Online adaptive deep inhalation breath-holding management

Abstract

An online adaptive deep inspiratory breath-holding process. A computer-implemented method for performing a radiotherapy procedure, comprising: acquiring a set of projected images of a target volume associated with the patient while the patient is placed in a first position and maintained at a first inspiratory level; generating a synthetic digital volume including the target volume based on a processing plan digital volume associated with the radiotherapy procedure and the set of projected images; generating a modified processing portion based on a processing plan associated with the processing plan digital volume and based on the synthetic digital volume; and executing the modified processing portion while the patient remains in the first position and maintains at least the first inspiratory level.

Description

Technical Field

[0001] Unless otherwise stated herein, the methods described in this section are not prior art to the claims of this application and are not acknowledged as prior art by virtue of their inclusion in this section.

[0002] Radiation therapy is a localized treatment targeting a specific tissue (planned target volume), such as a cancerous tumor. Ideally, radiation therapy is administered to the planned target volume, shielding surrounding normal tissue from doses exceeding a specified tolerance, thereby minimizing the risk of damage to healthy tissue. Before delivering radiation therapy, imaging systems are typically used to provide three-dimensional images of the target tissue and surrounding area. Based on such imaging, the size and mass of the target tissue can be estimated, and an appropriate treatment plan can be generated and the planned target volume determined. Background Technology

[0003] To ensure the prescribed dose is correctly delivered to the planned target volume (i.e., the target tissue) during radiotherapy, the patient must be properly positioned relative to the linear accelerator delivering the radiation. Typically, dosimetric and geometric data are checked before and during treatment to ensure proper patient placement and that the radiotherapy treatment being performed matches the previously planned treatment. This procedure is known as image-guided radiotherapy (IGRT) and involves using an imaging system to visualize the target tissue before or simultaneously with the delivery of the radiation treatment to the planned target volume. IGRT incorporates imaging coordinates from the treatment plan to ensure the patient is properly aligned for treatment within the radiotherapy apparatus. Summary of the Invention

[0004] According to at least some embodiments of this disclosure, a breath-hold-based radiotherapy method is disclosed, wherein a modified treatment portion is generated and implemented when the patient is unable to maintain a threshold inspiratory level on which the treatment plan is based. Specifically, before executing each treatment portion of the treatment plan, the patient's respiratory capacity is determined. When the patient is unable to maintain a breath-hold level equal to or greater than the threshold inspiratory level, the patient's anatomy is imaged at the achievable inspiratory level, and a modified treatment portion is generated based on the original treatment plan and the images of the patient's anatomy at the achievable inspiratory level. The modified treatment portion is then executed while the patient maintains a breath-hold level equal to or greater than the achievable inspiratory level. Therefore, each treatment portion can be adapted to the patient's respiratory capacity during execution. As a result, even patients who are unable to maintain a threshold inspiratory level on which the treatment plan is based can benefit from deep inspiratory breath-hold treatment.

[0005] The foregoing overview is illustrative only and is not intended to be limiting in any way. Other aspects, embodiments, and features will become apparent from the accompanying drawings and the following detailed description, in addition to the illustrative aspects, embodiments, and features described above. Attached Figure Description

[0006] The foregoing and other features of this disclosure will become more apparent from the following description taken in conjunction with the accompanying drawings and the appended claims. These drawings depict only a few embodiments according to this disclosure and should not be considered as limiting its scope. This disclosure will be described with additional specificity and detail using the drawings.

[0007] Figure 1 It is a diagram of the breath-holding curve associated with the processing plan procedure according to various embodiments.

[0008] Figure 2 This is a diagram of the breath-holding curve associated with the processing portion of the processing plan according to various embodiments.

[0009] Figure 3 It is a perspective view of a radiotherapy system that can advantageously realize various aspects of the present disclosure.

[0010] Figure 4 Schematic illustrations of various embodiments Figure 1 The drive frame and stand for the radiotherapy system.

[0011] Figure 5 Schematic illustrations of various embodiments Figure 1 The drive frame and stand for the radiotherapy system.

[0012] Figure 6 The illustration schematically depicts various embodiments based on the method comprising including Figure 1 A digital volume constructed from projected images generated by one or more X-ray imagers in a radiotherapy system.

[0013] Figure 7 A flowchart illustrating a radiotherapy procedure according to one or more embodiments is provided.

[0014] Figure 8 A flowchart illustrating a radiotherapy procedure according to one or more embodiments is provided.

[0015] Figure 9 This is an illustration of a computing device configured to perform various embodiments of the present disclosure.

[0016] Figure 10 This is a block diagram illustrating one or more embodiments of a computer program product for implementing the present disclosure. Detailed Implementation

[0017] In the following detailed description, reference is made to the accompanying drawings, which form part of the description. In the drawings, like symbols generally identify like components unless the context otherwise requires. The illustrative embodiments described in the detailed description, drawings, and claims are not intended to be limiting. Other embodiments may be utilized, and other changes may be made, without departing from the spirit or scope of the subject matter set forth herein. It will be readily understood that aspects of this disclosure as generally described herein and illustrated in the figures can be arranged, substituted, combined, and designed in a variety of different configurations, all of which are explicitly contemplated and form part of this disclosure.

