a range modulator and a range shifter, or a range and intensity modulator, or an intensity modulator, or an intensity modulator and a range shifter. Examples of beam modulators are disclosed in co-pending patent application, US Application No. 15 / 089,330, entitled “Radiation Therapy Systems and Methods”; however, the present disclosure is not limited thereto.

[0060] Note that system 400 may not include all Figure 4A Furthermore, the system 400 may be implemented to include Figure 4A One or more elements not shown. It should be noted that the system 400 can be utilized or implemented in any manner similar to that described and / or illustrated in this disclosure, but is not limited thereto.

[0061] Figure 4B is a block diagram illustrating a non-coplanar arrangement of a gantry 420 and a nozzle 406 relative to a patient support 408 according to various embodiments of the present disclosure. Figure 4C is a block diagram illustrating a coplanar arrangement of a gantry 420 and a nozzle 406 relative to a patient support 408 according to various embodiments of the present disclosure. Figure 4Dis a block diagram illustrating movement of the gantry 420 and nozzle 406 about the patient support 408, according to various disclosed embodiments. This movement can occur in a non-coplanar arrangement or a coplanar arrangement.

[0062] Figure 5 is a flow chart of a method 500 for performing a triggered radiation therapy treatment according to various embodiments of the present disclosure. Figure 5 Specific operations are disclosed in , but such operations are examples. Method 500 may not include all Figure 5 The operations shown. In addition, method 500 may include various other operations and / or variations of the operations shown. Likewise, the order of the operations of flowchart 500 may be modified. It should be understood that not all operations in flowchart 500 may be performed. In various embodiments, one or more operations of method 500 may be controlled or managed by software, firmware, hardware, or any combination thereof, but is not limited thereto. Method 500 may include processes of various embodiments of the present disclosure, which may be executed in computer or computing device readable and executable instructions or code (e.g., Figure 1 The computer or computing device readable and executable instructions (or code) may reside, for example, in a data storage feature such as a computer or computing device available volatile memory, a computer or computing device available non-volatile memory, and / or a computer or computing device available mass data storage device. However, the computer or computing device readable and executable instructions (or code) may reside in any type of computer or computing device readable medium or memory (e.g., such as in Figure 1 those seen within the computing system 100).

[0063] At operation 502, a patient treatment is simulated. It should be noted that operation 502 can be implemented in a wide variety of ways. For example, in various embodiments, operation 502 can include subjecting the patient to a scan (e.g., CT (computed tomography), MRI (magnetic resonance imaging), or other medical imaging) of one or more target volumes for simulating the patient treatment. In various embodiments, the one or more scans at operation 502 can be referred to as one or more planning images and can be loaded into one or more computing system memory devices. It should be noted that operation 502 can be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto.

[0064] exist Figure 5At operation 504, the patient is positioned within the triggered radiation therapy treatment system. It should be noted that operation 504 can be implemented in a wide variety of ways. For example, in various embodiments, the patient positioning at operation 504 can utilize a low-flexibility patient positioning technique, such as having the patient lie on a frameless and / or unshaded couch or sit on a frameless and / or unshaded chair. It should be noted that operation 504 can be implemented in any manner similar to, but not limited to, those described and / or illustrated herein.

[0065] At operation 506, images (e.g., static or non-static) of at least one target volume of the patient are loaded. It is noted that operation 506 can be implemented in a wide variety of ways. For example, images can be loaded at operation 506 using, but are not limited to, a cone beam computed tomography (CBCT) scan, an MRI scan, or any other medical imaging scan of the patient. Operation 506 can be implemented in any manner similar to, but not limited to, those described and / or illustrated herein.

