Systems and methods for shuttle mode radiation delivery

Abstract

To provide systems and methods for shuttle mode radiation delivery.SOLUTION: One method for radiation delivery comprises a step of moving a patient platform through a patient treatment region multiple times during a treatment session. This may be referred to as patient platform or couch shuttling (i.e., couch shuttle mode). Another method for radiation delivery comprises a step of moving a therapeutic radiation source jaw across a range of positions during a treatment session. The jaw may move across the same range of positions multiple times during a treatment session. This may be referred to as jaw shuttling (i.e., jaw shuttle mode). Some methods combine the couch shuttle mode and jaw shuttle mode. Methods of dynamic or pipelined normalization are also described.SELECTED DRAWING: Figure 1A

Description

[Technical Field]

[0001] (CROSS-REFERENCE TO RELATED APPLICATIONS) This application claims priority to U.S. Provisional Patent Application No. 62 / 562,212, filed September 22, 2017, which is incorporated herein by reference in its entirety. [Background technology]

[0002] Tumor motion modulates dose delivery in radiation therapy, often resulting in non-uniform dose distribution across the target region. Dose modulation can be caused by interactions between moving parts in the radiation therapy system (e.g., a multi-leaf collimator (MLC), a movable gantry on which the therapeutic radiation source and MLC are mounted, a patient platform, etc.) and tumor motion. For example, lung tumors undergo a wide range of motion, which causes the tumor to move unpredictably in and out of the treatment plane, making it difficult to deliver the prescribed radiation dose to the tumor.

[0003] Several solutions have been proposed to mitigate unwanted dose modulation. One solution for tomotherapy machines with rotatable gantries, called dose painting, involves moving the therapeutic radiation source twice in an arc across the patient treatment area at a specific couch location: first, moving the therapeutic radiation source clockwise, then moving it counterclockwise. The dose painting method can reduce the variability of the delivered dose, but at the expense of increased treatment time. Other solutions for motion management and dose artifact reduction include coached breathing, breath-holding, and respiratory gating. Instructing the patient to hold their breath between radiation beam pulses can help limit the range of tumor motion, but depending on the patient's health, ensuring consistent breath-holding may not be possible. Improved systems and methods for ensuring uniform delivery of radiation doses to a moving target area are desirable. Summary of the Invention [Means for solving the problem]

[0004] Disclosed herein are systems and methods for shuttle mode radiation delivery. Shuttle mode radiation delivery may be used in helical tomotherapy, with or without continuous or stepwise platform motion. A radiation therapy system for helical tomotherapy may include a rotatable gantry that rotates around a patient treatment region, a therapeutic radiation source mounted on the rotatable gantry, and a patient platform or couch that is movable within the patient treatment region. In some variations, the system may further include beam-shaping elements disposed in the beam path of the therapeutic radiation source, including jaws that are movable (e.g., along the direction of movement of the patient platform) and a dynamic multi-leaf collimator (MLC) that shapes radiation emitted by the therapeutic radiation source. Some variations of the radiation therapy system may further include one or more PET detectors. The radiation delivery system may be configured to move the patient platform through the same section of the patient treatment region multiple times during a treatment session. This may be referred to as patient platform or couch shuttling (i.e., couch shuttle mode). A system for radiation dose delivery may be configured to move the jaws across a range of positions while the patient platform moves (continuously or stepwise) through the patient treatment area during a treatment session. The jaws may move across the same range of positions multiple times during a treatment session. This may be referred to as jaw shuttling (i.e., jaw shuttle mode), which may help provide uniform jaw dwell time across the patient target area. Some radiation delivery systems may be configured to perform both couch shuttling and jaw shuttling. The systems and methods described herein may help mitigate dose modulation due to tumor movement and promote homogeneous dose delivery to the target area.For example, the systems and methods described herein can help mitigate dose modulation due to tumor movement and jaw / MLC interaction artifacts, and can also compensate for dose modulation due to low-frequency tumor motion (e.g., tumor motion with a period of about tens of seconds, tumor shift over several seconds).

[0005] One variation of a radiation delivery system may include a gantry, a therapeutic radiation source mounted on the gantry and configured to apply radiation in a radiation therapy beam plane, a platform movable relative to the gantry, and a controller in communication with the gantry, the radiation source, and the platform. The controller may be configured to acquire a first set of imaging data while moving a patient positioned on the platform from a first location to a second location so that the patient passes through the radiation therapy beam plane, and to apply a first dose of radiation using the radiation source as the patient passes through the radiation therapy beam plane, the first dose of radiation being derived from the first set of imaging data. The controller may further be configured to acquire a second set of imaging data while moving the patient from the second location to the first location so that the patient passes through the radiation therapy beam plane, and to apply a second dose of radiation using the radiation source as the patient passes through the radiation therapy beam plane, the second dose of radiation being derived from the second set of imaging data, the second dose of radiation being different from the first dose of radiation.

[0006] The first radiation dose may be determined based on a first set of imaging data, and the second radiation dose may be determined based on a second set of imaging data. The first and / or second sets of imaging data may include, for example, positron annihilation emission data, kV X-ray data, or MRI subsampling in k-space. The controller may be further configured to calculate a normalization factor k2 based on the first radiation dose, and the second radiation dose may be determined, at least in part, using the normalization factor and the second set of imaging data. The controller may further be configured to calculate a pre-scan image (X2) of a target area of ​​a patient located on the radiation therapy system platform. prescan) and obtain the pre-scan image (X prescan ), and the normalization factor k2 is a second normalization factor. Moving the patient from the first location to the second location may define a first shuttle pass, and moving the patient from the second location to the first location may define a second shuttle pass, and the controller may be configured to select a number of shuttle passes (N) and a cumulative attenuation factor (α) and calculate a normalized attenuation factor (β), where, for i=1, ..., N, [ka] Furthermore, the first radiation dose (D 1,calculated ) may be calculated based on the first set of imaging data and scaled by a first normalization factor k1. 1,calculated ) may be calculated by multiplying the first set of imaging data by the radiation firing matrix (RFM) of the treatment plan, spatially filtered with a bit mask BFZ corresponding to the spatial location of the target region, and multiplied by a first normalization factor k1. Calculating the second normalization factor k2 is then carried out to obtain the dose D delivered over (N-1) passes of radiation delivery. 1,calculated The predicted cumulative dose (D 1,predicted cumulative ) and calculate the planned dose (D plan ) and the first radiation dose (D 1,calculated ) and calculate the difference between the predicted cumulative dose (D 1,predicted cumulative ) to determine the ratio of the dose difference to the second radiation dose (D 2,calculated ) may be calculated by multiplying the second set of imaging data by the RFM of the treatment plan, spatially filtered with a bit mask BFZ corresponding to the spatial location of the target region, and multiplied by a first normalization factor k2. In some variations, the first normalization factor k1 may be determined by: [ka] However, D plan is the radiation dose or fluence as specified in the treatment plan, and D 0,raw is the radiation fluence given by [ka] D prescan is the pre-scan image (X prescan ) is the radiation fluence calculated by multiplying it by the radiation firing matrix (RFM) of the treatment plan, spatially filtered with a bit mask BFZ corresponding to the spatial location of the target region, and multiplied by the dose calculation matrix. 1,predicted cumulative ) may include multiplying the first set of imaging data by the radiation firing matrix (RFM) of the treatment plan and adding any negative radiation fluence resulting from spatially filtering with a bit mask BFZ corresponding to the spatial location of the target region.