[0018] introduce

[0019] Image-guided radiotherapy (IGRT) is used to treat tumors in areas of the body that are subject to voluntary movement, such as the lungs, or involuntary movement, such as organs affected by peristalsis, gas movement, muscle contraction, etc. IGRT involves using an imaging system to visualize the target tissue (also known as the “target volume”) before or during the delivery of radiation treatment. In IGRT, image-based coordinates of the target volume from a previously determined treatment plan are compared with image-based coordinates of the target volume determined during the application of the treatment beam. In this way, changes in surrounding organs of risk and / or movement or deformation of the target volume relative to the radiotherapy system can be detected. Therefore, dose limiting of organs of risk can be accurately implemented based on daily position and shape, and the patient’s position and / or the treatment beam can be adjusted to more precisely target the radiation dose to the tumor. For example, in the treatment of pancreatic tumors, organs of risk include the duodenum and stomach. The shape and relative position of these organs of risk relative to the target volume can vary considerably from day to day. Therefore, accurately adapting to the shape and relative position of these organs of risk allows for dose escalation to the target volume and better treatment outcomes.

[0020] In some radiotherapy systems, breath-hold-based radiotherapy is performed, such as deep inspiration breath-hold (DIBH) procedures, in which the patient performs one or more breath-holds throughout a specific treatment segment. DIBH procedures are typically used to separate organs at risk or other critical anatomical structures from the target volume during the treatment segment. Additionally, DIBH procedures can reduce movement and / or deformation of the target volume caused by the patient's breathing, thereby reducing the dose received by non-target tissues.

[0021] One drawback of DIBH treatment is that patients cannot receive the treatment portion unless they can perform breath-holding at the same inspiratory level achieved during the initial planned computed tomography scan. If the patient is unable to perform such breath-holding during treatment, a free-breathing plan is delivered instead. Generally, free-breathing plans deliver a higher dose to organs at risk (such as the heart in breast cancer radiation therapy) and may increase short-term and long-term treatment side effects for the patient.

[0022] Patient respiratory signals

[0023] According to various embodiments, when a patient is unable to maintain the threshold inspiratory level upon which the patient's treatment plan is based, a modified treatment component is generated and implemented. In some embodiments, the patient's ability to maintain a specific inspiratory level is based on a respiratory signal indicating the patient's current inspiratory level. In such embodiments, the respiratory signal can be measured using a reference point, marker blocks, or other internal or external markers and / or a surface recognition system that detects movement on the patient's body surface. In some embodiments, the patient's respiratory signal can be represented as a breath-hold curve indicating how the patient's inspiratory level changes over time. The following is in conjunction with... Figure 1 and Figure 2 Examples of different breath-holding curves are described.

[0024] Figure 1 This is an illustration of a breath-hold curve 100 associated with a processing procedure according to various embodiments. The breath-hold curve 100 shows the variation of the motion signal 105 over a time interval 101 including the patient's breath-holding. Figure 1 In the illustrated embodiment, time interval 101 is associated with a patient breath-hold performed during a planning CT scan of the patient's anatomy and / or during a training session prior to the planning CT scan. Generally, a patient's planning CT scan involves acquiring a set of projected images of the patient's anatomy, including a target volume such as a tumor. To facilitate DIBH treatment, the patient typically performs a maximal or near-maximal inspiratory breath during the planning CT scan to separate the target volume from the organ of risk or other critical anatomical structures during subsequent treatment phases. Therefore, motion signal 105 is associated with the patient's maximal or near-maximal inspiratory breath during time interval 101.

[0025] In some embodiments, the specific value of the motion signal 105 associated with the breath-hold curve 100 is based at least in part on the motion trajectory of one or more points on the patient's body surface and / or one or more internal or external markers (e.g., reference points, surface markers, etc.). For example, in some embodiments, the measurement of the motion signal 105 is performed via a patient monitoring optical sensor associated with the system performing the planned CT scan and one or more reference points, other markers, position sensors, and / or detection locations on the patient's body surface. Generally, the reference points, markers, position sensors, and / or detection locations on the body surface are selected such that the reference points, markers, position sensors, and / or detection locations move synchronously or substantially synchronously with the patient's target volume. Thus, in this embodiment, motion associated with the patient's respiratory cycle is accurately measured at time interval 101. This motion can be measured relative to any suitable reference location within or near the patient's anatomy.

[0026] In some embodiments, the value of the motion signal 105 at each time point in the breath-hold curve 100 is based on detected motion at a single internal or external marker, reference point, or point on the patient's body surface. In other embodiments, the value of the motion signal 105 at each time point in the breath-hold curve 100 is based on detected motion at multiple internal or external markers, reference points, and / or points on the patient's body surface. In this embodiment, the value of the motion signal 105 may be based on the average of multiple motion values, wherein each motion value is associated with a different internal or external marker, reference point, and / or point on the patient's body surface. In this embodiment, the average of the multiple motion values ​​may be a weighted average or a simple average.

[0027] In DIBH therapy, a predetermined threshold level 120 is determined for the patient based on a motion signal 105. The predetermined threshold level 120 indicates the minimum permissible inspiratory level maintained by the patient during a DIBH treatment segment that separates the at-risk organ or other critical anatomical structure from the target volume. In DIBH therapy, a treatment plan is generated for the patient during a planned treatment process based on the patient maintaining an inspiratory level equal to or greater than the predetermined threshold level 120 during the treatment segment. Therefore, if the patient cannot maintain an inspiratory level equal to or greater than the predetermined threshold level 120, the permissible movement of the patient's anatomical structure relative to the target volume may be exceeded, and the treatment plan cannot be safely executed without modification.