[0066] exist Figure 5 At operation 508 , based on the loaded image, the patient may be shifted or moved to align the patient with the desired target orientation of the planning image used to simulate the patient's treatment. It should be noted that operation 508 can be implemented in a wide variety of ways. For example, using the loaded image, a couch or chair in or on which the patient is positioned may be shifted in 3D at operation 508 to align the patient with the planning image (e.g., CT, MRI, or other medical imaging) used to simulate the patient's treatment, but is not limited thereto. It should be noted that operation 508 may be implemented in any manner similar to that described and / or illustrated herein, but is not limited thereto.

[0067] At operation 510, patient treatment begins with real-time fluoroscopic imaging. It should be noted that operation 510 can be implemented in a wide variety of ways. For example, at operation 510, a four-dimensional (4D) cone beam can be generated to produce a real-time video feed. It should be noted that operation 510 can be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto.

[0068] exist Figure 5 At operation 512, a calculation may be made (e.g., manually or automatically) as to whether the target volume of the real-time video imaging is substantially aligned with the target volume of the planning image. If so, the method 500 may proceed to operation 514. However, if it is calculated at operation 512 that the target volume of the real-time video imaging is not substantially aligned with the target volume of the planning image, the method 500 may proceed to the beginning of operation 512.

[0069] It should be noted that operation 512 can be implemented in a wide variety of ways. For example, at operation 512, manual monitoring can be implemented by a person (e.g., a therapist) who is trained to observe real-time video imaging of the patient and determine when the target volume is substantially aligned (e.g., within a certain deviation range) with the expected target volume from the planning image (e.g., CT, MRI, or other medical imaging). In various embodiments, at operation 512, a computing system (e.g., 100) can be used to include automatic monitoring, wherein one or more indicators are defined to calculate when the target volume is substantially aligned (e.g., within a certain deviation range) with the expected target volume from the planning image (e.g., CT, MRI, or other medical imaging).

[0070] In various embodiments, Figure 5 Operation 512 may be implemented using a visual representation of the mapping and alignment (e.g., within a certain range of deviation) of the target volume of real-time video imaging and planning images (e.g., CT, MRI, or other medical imaging). Figure 6 A visual representation 600 of a real-time deformed sum of vector fields with colors is shown according to various embodiments of the present disclosure. More specifically, the visual representation 600 shows the real-time deformed sum of vector fields with colors when a human user (e.g., a therapist) is guided to minimize the magnitude of the vector field. Note that when the magnitude of the vector field is minimized, the real-time video imaging of the target volume is substantially aligned with the target volume of the planning image (e.g., within a certain deviation range).

[0071] It should be noted that, in various embodiments, visual representation 600 may include a deformation vector field image 602 and a bar graph 606. Visual representation 600 may be generated by performing deformable image registration, wherein each voxel of the real-time video image is mapped to a voxel in the planning image, and this voxel mapping may be represented by deformation vector field 604, as shown in vector field image 602. It should be noted that areas where there are large changes from one image to another are represented by long arrows or vectors 604, while areas where there are less large changes are represented by small arrows 604. Thus, when the length of arrow 604 is minimized within the region of interest (e.g., the target volume), the treatment beam may be triggered (e.g., at operation 514). Furthermore, in various embodiments, arrows 604 may be color-coded, with lighter colors indicating areas of higher deformation between images and darker colors indicating areas of less deformation, but this is not limiting.

[0072] exist Figure 6In various embodiments, a bar graph 606 shows the sum of the deformation vector fields in each direction, resulting in rapid activation of the magnitude of how long these arrows are in the x, y, and z directions. Within the bar graph 606, each of x, y, and z will include a bar 608, 610, or 612, respectively, indicating how closely the first image is aligned with the second image (e.g., the planned image). The shorter the bar, the closer the alignment of the two images. Conversely, the longer the bar, the greater the misalignment of the two images. In various embodiments, the bars can each be color-coded. For example, a red bar (the leftmost bar of each group) indicates misalignment between the two images, a yellow bar (the middle bar of each group) indicates better alignment, and a green bar (the rightmost bar of each group) indicates an acceptable or desired range of alignment between the two images. In various embodiments of the bar graph 606, it should be noted that each of x, y, and z will include a single bar 608, 610, or 612, respectively, that can be changed in real time.