[0007] Another variation of a radiation delivery system for delivering radiation during a treatment session may include a gantry, a therapeutic radiation source mounted on the gantry, an imaging system mounted on the gantry, and a controller in communication with the gantry, the radiation source, and the imaging system. The controller uses the imaging system to obtain imaging data of a patient positioned on a platform and determines the treatment planning amount of radiation D. plan The controller may be configured to apply a dose of radiation to the patient using the radiation source to deliver a dose of radiation, the dose of radiation being derived from the acquired imaging data. The controller may further be configured to stop the application of radiation to the patient and record the amount of radiation D applied to the patient prior to stopping the application of radiation. delivered,pre-interrupt and may be configured to store the location of the platform when the application of radiation was stopped and resume application of radiation to the patient while acquiring additional imaging data, wherein a second radiation dose applied to the patient is derived from the additional imaging data; plan and D delivered,pre-interrupt is adjusted according to the difference between

[0008] Resuming the application of radiation may include moving the patient platform back to the location of the platform when the application of radiation was stopped. The amount applied before stopping the application of radiation may be a first radiation dose, and may be calculated based on the imaging data x obtained during the treatment session before stopping the application of radiation. i Furthermore, the first radiation dose may be derived from the acquired imaging data x i may be derived by multiplying a radiation firing matrix RFM by a biological firing area bit mask BFZ and applying RFM and BFZ, where RFM and BFZ are calculated during a treatment planning session. In some variations, applying a radiation dose to the patient may include applying a first pass of radiation while acquiring a first set of imaging data x1 as the patient platform is moved through the therapeutic radiation beam plane from a first location to a second location, and determining the radiation dose (D) emitted during the first pass. 1,calc ) multiplies the first set of imaging data x1 by the radiation emission matrix RFM and applies the biological emission area bit mask BFZ, D 1,raw and then normalize D by the first normalization factor k1 1,raw Additionally, in some variations, the first normalization factor k1 may be derived by multiplying a pre-scan image of the patient obtained during the treatment session by a radiation emission matrix RFM and applying a biological emission zone bit mask BFZ to obtain the radiation dose D. 0,raw Calculate D 0,raw by multiplying the total number of radiation passes in the treatment session, N, to obtain the cumulative predicted dose, D. 0,predicted cumulative Calculate D plan and cumulative predicted dose D 0,predicted cumulativeIn some variations, the step of applying a radiation dose to the patient may further include applying a second pass of radiation while acquiring a second set of imaging data x2 as the patient platform is moved through the therapeutic radiation beam plane from the second location to the first location, and determining the radiation dose (D 2,calc ) multiplies the second set of imaging data x2 by the radiation emission matrix RFM and applies the biological emission zone bit mask BFZ, D 2,raw and normalize D by the second normalization factor k2 2,raw The step of ceasing application of radiation to the patient may include ceasing application of radiation during the second pass of radiation. Additionally or alternatively, resuming application of radiation to the patient may include scaling the resumed set of imaging data x 2,resumed and delivering a radiation dose, the radiation dose being determined by obtaining a restarted set of imaging data x 2,resumed Multiply by the radiation emission matrix RFM and apply the biological emission area bit mask BFZ. 2,raw,post-interrupt and normalize D by the second normalization factor k2 2,raw,post-interrupt and the radiation dose that can be applied before stopping the application of radiation is D 2,raw,pre-interrupt Additionally, resuming application of radiation to the patient may further include applying a third pass of radiation while acquiring a third set of imaging data x3 as the patient platform moves through the therapeutic radiation beam plane from the first location to the second location, and the radiation dose delivered during the third pass may be derived by multiplying the third set of imaging data x3 by a radiation firing matrix RFM, applying a biological firing zone bit mask BFZ, and scaling by a third normalization factor k3. In some variations, the third normalization factor k3 is calculated ... plan and the first pass D 1,calc and the second passage D 2,calc Calculate the difference between the cumulative radiation dose applied at (D 2,raw,pre-interrupt+D 2,raw,post-interrupt ) by N-3 to obtain the cumulative predicted dose D 2,predicted cumulative Calculate (D plan -(D 1,calc +D 2,calc )) and cumulative predicted dose D 2,predicted cumulative In some variations, ceasing application of radiation to the patient may include ceasing application of radiation during the second pass of radiation, and resuming application of radiation to the patient may include obtaining a second pre-scan image of the patient, moving the patient platform back to its location when application of radiation was stopped, and obtaining a ratio between the resumed set of imaging data x 2,resumed Obtain a resumed set of imaging data x 2,resumed Multiply by the radiation emission matrix RFM and apply the biological emission area bit mask BFZ. 2,raw,post-interrupt and obtain the restarted normalization factor k 2_resumed By D 2,raw,post-interrupt where the radiation dose applied before terminating the application of radiation is D 2,raw,pre-interrupt and further comprising the step of: 2_resumed calculates the radiation dose D by multiplying the second pre-scan image of the patient by the radiation emission matrix RFM and applying the biological emission zone bit mask BFZ. 2,raw,post-interrupt Calculate (D 2,raw,pre-interrupt +D 2,raw,post-interrupt ) by N-2 to obtain the cumulative predicted dose D 2,predicted cumulative Calculate D plan and cumulative predicted dose D 2,predicted cumulativeThe step of resuming application of radiation to the patient may further include applying a third pass of radiation while acquiring a third set of imaging data x3 as the patient platform is moved through the therapeutic radiation beam plane from the first location to the second location, wherein the radiation dose delivered during the third pass is derived by multiplying the third set of imaging data x3 by a radiation firing matrix RFM, applying a biological firing zone bit mask BFZ, and scaling by a third normalization factor k3. The third normalization factor k3 is a function of D plan and the first pass D 1,calc and the second passage D 2,calc Calculate the difference between the cumulative radiation dose applied at (D 2,raw,pre-interrupt +D 2,raw,post-interrupt ) by N-3 to obtain the cumulative predicted dose D 2,predicted cumulative Calculate (D plan -(D 1,calc +D 2,calc )) and cumulative predicted dose D 2,predicted cumulative It may be calculated by taking the ratio between

[0009] Another variation of the radiation delivery system may include a gantry, a therapeutic radiation source mounted on the gantry and configured to apply radiation in a radiation treatment beam plane, a plurality of PET detectors mounted on the gantry, a platform movable relative to the gantry, and a controller in communication with the gantry, the therapeutic radiation source, and the platform. The controller may be configured to obtain images of a patient on the platform, calculate a normalization factor based on the patient images, and deliver radiation to the patient across a preselected number of shuttle passes. At each shuttle pass, the controller may be configured to update the radiation firing matrix of the treatment plan with the calculated normalization factor, move the platform from a first predetermined location to a second predetermined location and back to the first predetermined location such that the target region within the patient crosses the radiation treatment beam plane at least twice, acquire PET data using the PET detector, deliver radiation to the patient based on the updated radiation firing matrix and the acquired PET data, calculate a fluence delivered to the patient as the platform moves back to the first predetermined location, calculate a fluence difference between the fluence delivered to the patient and the treatment plan fluence, and calculate an updated normalization factor based on the fluence difference.

[0010] The PET detector may be coplanar with the radiation therapy beam plane, and in some variations, the acquired image may be a PET image. For example, calculating the normalization factor may include calculating an average PET intensity of the target region within the acquired PET image. The preselected number of shuttle passes may be an even number. For example, the preselected number of shuttle passes may be two or more. In some variations, calculating the updated normalization factor may include calculating an average fluence value of the radiation emitted by the therapeutic radiation source. Additionally or alternatively, calculating the updated normalization factor may include calculating a ratio between an average planned dose value of the radiation to the target region and an average delivered dose value of the radiation. Delivering radiation based on the updated radiation emission matrix and the acquired PET data may include multiplying the updated radiation emission matrix by one or more lines of response (LOR) of the acquired PET data to derive a delivery fluence map, and generating radiation using the therapeutic radiation source according to the delivery fluence map. In some variations, the radiation delivery system may further include a movable jaw positioned over the therapeutic radiation source and a multi-leaf collimator coupled to the jaw, wherein the treatment plane is defined by the position of the movable jaw relative to the therapeutic radiation source and the configuration of the multi-leaf collimator. In these variations, the controller may be configured to move the movable jaw from a first jaw location to a second jaw location and back to the first jaw location as radiation is delivered to the patient. In some variations, the controller may be configured to calculate a predicted dose and a dose value histogram by adjusting the image by a calculated normalization factor.