[0028] exist Figure 1In the illustrated embodiment, the predetermined threshold level 120 is expressed as an absolute displacement distance associated with the breath-hold curve 100, for example, 1.7 mm smaller (and / or larger) than the characteristic inspiratory level 106. In this embodiment, the characteristic inspiratory level 106 is also expressed as an absolute displacement distance associated with the breath-hold curve 100, for example, 17.3 mm. Alternatively, in some embodiments, the predetermined threshold level 120 may be expressed as a percentage of the characteristic inspiratory level 106 associated with the breath-hold curve 100, for example, 90% of the characteristic inspiratory level 106.

[0029] In some embodiments, the characteristic inspiratory level 106 is based on the average inspiratory level achieved during the time interval 102 associated with the motion signal 105. Figure 1 In the illustrated embodiment, time interval 102 corresponds to the time during which the detected patient inspiratory level remains substantially constant. In other embodiments, time interval 102 corresponds to most or all of time interval 101, or some other time interval associated with breath-hold curve 100, such as the final portion of time interval 101, the middle portion of time interval 101, etc. In some embodiments, characteristic inspiratory level 106 is based on the lowest inspiratory level 103 reached during time interval 102.

[0030] In some embodiments, in DIBH therapy, multiple predetermined threshold levels, such as a minimum threshold level and a maximum threshold level, are determined for the patient based on the motion signal 105. Figure 1 In the illustrated embodiment, predetermined threshold level 120 is implemented as a minimum threshold level based on motion signal 105, and predetermined threshold level 121 is implemented as a maximum threshold level based on motion signal 105. In this embodiment, predetermined threshold level 121 is determined based on a percentage of characteristic inspiratory level 106 associated with breath-hold curve 100, for example, 105% or 18.1 mm of characteristic inspiratory level 106. In this embodiment, a treatment plan for the patient is generated during planned treatment based on the patient maintaining an inspiratory level equal to or greater than predetermined threshold level 120 and equal to or less than predetermined threshold level 121 during the treatment phase.

[0031] Figure 2 This is an illustration of a breath-hold curve 200 associated with the processing portion of a processing plan according to various embodiments. The breath-hold curve 200 shows the variation of the motion signal 205 over a time interval 201 including the patient's breath-holding. Figure 2In the illustrated embodiment, time interval 201 is associated with patient breath-holding performed in preparation for a treatment segment to be performed, such as during patient setup for a specific treatment segment. Thus, patient breath-holding associated with breath-holding curve 200 is performed immediately before treatment, for example, after the patient has been positioned on the radiotherapy system examination table for treatment and before the treatment segment has begun.

[0032] Similar to Figure 1 Motion signal 105 and motion signal 205 are determined at least in part based on the motion trajectory of one or more points on the patient's body surface and / or one or more internal or external markers (e.g., reference points, surface markers, etc.). For reference, the patient's predetermined threshold level 120 is also shown in... Figure 2 According to various embodiments, based on motion signal 205, modified processing sections can be generated and implemented while the patient is being processed on the radiotherapy system examination table. Specifically, when motion signal 205 indicates that the patient cannot maintain an appropriate inspiratory level (e.g., an inspiratory level greater than or equal to a predetermined threshold level 120), a current partial inspiratory threshold 220 is determined based on motion signal 205. For example, the current partial inspiratory threshold 220 can be determined based on motion signal 205 and characteristic inspiratory level 206 in the same manner as the predetermined threshold level 120 based on motion signal 105. The modified processing section is then generated and implemented, as described below. Figure 7 and Figure 8 As stated above.

[0033] System Overview

[0034] Figure 3 This is a perspective view of a radiotherapy system 300 that can advantageously implement various aspects of the present disclosure. The radiotherapy (RT) system 300 is a radiation system configured to use X-ray imaging techniques to detect intrapartum motion in near real-time. Therefore, the RT system 300 is configured to provide stereotactic radiosurgery and precise radiation treatment for lesions, tumors, and conditions in any part of the body requiring radiation treatment. Thus, the RT system 300 may include one or more of the following: a linear accelerator (LINAC) generating a megavolt (MV) processing beam of high-energy X-rays, a kilovolt (kV) X-ray source, one or more X-ray imagers, and in some embodiments, an MV electronic portal imaging device (EPID). By way of example, the RT system 300 is described herein as being configured with a circular gantry. In other embodiments, the RT system 300 may be configured with a C-shaped gantry capable of infinite rotation via slip ring connections.

[0035] Generally, the RT system 300 is capable of kV imaging of the target volume during the application of an MV processing beam, thereby enabling the performance of IGRT and / or intensity-modulated radiotherapy (IMRT) procedures using X-ray imaging. The RT system 300 may include one or more touchscreens 301, examination table motion controls 302, apertures 303, a base positioning assembly 305, an examination table 307 mounted on the base positioning assembly 305, and an image acquisition and processing control computer 306, all located within the processing room. The RT system 300 also includes a remote control console 310 located outside the processing room and capable of remote processing delivery and patient monitoring. The following describes the process in conjunction with... Figure 9 The description includes exemplary embodiments of a computing device that can be implemented as an image acquisition and processing control computer 306 and / or a remote control console 310. A base positioning assembly 305 is configured to precisely position the examination table 307 relative to a hole 303, and a motion control 302 includes input devices, such as buttons and / or switches, enabling a user to operate the base positioning assembly 305 to automatically and precisely position the examination table 307 to a predetermined position relative to the hole 303. The motion control 302 also enables a user to manually position the examination table 307 to a predetermined position.