[0073] Note that the visual representation 600 may not include all Figure 6 Furthermore, the visual representation 600 may be implemented to include Figure 6 One or more elements not shown. It should be noted that visual representation 600 may be utilized or implemented in any manner similar to that described and / or illustrated in this disclosure, but is not limited thereto.

[0074] exist Figure 5 In, can be used with Figure 6 Operation 512 may be performed using a different visual representation than that shown in FIG. For example, in various embodiments, the visual representation may enable a three-dimensional volume to be "drawn" around a target area or region of interest. Within this region of interest, the magnitude of the real-time deformation vector field may be summed in real time to generate an indicator (e.g., a number that changes in real time). When this number is minimized (or within a defined range), the treatment beam may be triggered (e.g., at operation 514). Note that operation 512 may be performed in any manner similar to, but not limited to, that described and / or illustrated herein.

[0075] At operation 514, treatment is triggered, which may include, but is not limited to, delivering a dose of radiation therapy (or ultrasound, etc.) to the target volume in a fraction of a second (e.g., less than a second). Note that operation 514 can be implemented in a wide variety of ways. For example, at operation 514, the entire therapeutic dose of radiation therapy may be delivered to the target volume in a fraction of a second. In various embodiments, at operation 514, a fraction of the therapeutic dose of radiation therapy may be delivered to the target volume in a fraction of a second. In various embodiments, at operation 514, each beam may deliver a relatively high dose in a relatively short period of time. For example, each beam may, but is not limited to, deliver at least 0.01 gray (Gy) or 4 Gy in less than a second, and may deliver up to 20 Gy or 500 Gy or more in less than a second (sec). In various embodiments, at operation 514, each beam may, but is not limited to, deliver greater than 4 Gy / sec, greater than 20 Gy / sec, or greater than 40 Gy / sec. In various embodiments, at operation 514, each beam may deliver at least 1 Gy within 0.25 sec, at least 1 Gy within 0.05 sec, or at least 1 Gy within 0.025 sec. It should be noted that operation 514 may be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto.

[0076] exist Figure 5 At operation 516, online (or during treatment) triggered treatment quality assurance can be performed. It should be noted that operation 516 can be implemented in a wide variety of ways. For example, by obtaining a fluoroscopic examination during treatment at operation 516, 4D (four-dimensional) imaging information can be matched with the 4D beam time, thereby making it suitable for 4D dose calculation. In various embodiments, the results of this calculation can be summed in real time at operation 516 for online quality assurance (QA) when the next beam is delivered, thereby allowing 4D dose tracking for each fraction in the treatment process. It should be noted that operation 516 can be implemented in any manner similar to that described and / or shown in the present disclosure, but is not limited to such.

[0077] At operation 518, a calculation may be made as to whether the treatment has been completed. If so, method 500 may proceed to operation 522. However, if it is calculated at operation 518 that the treatment has not been completed, method 500 may proceed to operation 520. Note that operation 518 may be implemented in a wide variety of ways. For example, operation 518 may be implemented in any manner similar to, but not limited to, those described and / or illustrated in the present disclosure.

[0078] exist Figure 5At operation 520, the method 500 moves to the next beam position or angle. It should be noted that operation 520 can be implemented in a wide variety of ways. For example, the method 500 can move to the next beam position or angle at operation 520 by rotating the gantry (e.g., 420). In various embodiments, the method 500 can move to the next beam position at operation 520 by rotating the patient. It should be noted that operation 520 can be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto. After operation 520 is completed, the method 500 can proceed to the beginning of operation 510.