[0011] Another variation of the radiation delivery system may include a gantry, a therapeutic radiation source, a radiation therapy system platform, and a controller. Both the movable jaw and the multi-leaf collimator may be positioned within a radiation beam path of the radiation source, and the position of the movable jaw and the configuration of the multi-leaf collimator relative to the radiation source may define a treatment plane. In addition, the controller may be in communication with the gantry, the radiation source, and the radiation therapy system platform. The controller may be configured to (a) move a patient positioned on the platform by moving the platform from a first predetermined location to a second predetermined location so that one or more target regions within the patient intersect the treatment plane, and (b) deliver radiation to the patient using the radiation source when a portion of the one or more target regions intersects the treatment plane, wherein delivering the radiation includes moving the movable jaw from a first jaw location to a second location and back to the first jaw location while emitting radiation from the radiation source before moving to a next platform location.

[0012] Moving the platform may include moving the platform through a series of predetermined incremental patient-platform locations, and delivering radiation to the patient may include delivering radiation at each platform location where the target region intersects the treatment plane. Moving the platform may include translating the platform along a longitudinal axis, and moving the movable jaw may include moving the jaw so that the treatment plane shifts along the longitudinal axis. Moving the movable jaw may shift the treatment plane along the longitudinal axis by about 3 cm to about 6 cm and / or at a rate of about 0.5 cm / sec. Further, the controller may be configured to acquire images of the patient before radiation is delivered to the patient. For example, the system may include multiple PET detectors configured to acquire PET data including lines of response (LORs), and delivering radiation to the patient may include multiplying a radiation emission matrix of the treatment plan by one or more LORs to derive a delivery fluence map, and generating radiation using a therapeutic radiation source according to the delivery fluence map. The acquired images may be PET images. In some variations, the controller may be configured to repeat steps (a) and (b) a preselected number of shuttle passes. For example, the preselected number of shuttle passes may be two or more.

[0013] Another variation of the radiation delivery system may include a gantry, a therapeutic radiation source, and a controller in communication with the gantry and the radiation source. The controller may be configured to calculate a radiation fluence delivered to a patient target region during a previous radiation delivery session, compare the delivered radiation fluence to the target region with a treatment plan fluence to the target region, calculate a fluence difference, calculate a radiation firing matrix based on the calculated fluence difference, and deliver radiation to the patient in a subsequent radiation delivery session based on the calculated radiation firing matrix and PET data obtained during the subsequent radiation delivery session. Comparing the delivered radiation fluence and the planned radiation fluence may include comparing an average radiation fluence delivered to the target region with an average treatment plan fluence to the target region, and calculating the fluence difference by determining the difference between the average delivered radiation fluence and the average treatment plan fluence. In some variations, the PET data may include line of response (LOR) data.

[0014] One variation of a method for radiation delivery may include acquiring an image of a patient on a radiation therapy system platform, the radiation therapy system further comprising a therapeutic radiation source configured to apply radiation within a treatment plane and a plurality of PET detectors; calculating a normalization factor based on the patient image; and delivering radiation to the patient across a preselected number of shuttle passes. Each shuttle pass may include updating a radiation projection matrix of a treatment plan using the calculated normalization factor; moving the patient platform from a first predetermined location to a second predetermined location so that a target region within the patient crosses the treatment plane once; acquiring PET data using the PET detector; and delivering radiation to the patient based on the updated radiation projection matrix and the acquired PET data. When the platform is moved to the second predetermined location, the radiation therapy system may calculate a fluence delivered to the patient, calculate a fluence difference between the fluence delivered to the patient and the treatment plan fluence, and calculate a fluence difference between the fluence delivered to the patient and the treatment plan fluence. The PET detector may be coplanar with the treatment plane. The step of acquiring images may include acquiring PET images. The preselected number of shuttle passes may be an even number, e.g., two or more. The step of calculating a normalization factor may include calculating an average PET intensity of the target region in the acquired PET images. The step of calculating an updated normalization factor may include calculating an average fluence value of radiation emitted by the therapeutic radiation source. Additionally or alternatively, the step of calculating an updated normalization factor may include calculating a ratio between an average planned dose value of radiation to the target region and an average delivered dose value of radiation.The step of delivering radiation based on the updated radiation emission matrix and the acquired PET data may include multiplying the updated radiation emission matrix by one or more lines of response (LOR) of the acquired PET data to derive a delivery fluence map, and generating radiation using a therapeutic radiation source according to the delivery fluence map. The radiation therapy system may further include a movable jaw positioned over the therapeutic radiation source and a multi-leaf collimator coupled to the jaw, and the treatment plane may be defined by the position of the movable jaw relative to the therapeutic radiation source and the configuration of the multi-leaf collimator. The method may further include moving the movable jaw from a first jaw location to a second jaw location and back to the first jaw location while delivering radiation to the patient. Some variations may further include calculating a predicted dose and a dose value histogram by adjusting the image by the calculated normalization factor.

[0015] Another variation of the method for radiation delivery may include (a) moving a patient on a radiation therapy system platform from a first predetermined location to a second predetermined location, the radiation therapy system further comprising a therapeutic radiation source and a movable jaw and a multi-leaf collimator, both positioned in a radiation beam path of the therapeutic radiation source, wherein the position of the movable jaw and the configuration of the multi-leaf collimator relative to the therapeutic radiation define a treatment plane, and moving the patient from the first location to the second location causes one or more target regions within the patient to intersect the treatment plane, and (b) delivering radiation to the patient when portions of the one or more target regions intersect the treatment plane. Delivering radiation may include moving the movable jaw from the first jaw location to the second location and back to the first jaw location while emitting radiation from the therapeutic radiation source before moving to the next platform location. Moving the patient platform may include moving the platform through a series of predetermined incremental patient platform locations, and delivering radiation to the patient includes delivering radiation at each platform location where the target region intersects the treatment plane. Moving the platform may include translating it along a longitudinal axis, and moving the movable jaw includes moving the jaw such that the treatment plane is shifted along the longitudinal axis. Moving the movable jaw may shift the treatment plane about 3 cm to about 6 cm along the longitudinal axis. Moving the movable jaw shifts the treatment plane at a rate of about 0.5 cm / sec. The method may further include obtaining an image of the patient prior to delivering radiation to the patient. The radiation therapy system may further include a plurality of PET detectors configured to acquire PET data including lines of response (LORs), and delivering radiation to the patient includes multiplying a radiation emission matrix of the treatment plan by one or more LORs to derive a delivery fluence map, and generating radiation using a therapeutic radiation source according to the delivery fluence map. The acquired images may be PET images.The method may further include repeating steps (a) and (b) a preselected number of shuttle passes, the preselected number of shuttle passes being two or more times.