[0036] In some embodiments, the RT system 300 further includes one or more patient monitoring optical sensors 309. The patient monitoring optical sensors 309 are configured as a patient position monitoring system that generates external motion signals indicating a specific amplitude of respiratory movements of the patient on the examination table 307. Therefore, the patient monitoring sensors 309 can acquire the motion trajectory of one or more points on the patient's body surface, such as motion based on a reference point or other internal or external markers (or multiple markers) or positions(s) on the patient surface(s) positioned to move synchronously with the patient's target volume. In some embodiments, the patient monitoring optical sensors 309 include one or more cameras, surface scanners, etc.

[0037] Figure 4 The drive frame 400 and the stand 410 of the RT system 300 according to various embodiments are schematically shown. For clarity, Figure 4The cover, base positioning assembly 305, examination table 307, and other components of the RT system 300 are omitted. The drive frame 400 is a fixed support structure for the components of the RT processing system 310, including a table 410 and a drive system 401 for rotatably moving the table 410. The drive frame 400 rests on and / or is fixed to a support surface outside the RT processing system 310, such as the floor of the RT processing facility. The table 410 is rotatably coupled to the drive frame 400 and is a support structure on which various components of the RT system 300 are mounted, including a linear accelerator (LINAC) 404, an electronic portal imaging device (EPID) 405, an imaging X-ray source 406, and an X-ray imager 407. During operation of the RT processing system 310, the table 420 rotates about the aperture 303 when actuated by the drive system 401.

[0038] A drive system 401 rotatably actuates a stage 410. In some embodiments, the drive system 401 includes a linear motor that can be fixed to a drive frame 400 and interacts with a magnetic track (not shown) mounted on the stage 410. In other embodiments, the drive system 401 includes another suitable drive mechanism for precisely rotating the stage 410 about the aperture 401. A LINAC 404 generates a processing beam 430 of high-energy X-rays (or, in some embodiments, electrons, protons and / or other heavily charged particles, ultra-high dose rate X-rays (e.g., for FLASH radiotherapy), or microbeams for microbeam radiotherapy), and an EPD 405 is configured to acquire X-ray images with the processing beam 430. An imaging X-ray source 406 is configured to guide a cone-shaped X-ray beam (referred to herein as imaging X-ray 431) through an isocenter 403 of the RT system 300 to the X-ray imager 407, and the isocenter 403 generally corresponds to the location of the target volume 409 to be processed. Figure 4 In the illustrated embodiment, the X-ray imager 407 is depicted as a planar device, while in other embodiments, the X-ray imager 407 may have a curved configuration.

[0039] X-ray imager 407 receives imaging X-rays 431 and generates a suitable projection image therefrom. According to some embodiments, such projection images can then be used to construct or update a portion of the imaging data corresponding to a three-dimensional (3D) region including the target volume 409. That is, a 3D image of such a 3D region is reconstructed from the projection image. In some embodiments, cone-beam computed tomography (CBCT) and / or digital tomography synthesis (DTS) can be used to process the projection images generated by X-ray imager 407. CBCT is typically used to acquire projection images over a relatively long acquisition arc, such as when the gantry 410 is rotated 180° or more. As a result, a high-quality 3D reconstruction of the imaging volume can be generated. CBCT is typically employed at the beginning of a radiotherapy session to generate a pre-set 3D reconstruction. For example, CBCT can be used immediately before the application of the processing beam 430 to generate a 3D reconstruction, confirming that the target volume 409 has not moved or changed shape. Alternatively or additionally, in some embodiments, partial data reconstruction is performed by the RT system 300 during a portion of the IGRT or IMRT process, where a portion of the image data is used to generate a 3D reconstruction of the target volume 409. For example, as the processing beam 430 is guided to the isocenter 403 and the gantry 410 rotates through the processing arc, DTS image acquisition can be performed to generate image data for the target volume 409. Because DTS image acquisition is performed over a relatively short acquisition arc, for example, between approximately 10° and 60°, near real-time feedback on the shape and position of the target volume 409 can be provided via DTS imaging during the IGRT process.

[0040] exist Figure 4 In the illustrated embodiment, the RT system 300 includes a single X-ray imager and a single corresponding imaging X-ray source. In other embodiments, the RT system 300 may include two or more X-ray imagers, each having a corresponding imaging X-ray source. One such embodiment is... Figure 5 As shown in the image.

[0041] Figure 5 The drive frame 500 and the stand 510 of the RT system 300 according to various embodiments are schematically illustrated. The drive frame 500 and the stand 510 are configured similarly to... Figure 4The drive frame 400 and the stage 400 are basically similar, except that the components of the RT system 300 mounted on the stage 510 include a first imaging X-ray source 506, a first X-ray imager 507, a second imaging X-ray source 508, and a second X-ray imager 509. In this embodiment, including multiple X-ray imagers in the RT system 300 helps generate projected images (for reconstructing target volumes) over a shorter image acquisition arc. For example, when the RT system 300 includes two X-ray imagers and corresponding X-ray sources, the image acquisition arc for acquiring a projected image of a certain image quality can be approximately half that of acquiring a similar image quality projected image using a single X-ray imager and X-ray source.