[0079] At operation 522, offline (or post-treatment) triggered treatment quality assurance can be performed. It should be noted that operation 522 can be implemented in a wide variety of ways. For example, by obtaining a fluoroscopic examination after treatment at operation 522, the 4D imaging information can be matched to the 4D beam time, thereby making it suitable for 4D dose calculation. In various embodiments, the results of this calculation can be summed at operation 522 for offline quality assurance (QA), allowing 4D dose tracking for each fraction in the treatment process. In various embodiments, at operation 522, offline triggered treatment quality assurance can include: using actual log files from the machine to computationally check, confirm, and re-deliver (or replay) the dose on the 4D images and verify the completed dose. It should be noted that the use of such fluoroscopic examination for 4D dose tracking can be used for standard radiation delivery protocols and dose rates. It should be noted that operation 522 can be implemented in any manner similar to, but not limited to, those described and / or illustrated in the present disclosure. After operation 522 is completed, method 500 can end. In this manner, method 500 may perform triggered radiation therapy treatment according to various embodiments of the present disclosure.

[0080] Figure 7 is a flow chart of a method 700 for performing triggered therapy (eg, radiation therapy, ultrasound, etc.) according to various embodiments of the present disclosure. Figure 7 Specific operations are disclosed in , but such operations are examples. Method 700 may not include all Figure 7 The operations shown. In addition, method 700 may include various other operations and / or variations of the operations shown. Likewise, the order of the operations of flowchart 700 may be modified. It should be understood that not all operations in flowchart 700 may be performed. In various embodiments, one or more operations of method 700 may be controlled or managed by software, firmware, hardware, or any combination thereof, but is not limited thereto. Method 700 may include processes of various embodiments of the present disclosure, which may be executed in computer or computing device readable and executable instructions or code (e.g., Figure 1The computer or computing device readable and executable instructions (or code) may reside, for example, in a data storage feature such as a computer or computing device available volatile memory, a computer or computing device available non-volatile memory, and / or a computer or computing device available mass data storage device. However, the computer or computing device readable and executable instructions (or code) may reside in any type of computer or computing device readable medium or memory (e.g., such as in Figure 1 those seen within the computing system 100).

[0081] In various embodiments, it is noted that Figure 7 Operations 502, 504, 506, and 508 may be performed as described and / or illustrated in the present disclosure. Figure 5 Operations 502, 504, 506 and 508 are similarly performed, but are not limited thereto. Figure 7 After operation 508 is completed, method 700 proceeds to Figure 7 Operation 702.

[0082] exist Figure 7 At operation 702, treatment of the patient is initiated by monitoring (or continuously tracking) the real-time position of at least one target volume of the patient. It is noted that operation 702 can be implemented in a wide variety of ways. For example, monitoring (or continuously tracking) the real-time position of at least one target volume of the patient at operation 702 can be achieved by, but not limited to, real-time fluoroscopic imaging, magnetic resonance imaging (MRI), fiducial markers, cone-beam computed tomography (CBCT), digital tomosynthesis (DTS), ultrasound, external markers, any form of visualization of internal anatomical structures, surrogates of internal anatomical structures, 4D cone beams that produce a real-time video feed, etc. It is noted that operation 702 can be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto.

[0083] At operation 704, a calculation may be performed (e.g., manually or automatically) as to whether the real-time position of the at least one target volume is substantially aligned with the position of the corresponding at least one target volume of the planning image. If so, the method 700 may proceed to operation 706. However, if, at operation 704, it is calculated that the real-time position of the at least one target volume is not substantially aligned with the position of the corresponding at least one target volume of the planning image, the method 700 may proceed to the beginning of operation 704.

[0084] It should be noted that operation 704 can be implemented in a wide variety of ways. For example, at operation 704, manual monitoring can be implemented by a person (e.g., a therapist) who is trained to observe the real-time position of the at least one target volume and determine when it is substantially aligned (e.g., within a certain deviation range) with the corresponding at least one target volume from the planning image (e.g., CT, MRI, or other medical imaging). In various embodiments, at operation 704, a computing system (e.g., 100) can be used to include automatic monitoring, wherein one or more indicators are defined to calculate when the real-time position of the at least one target volume is substantially aligned (e.g., within a certain deviation range) with the corresponding at least one target volume from the planning image (e.g., CT, MRI, or other medical imaging).