[0016] Another variation of the method for radiation delivery may include calculating a radiation fluence delivered to a patient target area during a previous radiation delivery session, comparing the delivered radiation fluence to the target area with a treatment plan fluence to the target area and calculating a fluence difference, calculating a radiation firing matrix based on the calculated fluence difference, and delivering radiation to the patient in a subsequent radiation delivery session based on the calculated radiation firing matrix and PET data obtained during the subsequent radiation delivery session. Comparing the delivered radiation fluence and the planned radiation fluence may include comparing an average radiation fluence delivered to the target area with an average treatment plan fluence to the target area, and calculating the fluence difference by determining the difference between the average delivered radiation fluence and the average treatment plan fluence. In some variations, the PET data may include line of response (LOR) data. The present invention provides, for example, the following. (Item 1) 1. A radiation delivery system comprising: The gantry and a therapeutic radiation source mounted on the gantry and configured to apply radiation in a radiation treatment beam plane; and a platform movable relative to the gantry; a controller in communication with the gantry, the radiation source, and the platform, the controller comprising: acquiring a first set of imaging data while moving the patient, positioned on the platform, from a first location to a second location such that the patient passes through the radiation treatment beam plane; applying a first radiation dose with the radiation source as the patient passes through the radiation treatment beam plane, the first radiation dose being derived from the first set of imaging data; acquiring a second set of imaging data while moving the patient from the second location to the first location such that the patient passes through the radiation treatment beam plane; applying a second radiation dose using the radiation source as the patient passes through the radiation treatment beam plane, the second radiation dose being derived from a second set of imaging data and different from the first radiation dose; a controller configured to: A system comprising: (Item 2) Item 10. The system of item 1, wherein the first radiation dose is determined based on the first set of imaging data and the second radiation dose is determined based on the second set of imaging data. (Item 3) 3. The system of claim 2, wherein the first and second sets of imaging data are selected from the group consisting of positron annihilation emission data, kV X-ray data, and MRI subsampling in k-space. (Item 4) The system of any one of the preceding items, wherein the controller is configured to calculate a normalization factor k2 based on the first radiation dose, and the second radiation dose is determined, at least in part, using the normalization factor and a second set of imaging data. (Item 5) The controller receives a pre-scan image (X) of a target area of ​​the patient located on a radiation therapy system platform. prescan ) and obtain the pre-scan image (X prescan ) based on the first normalization factor k1, and the second normalization factor k2 is a second normalization factor. Moving the patient from the first location to a second location defines a first shuttle pass, and moving the patient from the second location to the first location defines a second shuttle pass, and the controller is configured to select a number of shuttle passes (N) and a cumulative attenuation coefficient (α) and calculate a normalized attenuation coefficient (β), wherein: For i=1, …, N, [ka] The system according to any one of the preceding items, (Item 7) The first radiation dose (D 1,calculated 7. The system of claim 6, wherein k is calculated based on the first set of imaging data and scaled by the first normalization factor k. (Item 8) The first radiation dose (D 1,calculated 8. The system of claim 7, wherein k is calculated by multiplying the first set of imaging data by a radiation firing matrix (RFM) of a treatment plan, spatially filtering with a bit mask BFZ corresponding to the spatial location of the target region, and multiplying by a first normalization factor k1. (Item 9) Calculating the second normalization factor k2 is the dose D delivered over (N-1) passes of radiation delivery. 1,calculated The predicted cumulative dose (D 1,predicted cumulative ) and calculate the planned dose (D plan ) and the first radiation dose (D 1,calculated ) and calculate the difference between the predicted cumulative dose (D 1,predicted cumulative 9. The system of any one of items 7 and 8, comprising determining a ratio of the dose difference to (Item 10) The second radiation dose (D 2,calculated9. The system of claim 8, wherein k is calculated by multiplying the second set of imaging data by the RFM of the treatment plan, spatially filtering with a bit mask BFZ corresponding to the spatial location of the target region, and multiplying by a first normalization factor k2. (Item 11) The first normalization coefficient k1 is [ka] is determined by, except that D plan is the radiation dose or fluence as specified in the treatment plan, and D 0,raw teeth, [ka] is the radiation fluence given by D prescan is the pre-scan image (X prescan ) multiplied by a radiation firing matrix (RFM) of the treatment plan, spatially filtered with a bit mask BFZ corresponding to the spatial location of the target region, and multiplied by a dose calculation matrix. (Item 12) The predicted cumulative dose (D 1,predicted cumulative 10. The system of claim 9, wherein calculating (BFZ) comprises multiplying the first set of imaging data by a treatment plan radiation firing matrix (RFM) and adding any negative radiation fluence resulting from spatially filtering with a bit mask BFZ corresponding to the spatial location of the target region. (Item 13) 1. A radiation delivery system for delivering radiation during a treatment session, the radiation delivery system comprising: The gantry and a therapeutic radiation source mounted on the gantry; an imaging system mounted on the gantry; a controller in communication with the gantry, the radiation source, and the imaging system, the controller comprising: obtaining imaging data of a patient positioned on a platform using the imaging system; Treatment planning dose of radiation D plan applying a radiation dose to the patient using the radiation source to deliver a radiation dose, the radiation dose being derived from the acquired imaging data; ceasing the application of the radiation to the patient; and The amount of radiation D applied to the patient prior to stopping the application of the radiation delivered,pre-interrupt and storing the location of the platform when the application of radiation was stopped; resuming the application of radiation to the patient while acquiring additional imaging data, wherein a second dose of radiation applied to the patient is derived from the additional imaging data; and D. plan and D delivered,pre-interrupt and a controller configured to: A system comprising: (Item 14) 14. The system of claim 13, wherein resuming radiation application includes moving the patient platform back to the location of the platform when the application of radiation was stopped. (Item 15) The radiation dose applied before stopping the application of radiation is a first radiation dose, and imaging data x obtained during the treatment session before stopping the application of radiation is i Item 14. The system according to item 13, derived from (Item 16) The first radiation dose is calculated based on the acquired imaging data x i 16. The system of claim 15, wherein the radiation firing matrix RFM is multiplied by a biological firing area bit mask BFZ and the biological firing area bit mask BFZ is applied, the RFM and the BFZ being calculated during a treatment planning session. (Item 17) Applying a radiation dose to the patient includes applying a first pass of radiation while acquiring a first set of imaging data x1 as the patient platform moves through a therapeutic radiation beam plane from a first location to a second location, and determining a radiation dose (D 1,calc ) multiplies the first set of imaging data x1 by the radiation emission matrix RFM and applies the biological emission zone bit mask BFZ; D 1,raw and then normalize D by the first normalization factor k1 1,raw Item 16. The system of item 15, wherein the σ is derived by scaling (Item 18) The first normalization coefficient k1 is A radiation dose D is calculated by multiplying the radiation emission matrix RFM by a pre-scan image of the patient acquired during the treatment session and applying the biological emission zone bit mask BFZ. 0,raw and D 0,raw by the total number of radiation passes in the treatment session, N, to obtain the cumulative predicted dose, D. 0,predicted cumulative and D plan and the cumulative predicted dose D 0,predicted cumulative Find the ratio between Item 18. The method according to item 17, wherein the calculated value is (Item 19) Applying a dose of radiation to the patient further includes applying a second pass of radiation while acquiring a second set of imaging data x2 as the patient platform moves from the second location to the first location through the therapeutic radiation beam plane, and determining a radiation dose (D 2,calc ) multiplies the second set of imaging data x2 by the radiation emission matrix RFM and applies the biological emission zone bit mask BFZ; D 2,raw and normalize D by the second normalization factor k2 2,raw 19. The system of any one of items 17 and 18, wherein the σ is derived by scaling (Item 20) Ceasing application of the radiation to the patient includes ceasing application of the radiation during a second pass of the radiation, and resuming application of the radiation to the patient includes obtaining a resumed set of imaging data x 2,resumed and obtaining the resumed set x of imaging data. 2,resumed multiplying the radiation emission matrix RFM by the biological emission area bit mask BFZ; 2,raw,post-interrupt and normalize D by the second normalization factor k2 2,raw,post-interrupt and emitting a radiation dose derived by scaling D 2,raw,pre-interrupt Item 20. The system according to Item 19, (Item 21) 21. The system of claim 20, wherein resuming application of radiation to the patient further includes applying a third pass of radiation while acquiring a third set of imaging data x3 as the patient platform moves through the therapeutic radiation beam plane from the first location to the second location, wherein the radiation dose emitted during the third pass is derived by multiplying the third set of imaging data x3 by the radiation firing matrix RFM, applying the