[0042] Projected images generated by X-ray imager 407 (or by first X-ray imager 507 and second X-ray imager 509) are used to construct digital volume imaging data of the patient's anatomy within a 3D region including the target volume. Alternatively or additionally, such projected images can be used to update portions of existing imaging data corresponding to the digital volume of the 3D region. (The following is in conjunction with...) Figure 6 An example of such a digital volume is described.

[0043] Figure 6 A digital volume 600 based on projected images generated by one or more X-ray imagers included in the RT system 300 is schematically illustrated according to various embodiments. For example, in some embodiments, the projected images may be generated by a single X-ray imager such as X-ray imager 407, and in other embodiments, the projected images may be generated by multiple X-ray imagers, such as a first X-ray imager 507 and a second X-ray imager 509.

[0044] The digital volume 600 includes multiple voxels 601 (dashed lines) of anatomical image data, where each voxel 601 corresponds to a different location within the digital volume 600. For example, Figure 6 Only a single voxel 601 is shown. Digital volume 600 corresponds to a 3D region including target volume 610. Figure 6 In the diagram, the digital volume 600 is depicted as an 8x8x8 voxel cube, but in reality, the digital volume 600 typically includes more voxels, for example, more than... Figure 6 The order of magnitude shown is much larger.

[0045] For the purposes of discussion, target volume 610 may refer to the total tumor volume (GTV), clinical target volume (CTV), or planned target volume (PTV) for a specific treatment. GTV depicts the location and extent of the total tumor, such as what can be seen or imaged; CTV includes the GTV and additional margins of subclinical disease spread, which are often unimaginable; and PTV is a geometric concept designed to ensure that an appropriate dose of radiotherapy is actually delivered to the CTV without adversely affecting nearby organs at risk. Therefore, PTV is generally larger than CTV, but in some cases, it may be reduced in certain sections to provide a safety margin around organs at risk. PTV is typically determined based on imaging performed prior to treatment time, and X-ray imaging of digital volume 600 facilitates alignment of PTV with the current position of the patient's anatomy at the time of treatment.

[0046] In some embodiments, the image information associated with each voxel 601 of the digital volume 600 is constructed from projection images generated by one or more X-ray imagers via a CBCT process. For example, such a CBCT process can be employed immediately before the processing beam 430 is delivered to the target volume 610, thereby allowing the position and shape of the target volume 610 to be confirmed before processing begins. Additionally, in some embodiments, the image information associated with some or all of the voxels 601 of the digital volume 600 is updated via projection images generated by one or more X-ray imagers. In this way, the position and shape of the target volume 610 can be confirmed during processing. Therefore, if a sufficient portion of the target volume 610 is detected to extend beyond a threshold region, the processing can be aborted or modified.

[0047] Adaptive deep inhalation and breath-holding

[0048] According to various embodiments, when a patient is unable to maintain the threshold inspiratory level upon which the patient's treatment plan is based, a modified treatment section is generated and implemented. In some embodiments, the patient's ability to maintain the threshold inspiratory level is checked before starting each treatment section of the treatment plan. In this embodiment, when it is determined that the patient can maintain the threshold inspiratory level, a normal treatment section is performed, and when it is determined that the patient cannot maintain the threshold inspiratory level, a modified treatment section is generated and implemented. The following is in conjunction with... Figure 7 Describe one such embodiment.

[0049] Figure 7A flowchart illustrating a radiotherapy procedure 700 according to one or more embodiments is provided. The radiotherapy procedure 700 may include one or more operations, functions, or actions, as shown in one or more of blocks 701 to 720. Although these blocks are shown in sequential order, they may be performed in parallel, and / or in a different order than those described herein. Furthermore, various blocks may be combined into fewer blocks, divided into additional blocks, and / or eliminated based on desired implementation. Despite combination Figures 1 to 6 The system described herein is a radiotherapy procedure 700, but those skilled in the art will understand that any properly configured radiotherapy system is within the scope of this embodiment.

[0050] Some of the boxes 701 to 720 may be executed by a single computing device or multiple computing devices. For example, in some embodiments, boxes 703 to 716 are executed by one or more computing devices associated with a radiotherapy system, such as... Figure 5 The image acquisition and processing control computer 506 and / or remote console 510 are used. Furthermore, in some embodiments, certain boxes 701 to 720 may be performed by multiple systems. For example, in some embodiments, box 701 is performed by an imaging CT system, box 702 is performed by one or more processing planning systems, and boxes 703 to 716 are performed by a radiotherapy system.

[0051] In step 701, a treatment planning CT scan is performed on the patient's anatomical region surrounding the target volume (e.g., a tumor or other target tissue), and a 3D treatment planning CT image is generated. Generally, the treatment planning CT image is generated by scanning the patient (e.g., acquiring a set of projected images of the target volume), such as during a clinical visit. The treatment planning CT image is a digital volume of the treatment plan that includes the target volume and is generated based on the projected images acquired in step 701. The treatment planning CT scan is performed while the patient maintains an inspiratory level equal to or greater than a predetermined threshold level 120. Any technically feasible CT scanning procedure can be used to generate the treatment planning CT, such as spiral CT or CBCT.