[0085] In various embodiments, Figure 7 Operation 704 may be implemented using a visual representation of the mapping and alignment (e.g., within a deviation range) of the real-time position of at least one target volume and the position of the corresponding at least one target volume from a planning image (e.g., CT, MRI, or other medical imaging) in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto. In various embodiments, it should be noted that Figure 7 Operation 704 may be performed as described and / or illustrated in the present disclosure. Figure 5 Operation 512 may be implemented in any similar manner, but is not limited thereto.

[0086] At operation 706, treatment is triggered, which may include, but is not limited to, delivering a dose of radiation therapy (or ultrasound, etc.) to at least one target volume in a fraction of a second (e.g., less than a second). Note that operation 706 can be implemented in a wide variety of ways. For example, at operation 706, the entire therapeutic dose of radiation therapy may be delivered to at least one target volume in less than a second. In various embodiments, at operation 706, a fraction of the therapeutic dose of radiation therapy may be delivered to the target volume in less than a second. In various embodiments, at operation 706, each beam may deliver a relatively high dose in a relatively short period of time. For example, each beam may, but is not limited to, deliver at least 0.01 Gy or 4 Gy in less than a second, and may deliver up to 20 Gy or 500 Gy or more in less than a second (sec). In various embodiments, at operation 706, each beam may, but is not limited to, deliver greater than 4 Gy / sec, greater than 20 Gy / sec, or greater than 40 Gy / sec. In various embodiments, at operation 706, each beam may deliver at least 1 Gy within 0.25 sec, at least 1 Gy within 0.05 sec, or at least 1 Gy within 0.025 sec. It should be noted that operation 706 may be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto.

[0087] exist Figure 7 At operation 708, online (or during treatment) triggered treatment quality assurance can be performed. It should be noted that operation 708 can be implemented in a wide variety of ways. For example, by obtaining data (or information) for real-time position monitoring of at least one target volume during treatment at operation 708, it can be matched with the 4D beam time, thereby making it suitable for 4D dose calculation. In various embodiments, the results of this calculation can be summed in real time at operation 708 for online quality assurance (QA) when delivering the next beam, thereby allowing 4D dose tracking for each fraction in the treatment process. It should be noted that operation 708 can be implemented in any manner similar to that described and / or shown in the present disclosure, but is not limited to this.

[0088] At operation 710, a calculation may be made as to whether the treatment has been completed. If so, method 700 may proceed to operation 714. However, if it is calculated at operation 710 that the treatment has not been completed, method 700 may proceed to operation 712. Note that operation 710 may be implemented in a wide variety of ways. For example, operation 710 may be implemented in any manner similar to, but not limited to, those described and / or illustrated in the present disclosure.

[0089] exist Figure 7At operation 712, the method 700 moves to the next beam position or angle. It should be noted that operation 712 can be implemented in a wide variety of ways. For example, the method 700 can move to the next beam position or angle at operation 712 by rotating the gantry (e.g., 420). In various embodiments, the method 700 can move to the next beam position at operation 712 by rotating the patient. It should be noted that operation 712 can be implemented in any manner similar to that described and / or illustrated in the present disclosure, but is not limited thereto. After operation 712 is completed, the method 700 can proceed to the beginning of operation 702.