biological firing zone bit mask BFZ, and scaling by a third normalization factor k3. (Item 22) The third normalization factor k3 is D plan and the first pass D 1,calc and the second pass D 2,calc calculating the difference between the cumulative radiation dose applied at (D 2,raw,pre-interrupt +D 2,raw,post-interrupt ) by N-3 to obtain the cumulative predicted dose D 2,predicted cumulative and (D plan -(D 1,calc +D 2,calc )) and the cumulative predicted dose D 2,predicted cumulative Find the ratio between Item 22. The system according to item 21, wherein the calculated value is: (Item 23) Ceasing application of the radiation to the patient includes ceasing application of the radiation during a second pass of the radiation, and resuming application of the radiation to the patient includes: obtaining a second pre-scan image of the patient; moving the patient platform back to its location when the application of radiation was stopped; resumed set of imaging data x 2,resumed and obtaining the resumed set x of imaging data. 2,resumed multiplying the radiation emission matrix RFM by the biological emission area bit mask BFZ; 2,raw,post-interrupt and obtain the restarted normalization factor k 2_resumed By D 2,raw,post-interrupt and emitting a radiation dose derived by scaling D 2,raw,pre-interrupt That is, Item 20. The system of item 19, comprising: (Item 24) The resumed normalization factor k 2_resumed teeth, The radiation dose D is calculated by multiplying the second pre-scan image of the patient by the radiation emission matrix RFM and applying the biological emission zone bit mask BFZ. 2,raw,post-interrupt and (D 2,raw,pre-interrupt +D 2,raw,post-interrupt ) by N-2 to obtain the cumulative predicted dose D 2,predicted cumulative and D plan and the cumulative predicted dose D 2,predicted cumulative Find the ratio between Item 24. The system according to item 23, wherein the calculated value is: (Item 25) 25. The system of claim 24, wherein resuming application of radiation to the patient further includes applying a third pass of radiation while acquiring a third set of imaging data x3 as the patient platform moves through the therapeutic radiation beam plane from the first location to the second location, wherein the radiation dose emitted during the third pass is derived by multiplying the third set of imaging data x3 by the radiation firing matrix RFM, applying the biological firing area bit mask BFZ, and scaling by a third normalization factor k3. (Item 26) The third normalization factor k3 is D plan and the first pass D 1,calc and the second pass D 2,calc calculating the difference between the cumulative radiation dose applied at (D 2,raw,pre-interrupt +D 2,raw,post-interrupt ) by N-3 to obtain the cumulative predicted dose D 2,predicted cumulative and (D plan -(D 1,calc +D 2,calc )) and the cumulative predicted dose D 2,predicted cumulative Find the ratio between Item 26. The system according to item 25, wherein the calculated value is: (Item 27) 1. A radiation delivery system comprising: The gantry and a therapeutic radiation source mounted on the gantry and configured to apply radiation in a radiation treatment beam plane; and a plurality of PET detectors mounted on the gantry; a platform movable relative to the gantry; a controller in communication with the gantry, the therapeutic radiation source, and the platform, the controller configured to obtain images of a patient on the platform, calculate a normalization factor based on the images of the patient, and deliver radiation to the patient across a preselected number of shuttle passes; Equipped with At each shuttle pass, the controller: updating a radiation firing matrix of a treatment plan using the calculated normalization factor; moving the platform from a first predetermined location to a second predetermined location and back to the first predetermined location such that a target area within the patient intersects the radiation treatment beam plane at least twice; obtaining PET data using the PET detector; delivering radiation to the patient based on the updated radiation firing matrix and the acquired PET data; calculating a fluence delivered to the patient when the platform moves back to the first predetermined location; calculating a fluence difference between the fluence delivered to the patient and the treatment plan fluence; calculating an updated normalization factor based on the fluence difference; A system configured to: (Item 28) 28. The system of claim 27, wherein the PET detector is coplanar with the radiation treatment beam plane. (Item 29) 28. The system of claim 27, wherein the acquired images are PET images. (Item 30) 30. The system of claim 29, wherein calculating the normalization factor comprises calculating an average of PET intensities of the target region within the acquired PET images. (Item 31) Item 32. The system of item 27, wherein the preselected number of shuttle passes is an even number. Item 31. The system of item 30, wherein the preselected number of shuttle passes is two or more. (Item 33) 28. The system of claim 27, wherein calculating an updated normalization factor includes calculating an average fluence value of the radiation emitted by the therapeutic radiation source. (Item 34) 28. The system of claim 27, wherein calculating an updated normalization factor includes calculating a ratio of an average planned dose value of radiation to the target region and an average delivered dose value of the radiation. (Item 35) delivering radiation based on the updated radiation firing matrix and the acquired PET data; multiplying the updated radiation emission matrix by one or more lines of response (LOR) of the acquired PET data to derive a delivery fluence map; generating radiation using the therapeutic radiation source according to the delivery fluence map; and Item 28. The system according to item 27, comprising: (Item 36) 28. The system of claim 27, further comprising a movable jaw positioned over the therapeutic radiation source and a multi-leaf collimator coupled to the jaw, wherein the treatment plane is defined by a position of the movable jaw relative to the therapeutic radiation source and a configuration of the multi-leaf collimator. (Item 37) Item 37. The system of item 36, wherein the controller is configured to move the movable jaw from a first jaw location to a second jaw location and back to the first jaw location when radiation is delivered to the patient. (Item 38) 28. The system of claim 27, wherein the controller is configured to calculate a predicted dose and a dose value histogram by adjusting the image by the calculated normalization factor. (Item 39) 1. A radiation delivery system comprising: The gantry and a therapeutic radiation source, wherein a movable jaw and a multi-leaf collimator are both positioned in a radiation beam path of the radiation source, and the position of the movable jaw and the configuration of the multi-leaf collimator relative to the radiation source define a treatment plane; a radiation therapy system platform; a controller in communication with the gantry, the radiation source, and the radiation therapy system platform, the controller comprising: (a) moving the patient positioned on the platform by moving the platform from a first predetermined location to a second predetermined location such that one or more target regions within the patient intersect the treatment plane; (b) delivering radiation to the patient using the radiation source when a portion of the one or more target regions intersects the treatment plane, wherein delivering the radiation includes moving the movable jaw from a first jaw location to a second location and back to the first jaw location while emitting radiation from the radiation source before moving to a next platform location; a controller configured to: A system comprising: (Item 40) 40. The system of claim 39, wherein moving the platform comprises moving the platform through a series of predetermined incremental patient-platform locations, and delivering radiation to the patient comprises delivering radiation at each platform location where the target region intersects the treatment plane. (Item 41) 40. The system of claim 39, wherein moving the platform comprises translating the platform along a longitudinal axis, and moving the movable jaw comprises moving the jaw such that the treatment plane is shifted along the longitudinal axis. (Item 42) Item 42. The system of item 41, wherein moving the movable jaw shifts the treatment plane along the longitudinal axis by about 3 cm to about 6 cm. (Item 43) Item 43. The system of item 42, wherein moving the movable jaw shifts the treatment plane at a rate of about 0.5 cm / sec. (Item 44) 40. The system of claim 39, wherein the controller is configured to obtain an image of the patient before radiation is delivered to the patient. (Item 45) Item 45. The system of item 44, further comprising a plurality of PET detectors configured to obtain PET data including lines of response (LORs), wherein delivering radiation to the patient includes multiplying a radiation emission matrix of a treatment plan by one or more LORs to derive a delivery fluence map, and generating radiation using the therapeutic radiation source according to the delivery fluence map. (Item 46) Item 45. The system of item 44, wherein the acquired images are PET images. (Item 47) Item 40. The system of item 39, wherein the controller is configured to repeat steps (a) and (b) a preselected number of shuttle passes. (Item 48) Item 48. The system of item 47, wherein the preselected number of shuttle passes is two or more. (Item 49) 1. A radiation delivery system comprising: The gantry and a therapeutic radiation source; a controller in communication with the gantry and the radiation source, the controller comprising: Calculating the radiation fluence delivered to the patient target area during a previous radiation delivery session; comparing the delivered radiation fluence to the target area with the treatment plan fluence to the target area and calculating a fluence difference; calculating a radiation emission matrix based on the calculated fluence difference; delivering radiation to the patient in the subsequent radiation delivery session based on the calculated radiation firing matrix and PET data obtained during the subsequent radiation delivery session; a controller configured to: A system comprising: (Item 50) Item 50. The system of item 49, wherein comparing includes comparing an average radiation fluence delivered to the target area with an average treatment plan fluence to the target area, and calculating a fluence difference by determining the difference between the average delivered radiation fluence and the average treatment plan fluence. (Item 51) 50. The system of claim 49, wherein the PET data includes line of response (LOR) data. [Brief explanation of the drawings]