[0052] In step 702, a treatment plan is generated for the patient. Generally, the process of generating a treatment plan involves multiple treatment planning steps. For example, this process typically includes specifying target and normal tissue structures, such as GTV, CTV, Internal Target Volume (ITV), PTV, Organ at Risk (OAR), and Planned Organ at Risk (PRV), in the treatment planning CT image. In some embodiments, the process also includes steps such as target segmentation, OAR segmentation, and plan optimization. Typically, the treatment plan is based on the treatment planning CT image generated in step 701 and includes one or more beam geometries for implementing the planned treatment and an optimized dose distribution for each beam geometry.

[0053] In step 703, the treatment phases are initiated. Generally, a radiotherapy procedure comprises multiple treatment phases, each performed by the radiotherapy system during a different clinical visit. For example, in some embodiments, each treatment phase is performed on a different day. Therefore, in Figure 7 In the illustrated embodiment, steps 703 to 716 are performed multiple times during the completion of the planned radiotherapy procedure.

[0054] For a specific treatment portion, in step 703, the patient is precisely positioned at the treatment location relative to the radiotherapy system. For example, in some embodiments, when the patient is at the treatment location, the isocenter of the radiotherapy system coincides with a target volume associated with the patient, such as target volume 610. In some embodiments, the patient is precisely positioned at the treatment location via an examination table (such as examination table 307) and / or via one or more patient monitoring optical sensors (such as patient monitoring optical sensor 309). In some embodiments, the patient is positioned by external marking on the patient's body. Alternatively or additionally, in some embodiments, the patient is positioned based on X-ray imaging performed in step 703.

[0055] In step 704, respiratory cycle data is collected for the patient while they are in the treatment position. For example, in some embodiments, the radiotherapy system performing the current treatment portion receives a respiratory signal indicating the patient's inspiratory level. In some embodiments, a breath-hold curve is generated based on the respiratory signal. In this embodiment, the breath-hold curve may indicate whether the patient's inspiratory level, which they can maintain during the current treatment portion, is at or above a predetermined threshold inspiratory level, such as a predetermined threshold level 120.

[0056] In step 705, the radiotherapy system performing the current treatment portion determines whether the patient can maintain an inspiratory level 120 equal to or greater than a predetermined threshold level. In some embodiments, this determination is based on breath-holding curves and / or other respiratory cycle data collected in step 704. For example, in some embodiments, the respiratory cycle data collected in step 704 is compared with the predetermined threshold level 120. When the patient is able to maintain such an inspiratory level, the radiotherapy procedure 700 proceeds to step 710; when the patient cannot maintain such an inspiratory level, the radiotherapy procedure 700 proceeds to step 711.

[0057] In step 710, the normal treatment portion from the treatment plan is performed. In some embodiments, the performance of the normal treatment portion includes applying beam parameters and dose distribution determined for the patient based on the treatment plan generated for the patient in step 702. In some embodiments, the performance of the normal portion includes performing additional X-ray imaging on the patient while the patient is placed in the treatment position, and modifying one or more beam parameters and / or dose distribution based on the additional X-ray imaging. For example, changes in patient anatomy that have occurred since the CT scan of the treatment plan was performed in step 701 can be compensated for at this time. Alternatively, in some embodiments, the performance of the normal portion does not include additional X-ray imaging of the patient. In either case, in step 710, the current treatment portion is performed without modifying the treatment plan, which is based on a different inspiratory level maintained by the patient than when the CT scan of the treatment plan was performed. After the treatment portion is completed, the radiotherapy procedure 700 proceeds to step 716.

[0058] In some embodiments, the normal treatment portion is performed on a single arc of rotation of the radiotherapy system gantry. Alternatively, in some embodiments, the normal treatment portion is performed on multiple arcs of rotation of the radiotherapy system gantry. Alternatively, in some embodiments, the normal treatment portion is performed on a portion of the arc of rotation of the radiotherapy system gantry or on multiple separate portions of the arc of rotation of the gantry. Alternatively, in some embodiments, the normal treatment portion is performed during a static gantry radiotherapy procedure, such as IMRT or 3D conformal radiotherapy.

[0059] In step 711, the radiation system performing the current processing portion determines the current inspiratory threshold, such as the current inspiratory threshold 220, based on the respiratory signal received in step 704.

[0060] In step 712, the radiotherapy system performing the current treatment portion acquires a projected image of the patient. For example, in some embodiments, the projected image is acquired via a CBCT scan of the patient. In step 712, a projected image of the patient is acquired while the patient maintains the treatment position set in step 703. Furthermore, a projected image of the patient is acquired while the patient maintains the current partial inspiratory threshold determined in step 711.

[0061] In step 713, a synthetic CT image including the target volume is generated. The synthetic CT image is based on a processing plan digital volume associated with the radiotherapy procedure, such as the processing plan CT image generated in step 701. The synthetic CT image is further based on the patient's projected images acquired in step 712. In some embodiments, the synthetic CT image is generated by deformably registering image data within the processing plan digital volume to corresponding image data associated with the set of projected images. For example, in some embodiments, the digital volume is generated based on the patient's set of projected images acquired in step 712, and this digital volume captures the patient's current anatomy while maintaining the current partial inspiratory threshold. In this embodiment, the image data within the processing plan digital volume is deformably registered to corresponding image data included in the digital volume, which captures the patient's current anatomy while maintaining an inspiratory level that reaches or exceeds the current partial inspiratory threshold. Therefore, in this embodiment, in step 713, when maintaining an inspiratory level that reaches or exceeds the current partial inspiratory threshold but does not reach or exceed a predetermined threshold level 120, the synthetic CT image is generated by modifying the processing plan digital volume based on the patient's anatomy.