[0090] At operation 714, offline (or post-treatment) triggered treatment quality assurance can be performed. It should be noted that operation 714 can be implemented in a wide variety of ways. For example, by acquiring data (or information) from real-time position monitoring of at least one target volume after treatment at operation 714, this data can be matched to the 4D beam timing, thereby making it suitable for 4D dose calculation. In various embodiments, this calculation result can be summed at operation 714 for offline quality assurance (QA), allowing 4D dose tracking for each fraction during the treatment process. In various embodiments, at operation 714, offline triggered treatment quality assurance can include computationally checking, confirming, and re-delivering (or replaying) the dose on (for example) 4D images using actual log files from the machine and verifying the achieved dose. It should be noted that, in various embodiments, the use of fluoroscopy (or other position monitoring techniques) for 4D dose tracking can be used with standard radiation delivery protocols and dose rates. It should be noted that operation 714 can be implemented in any manner similar to, but not limited to, those described and / or illustrated in the present disclosure. After operation 714 is completed, method 700 can end. In this manner, method 700 can perform triggered treatment (eg, radiation therapy, ultrasound, etc.) according to various embodiments of the present disclosure.

[0091] The foregoing descriptions of various specific embodiments of the present disclosure have been presented for purposes of illustration and description. They are not intended to be exhaustive or to limit the disclosure to the precise forms disclosed, and many modifications and variations are possible in light of the above teachings. The present disclosure is to be construed in accordance with the claims and their equivalents.

Claims

1. A radiation therapy system comprising: a device configured to load a planning image of a target within a human body; means configured to monitor the position of the target; means configured to calculate the occurrence of substantial alignment between the position of the target and the position of the target of the planning image, wherein the calculating includes including a visual representation of a region of interest, and wherein the calculating includes summing the magnitude of a real-time deformation vector field within the region of interest; and Means configured to trigger a radiation beam after said calculation to deliver at least 4 Gy to said target within one second.

2. The system of claim 1, wherein the means configured to monitor the location of the target comprises means configured to perform a real-time video feed.

3. The system of claim 1, wherein the device configured to monitor the position of the target comprises a device configured to perform real-time fluoroscopic imaging.

4. The system of claim 1, wherein the device configured to monitor the position of the target comprises a device configured to perform magnetic resonance imaging.

5. The system of claim 1, wherein the device configured to monitor the position of the target comprises a device configured to perform cone-beam computed tomography.

6. The system of claim 1, wherein the means configured to monitor the position of the target comprises means configured to perform digital tomosynthesis.

7. The system of claim 1, wherein the device configured to monitor the location of the target comprises a device configured to perform ultrasound.

8. The system of claim 1, wherein the means configured to monitor the position of the target comprises means configured to perform fiducial marking.

9. A radiation therapy system comprising: a device configured to load a planning image of a target within a human body; means configured to monitor the position of the target; means configured to calculate the occurrence of substantial alignment between the position of the target and the position of the target of the planning image, wherein the calculating includes including a visual representation of a region of interest, and wherein the calculating includes summing the magnitude of a real-time deformation vector field within the region of interest; and Means configured to trigger a radiation beam after said calculation to deliver at least 20 Gy to said target within one second.

10. The system of claim 9, wherein the means configured to calculate the occurrence of substantial alignment between the position of the target and the position of the target of the planning image comprises a computing system that automatically performs the calculation.

11. The system of claim 9, wherein the radiation beam comprises protons.

12. The system of claim 9, wherein the radiation beam comprises photons.

13. The system of claim 9, wherein the radiation beam comprises ions.

14. The system of claim 9, wherein the radiation beam comprises electrons.

15. A radiation therapy system comprising: a device configured to load a planning image of a target within a human body; means configured to monitor the position of the target; means configured to calculate the occurrence of substantial alignment between the position of the target and the position of the target of the planning image, wherein the calculating includes including a visual representation of a region of interest, and wherein the calculating includes summing the magnitude of a real-time deformation vector field within the region of interest; and Means configured to trigger a radiation beam after said calculation to deliver at least 40 Gy to said target within one second.

16. The system of claim 15, wherein the planning image comprises a magnetic resonance imaging (MRI) image.

17. The system of claim 15, wherein the planning image comprises a computed tomography (CT) image.

18. The system of claim 15, wherein the means configured to calculate the occurrence of substantial alignment between the position of the target and the position of the target of the planning image comprises means configured to utilize a visual representation.