[0017] [Figure 1A] FIG. 1A depicts one variation of a radiation therapy system.

[0018] [Figure 1B] FIG. 1B depicts a perspective component view of a radiation therapy system (eg, the radiation therapy system of FIG. 1A).

[0019] [Figure 1C] FIG. 1C depicts one variation of the beamforming module.

[0020] [Figure 2A] FIG. 2A depicts a plot representing the frequency spectrum of respiratory motion.

[0021] [Figure 2B] FIG. 2B depicts a plot showing the movement of the target area during a treatment session.

[0022] [Figure 2C] FIG. 2C depicts the planned dose distribution plot.

[0023] [Figure 2D] FIG. 2D depicts the delivered dose distribution plot.

[0024] [Figure 3A] FIG. 3A depicts a plot showing the movement of the target area during a treatment session.

[0025] [Figure 3B] FIG. 3B depicts a plot showing the movement of the target area during a treatment session in shuttle mode.

[0026] [Figure 3C] FIG. 3C depicts a table showing the dose delivered to the target area after one shuttle pass and after eight shuttle passes.

[0027] [Figure 3D] FIG. 3D depicts the planned dose distribution plot.

[0028] [Figure 3E] FIG. 3E depicts a delivered dose distribution plot for radiation delivered in shuttle mode.

[0029] [Figure 4] FIG. 4 depicts a flowchart representation of one variation of the method for the patient platform or couch shuttle mode.

[0030] [Figure 5] FIG. 5 depicts a flow chart representation of one variation of the method for the jaw shuttle mode.

[0031] [Figure 6] FIG. 6 depicts a flowchart representation of one variation of a method for updating a radiation firing matrix (RFM) during a treatment session.

[0032] [Figure 7] FIG. 7 depicts a flowchart representation of one variation of a method for dynamically updating the RFM during an emission stimulation radiation therapy session.

[0033] [Figure 8A] FIG. 8A depicts one variation of a method for radiation delivery.

[0034] [Figure 8B] FIG. 8B depicts one variation of how radiation delivery is modified according to a normalization factor.

[0035] [Figure 8C] FIG. 8C depicts one variation of the pipeline normalization method.

[0036] [Figure 9A] 9A-9D depict simulated dose-volume plots or histograms (DVH) based on one variation of the method of radiation delivery over four couch shuttle passes to the planning target region (PTV) and biological fire zone (BFZ) regions. Figure 9A depicts the DVH curve after one shuttle pass, Figure 9B depicts the DVH curve after two shuttle passes, Figure 9C depicts the DVH curve after three shuttle passes, and Figure 9D depicts the DVH curve after four shuttle passes. [Figure 9B] 9A-9D depict simulated dose-volume plots or histograms (DVH) based on one variation of the method of radiation delivery over four couch shuttle passes to the planning target region (PTV) and biological fire zone (BFZ) regions. Figure 9A depicts the DVH curve after one shuttle pass, Figure 9B depicts the DVH curve after two shuttle passes, Figure 9C depicts the DVH curve after three shuttle passes, and Figure 9D depicts the DVH curve after four shuttle passes. [Figure 9C]9A-9D depict simulated dose-volume plots or histograms (DVH) based on one variation of the method of radiation delivery over four couch shuttle passes to the planning target region (PTV) and biological fire zone (BFZ) regions. Figure 9A depicts the DVH curve after one shuttle pass, Figure 9B depicts the DVH curve after two shuttle passes, Figure 9C depicts the DVH curve after three shuttle passes, and Figure 9D depicts the DVH curve after four shuttle passes. [Figure 9D] 9A-9D depict simulated dose-volume plots or histograms (DVH) based on one variation of the method of radiation delivery over four couch shuttle passes to the planning target region (PTV) and biological fire zone (BFZ) regions. Figure 9A depicts the DVH curve after one shuttle pass, Figure 9B depicts the DVH curve after two shuttle passes, Figure 9C depicts the DVH curve after three shuttle passes, and Figure 9D depicts the DVH curve after four shuttle passes.

[0037] [Figure 10] FIG. 10 depicts one variation of a method for radiation delivery.

[0038] [Figure 11A] 11A-11B are simulated DVH plots depicting the results of two methods of radiation delivery over four couch shuttle passes to the planning target region (PTV) and biological launch zone (BFZ). Figure 11A depicts the DVH plot when negative fluence values ​​are incorporated as part of the radiation delivery.

[0039] [Figure 11B] FIG. 11B depicts the DVH plot when negative fluence values ​​are not incorporated as part of the radiation delivery.

[0040] [Figure 12A]12A-12C depict multiple views of the planned dose distribution: Fig. 12A depicts a projection of the planned dose distribution on the IEC-Z / IEC-X plane, Fig. 12B depicts a projection of the planned dose distribution on the IEC-Z / IEC-Y plane, and Fig. 12C depicts a projection of the planned dose distribution on the IEC-Y / IEC-X plane. [Figure 12B] 12A-12C depict multiple views of the planned dose distribution: Fig. 12A depicts a projection of the planned dose distribution on the IEC-Z / IEC-X plane, Fig. 12B depicts a projection of the planned dose distribution on the IEC-Z / IEC-Y plane, and Fig. 12C depicts a projection of the planned dose distribution on the IEC-Y / IEC-X plane. [Figure 12C] 12A-12C depict multiple views of the planned dose distribution: Fig. 12A depicts a projection of the planned dose distribution on the IEC-Z / IEC-X plane, Fig. 12B depicts a projection of the planned dose distribution on the IEC-Z / IEC-Y plane, and Fig. 12C depicts a projection of the planned dose distribution on the IEC-Y / IEC-X plane.

[0041] [Figure 13A] 13A-13C depict multiple views of the planned dose distribution: Fig. 13A depicts a projection of the delivered dose distribution on the IEC-Z / IEC-X plane, Fig. 13B depicts a projection of the delivered dose distribution on the IEC-Z / IEC-Y plane, and Fig. 13C depicts a projection of the delivered dose distribution on the IEC-Y / IEC-X plane. [Figure 13B] 13A-13C depict multiple views of the planned dose distribution: Fig. 13A depicts a projection of the delivered dose distribution on the IEC-Z / IEC-X plane, Fig. 13B depicts a projection of the delivered dose distribution on the IEC-Z / IEC-Y plane, and Fig. 13C depicts a projection of the delivered dose distribution on the IEC-Y / IEC-X plane. [Figure 13C] 13A-13C depict multiple views of the planned dose distribution: Fig. 13A depicts a projection of the delivered dose distribution on the IEC-Z / IEC-X plane, Fig. 13B depicts a projection of the delivered dose distribution on the IEC-Z / IEC-Y plane, and Fig. 13C depicts a projection of the delivered dose distribution on the IEC-Y / IEC-X plane.