[0062] In step 714, a modified processing portion is generated based on the synthetic CT image generated in step 713 and the processing plan generated in step 702. For example, in some embodiments, generating the modified processing portion includes detecting anatomical structures within the synthetic CT image. In such embodiments, such anatomical structures include one or more of GTV, CTV, ITV, PTV, one or more organs at risk (OAR), PRV, etc. In some embodiments, conventional automated segmentation procedures or automated segmentation software applications are used to detect one or more such anatomical structures. Alternatively or additionally, in some embodiments, artificial intelligence algorithms are used to detect one or more such anatomical structures.

[0063] In some embodiments, generating a modified processing portion includes determining one or more processing bundle parameters for the modified processing portion based on anatomical structures detected within the digital volume of the processing plan. Therefore, in this embodiment, while maintaining the current inspiratory portion threshold, one or more processing bundle parameters associated with the processing plan generated in step 702 are modified based on the patient's current anatomy.

[0064] In step 715, while the patient remains in the treatment position and maintains an inspiratory level that reaches or exceeds the current partial inspiratory threshold (e.g., the current partial inspiratory fraction threshold 220), the radiotherapy system performs a modified treatment portion. Similar to step 710, in step 715, the modified treatment portion can be performed on a single rotational arc, multiple rotational arcs, portions of rotational arcs, multiple individual portions of rotational arcs, or via multiple static IMRT fields on the radiotherapy system gantry.

[0065] In step 716, the radiotherapy system executing the current processing portion determines whether there are any further processing portions to be executed. If yes, the radiotherapy process 700 returns to step 703; if no, the radiotherapy process 700 proceeds to step 720 and terminates.

[0066] According to various embodiments, modified treatment sections are generated and implemented for each treatment portion of the treatment plan. In this embodiment, for each treatment section, the modified treatment section is generated based on the inspiratory level that the patient can maintain on the day of the treatment section. The following is in conjunction with... Figure 8 Describe one such embodiment.

[0067] Figure 8 A flowchart of a radiotherapy procedure 800 according to one or more embodiments is illustrated. The radiotherapy procedure 800 may include one or more operations, functions, or actions, as shown in one or more of blocks 701 to 720. Although these blocks are shown in sequence, they may be performed in parallel, and / or in a different order than those described herein. Furthermore, various blocks may be combined into fewer blocks, divided into additional blocks, and / or eliminated based on desired implementation. Despite the combination Figures 1 to 6 The system described herein is a radiotherapy procedure 800, but those skilled in the art will understand that any properly configured radiotherapy system is within the scope of this embodiment.

[0068] As shown in the figure, the radiotherapy process is basically similar to... Figure 7 The radiotherapy procedure 700, except for steps 704, 705, and 710, is not included in radiotherapy procedure 800. Instead, the same procedure is performed for each treatment section, and there is no check to confirm that the patient can maintain an inspiratory level equal to or greater than the predetermined threshold level 120. Figure 8 In the radiotherapy procedure 800, each of the boxes 701 to 720 is substantially the same as the corresponding step in the radiotherapy procedure 700, and is therefore numbered accordingly.

[0069] Example computing device

[0070] Figure 9This is an illustration of a computing device 900 configured to perform various embodiments of the present disclosure. For example, in some embodiments, the computing device 900 may be implemented as Figure 2 The image acquisition and processing control computer 306 and / or remote console 310 are included. The computing device 900 may be a desktop computer, laptop computer, smartphone, or any other type of computing device suitable for practicing one or more embodiments of this disclosure. In operation, the computing device 900 is configured to execute instructions associated with radiotherapy procedure 700 and / or radiotherapy procedure 800, as described herein. Note that the computing device described herein is illustrative, and any other technically feasible configuration falls within the scope of this disclosure.

[0071] As shown in the figure, the computing device 900 includes, but is not limited to, an interconnect (bus) 940 connecting the processing unit 950, an input / output (I / O) device interface 960 coupled to the input / output (I / O) device 980, a memory 910, a storage device 930, and a network interface 970. The processing unit 950 can be any suitable processor, implemented as a central processing unit (CPU), graphics processing unit (GPU), application-specific integrated circuit (ASIC), field-programmable gate array (FPGA), any other type of processing unit, or a combination of different processing units, such as a CPU configured to run alongside a GPU or digital signal processor (DSP). Generally, the processing unit 950 can be any technically feasible hardware unit capable of processing data and / or executing software applications, including radiotherapy procedure 700 and / or radiotherapy procedure 800.

[0072] I / O device 980 may include devices capable of providing input, such as a keyboard, mouse, touchscreen, etc., and devices capable of providing output, such as display devices, etc. Additionally, I / O device 980 may include devices capable of both receiving input and providing output, such as a touchscreen, Universal Serial Bus (USB) port, etc. I / O device 980 may be configured to receive various types of input from end users of computing device 900 and also to provide various types of output to end users of computing device 900, such as displayed digital images or digital video. In some embodiments, one or more devices of I / O device 980 are configured to couple computing device 900 to a network.