19. The system of claim 15, wherein the device configured to monitor the position of the target comprises a four-dimensional (4D) cone beam.

20. A radiation therapy system comprising: a device configured to load a planning image of a target within a human body; means configured to monitor the position of the target; means configured to calculate the occurrence of substantial alignment between the position of the target and the position of the target of the planning image, wherein the calculating includes including a visual representation of a region of interest, and wherein the calculating includes summing the magnitude of a real-time deformation vector field within the region of interest; as well as Means are configured to trigger a radiation beam after the calculation to deliver radiation therapy to the target in less than one second.

21. The system of claim 20, wherein the means configured to monitor the location of the target comprises means configured to perform a real-time video feed.

22. The system of claim 20, wherein the means configured to monitor the position of the target comprises means configured to perform real-time fluoroscopic imaging.

23. The system of claim 20, wherein the device configured to monitor the position of the target comprises a device configured to perform magnetic resonance imaging.

24. The system of claim 20, wherein the device configured to monitor the position of the target comprises a device configured to perform cone-beam computed tomography.

25. The system of claim 20, wherein the means configured to monitor the position of the target comprises means configured to perform digital tomosynthesis.

26. The system of claim 20, wherein the device configured to monitor the location of the target comprises a device configured to perform ultrasound.

27. The system of claim 20, wherein the means configured to monitor the position of the target comprises means configured to perform fiducial marking.

28. The system of claim 20, wherein the radiation beam comprises at least one of protons, photons, ions, and electrons.

29. The system of claim 20, wherein: The planning image includes at least one of a magnetic resonance imaging image and a computed tomography image.

30. A radiation therapy system comprising: a device configured to load a planning image of at least one target volume within a human body; means configured to continuously track the real-time position of the at least one target volume; means configured to calculate the occurrence of substantial alignment between the real-time position of the at least one target volume and the real-time position of the at least one target volume of the planning image, wherein the calculating comprises including a visual representation of a region of interest, and wherein the calculating comprises summing a magnitude of a real-time deformation vector field within the region of interest; and Means are configured to trigger a radiation beam after the calculation to deliver a radiation therapy dose to the at least one target volume in less than one second.

31. The system of claim 30, wherein the means configured to continuously track the real-time position of the at least one target volume comprises means using real-time fluoroscopic imaging.

32. The system of claim 30, wherein the means configured to continuously track the real-time position of the at least one target volume comprises means using magnetic resonance imaging.

33. The system of claim 30, wherein the means configured to continuously track the real-time position of the at least one target volume comprises means using a surrogate of an internal anatomical structure.

34. The system of claim 30, wherein the means configured to continuously track the real-time position of the at least one target volume comprises means using cone-beam computed tomography.

35. A radiation therapy system comprising: a device configured to load a planning image of at least one target volume within a human body; means configured to continuously track the real-time position of at least one target volume using a four-dimensional (4D) cone beam, thereby generating a real-time video feed; means configured to calculate an occurrence of substantial alignment between the real-time position of the at least one target volume and the real-time position of the at least one target volume of the planning image, wherein the calculating comprises including a visual representation of a region of interest, and wherein the calculating comprises summing a magnitude of a real-time deformation vector field within the region of interest; Means are configured to trigger delivery of a dose of radiation therapy to the at least one target volume in less than one second following the calculation.

36. The system of claim 35, wherein the means configured to calculate the occurrence of substantial alignment between the real-time position of the at least one target volume and the real-time position of the at least one target volume of the planning image comprises a computing system that automatically performs the calculation.

37. The system of claim 35, wherein the radiation therapy dose comprises at least one of protons, photons, ions, and electrons.

38. The system of claim 35, wherein the planning image comprises at least one of a magnetic resonance imaging image and a computed tomography image.

Images