[0042] [Figure 14A] Figures 14A-14C depict multiple views of the γ (gamma) metric distribution: Figure 14A depicts the projection of the γ (gamma) metric distribution onto the IEC-Z / IEC-X plane, Figure 14B depicts the projection of the γ (gamma) metric distribution onto the IEC-Z / IEC-Y plane, and Figure 14C depicts the projection of the γ (gamma) metric distribution onto the IEC-Y / IEC-X plane. [Figure 14B] Figures 14A-14C depict multiple views of the γ (gamma) metric distribution: Figure 14A depicts the projection of the γ (gamma) metric distribution onto the IEC-Z / IEC-X plane, Figure 14B depicts the projection of the γ (gamma) metric distribution onto the IEC-Z / IEC-Y plane, and Figure 14C depicts the projection of the γ (gamma) metric distribution onto the IEC-Y / IEC-X plane. [Figure 14C] Figures 14A-14C depict multiple views of the γ (gamma) metric distribution: Figure 14A depicts the projection of the γ (gamma) metric distribution onto the IEC-Z / IEC-X plane, Figure 14B depicts the projection of the γ (gamma) metric distribution onto the IEC-Z / IEC-Y plane, and Figure 14C depicts the projection of the γ (gamma) metric distribution onto the IEC-Y / IEC-X plane.

[0043] [Figure 14D] FIG. 14D depicts a plot showing cumulative fluence as a function of beam station for a treatment session involving four shuttle passes.

[0044] [Figure 15A] FIG. 15A depicts one variation of the method of radiation delivery when there is a break during the shuttle pass, in which radiation delivery is resumed without a new pre-scan image.

[0045] [Figure 15B] FIG. 15B depicts one variation of the method of radiation delivery when there is a break between shuttle passes, in which radiation delivery is resumed using a new pre-scan image.

[0046] [Figure 16] FIG. 16 is a plot depicting cumulative fluence as a function of beam station for a treatment session with four shuttle passes in which treatment was interrupted on the second shuttle pass, with various interruption characteristics. DETAILED DESCRIPTION OF THE INVENTION

[0047] Radiation Therapy System A radiation therapy system that can be used in shuttle mode radiation delivery may include a rotatable gantry that rotates about a patient treatment region, a therapeutic source mounted on the rotatable gantry, and a patient platform that is movable within or through the patient treatment region. The rotatable gantry may be configured to rotate from 0° to 360° (e.g., a continuously rotatable gantry) or to rotate only along an arc segment that sweeps a subset of angles (e.g., 0° to 180°, 0° to 270°, etc.). One example of a therapeutic radiation source is a linear accelerator (linac). One or more beam-shaping elements may be positioned in the beam path of the therapeutic radiation source to define a treatment plane. For example, the beam-shaping elements may include jaws and a dynamic multi-leaf collimator (MLC). The jaws may be located between the therapeutic radiation source and the MLC or below the MLC. Alternatively, the jaws may be split jaws, with a first portion of the jaws positioned between the therapeutic radiation source and the MLC and a second portion of the jaws positioned below the MLC and coupled to the first portion of the jaws so that both portions move together. The jaws may be movable within the beam of the therapeutic radiation source so that a treatment plane defined by the jaws may shift in a direction parallel to the movement of the patient platform. For example, if the patient platform moves through the patient treatment region in the IEC-Y direction, the jaws and MLC may define a treatment plane in the IEC-XZ plane, and moving the jaws may shift the treatment plane along the IEC-Y direction. The MLC and jaws may be separate or decoupled so that shifting or moving the jaws does not move the MLC, although in other variations, the MLC and jaws may be coupled together so that shifting or moving the jaws also causes a corresponding shift or movement of the MLC. Some variations of radiation therapy systems may include a radiation detector mounted on the gantry opposite the therapeutic radiation source. For example, some variations may include an MV radiation detector located opposite the linac.

[0048] Additionally, some radiation therapy systems may include one or more PET detectors, which may be mounted on the same rotatable gantry or on a separate / second gantry that may or may not be rotatable around the patient treatment region. A line of response (LOR) defined by a pair of coincident 511 keV photons emitted by a positron annihilation event may be detected by the PET detector and transmitted to a system controller. In some variations, the patient may be injected with a PET tracer prior to a treatment session, and the LOR from the PET tracer may be detected by the PET detector. For example, the PET tracer may accumulate in a patient region with a high metabolic rate, such as a tumor region. The system controller may communicate with all of the components of the radiation therapy system and may, for example, generate commands to the therapeutic radiation source, the gantry, the beamforming elements, and / or the patient platform based on data obtained by the PET detector and / or the MV detector. The system controller may also include one or more processors, which may be programmed or configured to perform any of the calculations and methods described herein. The controller may also comprise one or more memories that may store data associated with any of the calculations and methods described herein, including, but not limited to, imaging data (e.g., LOR data as detected by a PET detector), radiation delivery parameters and / or adjustment coefficients, machine commands, machine configurations, sensor data, and any other data as described herein.

[0049] One variation of a radiation therapy system is depicted in FIG. 1A. FIG. 1A depicts one variation of a radiation delivery therapy system that can be used in shuttle mode radiation delivery. The radiation therapy system (100) may include a gantry (102) rotatable about a patient treatment region (104), one or more PET detectors (106) mounted on the gantry, a therapeutic radiation source (108) mounted on the gantry, a beam-forming module (110) positioned in the beam path of the therapeutic radiation source, and a patient platform (112) movable within the patient treatment region (104). The beam-forming module (110) may include movable jaws and a dynamic multi-leaf collimator (MLC). The beam-forming module may be arranged to provide a variable collimation width in the vertical direction of 1 cm, 2 cm, or 3 cm at the system isocenter (e.g., the center of the patient treatment region). The jaws may be located between the therapeutic radiation source and the MLC or below the MLC. Alternatively, the beam shaping module may include split jaws, with a first portion of the jaw positioned between the therapeutic radiation source and the MLC and a second portion of the jaw positioned below the MLC and coupled to the first portion of the jaw so that both portions move together. FIG. 1B is a perspective component view of the radiation therapy system (100). As shown therein, the beam shaping module may further include a primary collimator or jaw (107) positioned above the binary MLC (122). Optionally, the radiation therapy system (100) may further include a kV CT scanning device (109) on a rotatable ring (111) mounted to the rotatable gantry (102) such that rotating the gantry (102) also rotates the ring (111). The therapeutic radiation source or linac (108) and the PET detector (106) may be mounted on the same cross-sectional plane of the gantry (i.e., the PET detector is coplanar with the treatment plane defined by the linac and beamforming module), while the kV CT scanning device and ring may be mounted on a different cross-sectional plane (i.e., not coplanar with the treatment plane).