[0073] Memory 910 may include random access memory (RAM) modules, flash memory cells, or any other type of memory cell or combination thereof. Processing unit 950, I / O device interface 960, and network interface 970 are configured to read data from memory 910 and write data to memory 910. Memory 910 includes various software programs executable by processor 950 and application data associated with said software programs, including radiotherapy procedure 700 and / or radiotherapy procedure 800.

[0074] Example computer program product

[0075] Figure 10 This is a block diagram of an illustrative embodiment of a computer program product 1000 for implementing a method of radiotherapy according to one or more embodiments of the present disclosure. The computer program product 1000 may include a signal carrying medium 1004. The signal carrying medium 1004 may include one or more sets of executable instructions 1002, which, when executed by a processor of, for example, a computing device, can provide at least information about… Figures 1 to 9 The functionality described.

[0076] In some implementations, the signal-bearing medium 1004 may include a non-transient computer-readable medium 1008, such as, but not limited to, a hard disk drive, a compact disc (CD), a digital video disc (DVD), digital magnetic tape, a memory, etc. In some implementations, the signal-bearing medium 1004 may include a recordable medium 1010, such as, but not limited to, a memory, a read / write (R / W) CD, a R / W DVD, etc. In some implementations, the signal-bearing medium 1004 may include a communication medium 1006, such as, but not limited to, digital and / or analog communication media (e.g., fiber optic cables, waveguides, wired communication links, wireless communication links, etc.). The computer program product 1000 may be recorded on the non-transient computer-readable medium 1008 or another similar recordable medium 1010.

[0077] The various embodiments described are presented for illustrative purposes and are not intended to be exhaustive or limiting of the disclosed embodiments. Many modifications and variations will be apparent to those skilled in the art without departing from the scope and spirit of the described embodiments.

[0078] Aspects of this embodiment may be embodied as a system, method, or computer program product. Therefore, aspects of this disclosure may take the form of a completely hardware embodiment, a completely software embodiment (including firmware, resident software, microcode, etc.), or an embodiment combining software and hardware aspects, all of which are collectively referred to herein as a “circuit,” a “module,” or a “system.” Furthermore, aspects of this disclosure may take the form of a computer program product embodied in one or more computer-readable media having computer-readable program code embodied thereon.

[0079] Any combination of one or more computer-readable media may be used. A computer-readable medium can be a computer-readable signal medium or a computer-readable storage medium. A computer-readable storage medium can be, for example, but not limited to, electronic, magnetic, optical, electromagnetic, infrared, or semiconductor systems, apparatuses, or devices, or any suitable combination of the foregoing. More specific examples (not an exhaustive list) of computer-readable storage media will include the following: electrical connections having one or more wires, portable computer floppy disks, hard disks, random access memory (RAM), read-only memory (ROM), erasable programmable read-only memory (EPROM or flash memory), optical fiber, portable optical disc read-only memory (CD-ROM), optical storage devices, magnetic storage devices, or any suitable combination of the foregoing. In the context of this document, a computer-readable storage medium can be any tangible medium that can contain or store programs for use by or in connection with an instruction execution system, apparatus, or device.

[0080] While various aspects and embodiments have been disclosed herein, other aspects and embodiments will be apparent to those skilled in the art. The aspects and embodiments disclosed herein are for illustrative purposes and not restrictive, and the true scope and spirit are indicated by the appended claims.

Claims

1. A system for performing a processing portion of radiotherapy, the system comprising: X-ray imaging equipment; The X-ray delivery source is configured to guide the processing X-rays to a target volume of the patient's anatomical structure. An imaging X-ray source is configured to guide imaging X-rays through the target volume and toward the X-ray imager; as well as The processor is configured as follows: While the patient is positioned in the first position and maintained at the first inspiratory level, a set of projected images of the target volume associated with the patient is acquired; Based on the digital volume of the processing plan associated with the radiotherapy procedure and the set of projected images, a synthetic digital volume including the target volume is generated; Based on the processing plan associated with the digital volume of the processing plan and based on the synthetic digital volume, a modified processing portion is generated; as well as The modified processing portion is performed while the patient remains in the first position and maintains at least the first inspiratory level.

2. The system of claim 1, wherein the processing plan digital volume is based on the projection image of the processing plan CT scan of the target volume.

3. The system according to claim 1, wherein acquiring the set of projected images of the target volume comprises: Perform cone-beam computed tomography (CBCT) scans of the target volume.

4. The system according to claim 1, further comprising: Before acquiring the set of projected images of the target volume, it is determined that the patient cannot maintain an inspiratory level that reaches or exceeds a predetermined threshold.

5. The system of claim 4, wherein determining that the patient cannot maintain the inspiratory level at or above the predetermined threshold comprises: Receive a respiratory signal indicating the patient's inspiratory level.

6. The system of claim 4, wherein determining that the patient cannot maintain the inspiratory level at or above the predetermined threshold is performed when the patient is placed in the first position.

7. The system of claim 1, wherein generating the synthesized digital volume comprises: Image data within the digital volume of the processing plan can be deformably registered to corresponding image data associated with the set of projected images.

Images