[0050] FIG. 1C is a schematic illustration of one variation of a beam-shaping module including a split jaw (120) and a dynamic MLC (122). In this variation, the dynamic MLC (122) may be a binary MLC, but may be any type of MLC (e.g., a 2-D MLC). The split jaw (120) may include an upper jaw (124) positioned between a therapeutic radiation source (128) (e.g., a linac) and the MLC (122), and a lower jaw (126) positioned below the MLC (122). The upper jaw (124) and the lower jaw (126) may be coupled together by one or more plates (130) or frames. The jaws may be mounted on one or more curved linear rails. For example, the split jaw (120) may be slidably mounted on one or more curved linear rails (132). One or more plates or frames of the split jaw may have one or more slots sized and shaped to be larger than the cross-sectional size of the rails, so that the slots can slide over the rails (as indicated by arrows (134)). Optionally, there may be additional rails perpendicular to the rails (132) to provide further support for the jaws. While the rails (132) are curved in this example, they may not be curved in other variations (i.e., they may be straight without any curves). The jaws may be coupled to actuators or motors that move the position of the jaws along the curved linear rails. Movement of the jaws along the rails may result in a corresponding shift of the treatment plane along the IEC-Y axis (i.e., parallel to the axis of patient platform motion). In other variations, the jaws may instead be mounted to the gantry via one or more movable or rotatable mounting mechanisms, such as one or more hinges or pivots. The jaws may be movable about 0.5 cm to about 2 cm to the right or left of the isocenter, with a total range of movement (end-to-end) of about 1 cm to about 4 cm, which may correspond to a similar shift in the treatment plane, which may shift along the longitudinal axis of the patient platform, with a total range of movement of about 1 cm to about 4 cm.It should be appreciated that the total range of movement along the patient platform's longitudinal axis (e.g., IEC-Y) can be from about 1 cm to about 12 cm, e.g., about 1 cm, about 2 cm, about 3 cm, etc. In some variations, the binary MLC may comprise 64 leaves defining an axial plane (IEC-XZ), each 0.6 cm wide at the isocenter, leading to a field of view (FOV) of about 40 cm. The jaw actuators may be configured to move the jaws at a velocity of about 0.25 cm / sec to about 2 cm / sec, e.g., about 0.5 cm / sec, about 1 cm / sec, etc. In some variations, the velocity of the jaws may exceed the velocity of the patient platform. Although the beam shaping module depicted and described in Figures 1A-1C includes jaws and an MLC that are not movably attached to one another (i.e., moving or shifting the jaws does not necessarily move or shift the MLC), in other variations the jaws and MLC may be movably attached (i.e., the jaws and MLC move or shift together in concert).

[0051] In some variations, the radiation therapy system may include a beamforming module (110) comprising a first array (106a) of PET detectors and a second array (106b) of PET detectors positioned across from the first array, a linear accelerator (108) or linac, jaws, and a dynamic binary MLC. The system may further include a controller in communication with the gantry, PET detectors, linac, and MLC, the controller having one or more memories that may store treatment plans, radiation emission matrices, fluence maps, and system instructions / commands, and a processor configured to perform the calculations and methods described herein. A patient positioned on or disposed on a patient platform (112) within the patient treatment region (104) may be injected with a positron-emitting PET tracer that may accumulate in a specific region of the patient (e.g., a tumor region, etc.). Annihilation of a positron by a nearby electron results in the emission of two photons traveling in opposite directions, defining a LOR or positron annihilation emission path. The PET detector may detect one or more LORs. In some variations, the PET detector may be a time-of-flight PET detector, which may help identify the location of positron annihilation events. The previously calculated treatment plan P and / or radiation firing matrix RFM may be configured according to data acquired by an MV detector located opposite the therapeutic radiation source and / or LOR data and / or PET imaging data acquired by a PET detector to update the treatment plan fluence map so that the linac and MLC leaf configuration / beamlet selection takes tumor movement into account. The treatment plan fluence map may be updated using LOR data and / or PET imaging data and / or MV detector data as the patient is moved through the patient treatment region (e.g., in predetermined patient platform steps or increments, or with continuous patient platform movement through the patient treatment region and / or treatment plane). Optionally, the radiation therapy system (100) may include a CT imaging system, mounted on the same gantry as the therapeutic radiation source or on a separate gantry.Additional details and examples of PET-based radiation therapy systems are described in U.S. Patent Application No. 15 / 814,222, filed November 15, 2017, which is incorporated herein by reference in its entirety.

[0052] The gantry (102) may be configured to rotate at a rate of about 15 RPM to about 70 RPM (e.g., about 50 RPM, about 60 RPM), the binary dynamic MLC may be configured to change leaf configuration within about 15 milliseconds or less (e.g., about 10 milliseconds or less, about 8 milliseconds or less), and the patient platform (112) may be configured to move at a rate of about 0.5 mm / sec or less. For example, a high-speed binary multi-leaf collimator may include a leaf actuation mechanism having a spring system coupled to a pneumatic system to provide sufficient motive force to move the MLC leaves between open and closed configurations within the time constraints described above. As the gantry (102) rotates, it may move to (and / or across) discrete, predetermined circumferential firing positions. Some systems have 100 firing positions or angles (e.g., from about 0 degrees to about 360 degrees, with each position separated by a regular angular interval).

[0053] The treatment plan may define the radiation dose to be delivered to each target region within the patient by the radiation therapy system. The treatment plan's fluence and / or dose maps may be used to determine jaw position / configuration, MLC position / configuration, gantry position and / or motion, and couch position and / or motion during a treatment session. In some variations, a radiation firing matrix (RFM) may be calculated as part of the treatment plan. The RFM may be a matrix that specifies the transformation from a partial image (e.g., a set of LORs or incomplete image data) to the radiation beamlet pattern and / or beamlet intensities to be applied to the patient during a treatment session. For example, in biologically guided radiation therapy, such as emission-guided radiation therapy, where therapeutic radiation is applied to target regions based on detected PET LORs, the RFM may be multiplied by LOR data during a treatment session to generate a fluence map that defines the radiation dose to be delivered to each patient target region. Additional details regarding treatment planning methods and calculation of radiation firing matrices are provided in U.S. Provisional Patent Application No. 62 / 537,384, filed July 26, 2017, which is incorporated herein by reference in its entirety.

[0054] Dose modulation artifact The treatment plan and / or RFM are calculated based on images and data of the patient and / or target area in advance of a treatment session, often weeks or even days before the treatment session. It is not uncommon for target areas, particularly those in or near the lung (e.g., lung tumors), to move during a treatment session, particularly deviating from their location during treatment planning. Irregular and / or unpredictable movement of the target area, coupled with movement of the jaws, MLC, and / or couch, can modulate the delivered dose, resulting in radiation being delivered to non-target tissue and / or areas of the target area being over- or under-irradiated (e.g., hot spots and cold spots, respectively). As the patient platform or couch advances within the target area along the longitudinal direction (IEC-Y), the target volume is irradiated using a fan beam of radiation (e.g., a treatment plane) as defined by the system's beam-shaping elements. Radiation therapy systems with high-speed rotating gantries (e.g., greater than about 15 RPM, e.g., about 60 RPM or about 70 RPM) and high-speed binary MLCs (e.g., with leaf transition times of about 8 ms to about 15 ms) can result in pitch (i.e., the ratio of couch movement to collimator thickness in one rotation along IEC-Y) that is less than about 0.3. It has been suggested that patient and couch motion along IEC-Y (longitudinal) can contribute significantly to dose modulation artifacts.

[0055] An example of dose modulation due to tumor motion is depicted in Figures 2A-2D. Figures 2A and 2B are plots representing tumor motion (due to respiratory motion) on a radiation therapy system with a patient platform or couch moving at a speed of approximately 0.5 mm / s or less and binary MLC leaves sized 20 mm in the longitudinal direction (e.g., IEC-Y), where the time to traverse the beam in the longitudinal direction would be approximately 40 seconds (20 mm / [0.5 mm / s]). The time to traverse the beam can be referred to as the "jaw dwell time." While in the transverse plane (e.g., IEC-XZ plane), the time scale for the binary MLC (e.g., leaf transition speed) is an order of magnitude higher, at approximately 0.01 seconds for a system with 100 firing positions. In this radiation therapy system, the rate of opening and closing of the binary MLC leaves is relatively fast compared to the rate of couch motion. As depicted in Figure 2A, the dominant component of respiratory motion has a frequency of approximately 0.2 Hz. Dose modulation due to respiratory and patient platform motion can be described as a function of jaw dwell time variation. The dose D received at any given point (y) along the longitudinal axis (IEC axis) in the jaw reference frame may be expressed as: [ka] where y is the beam center or machine location in the longitudinal direction (IEC-Y), B defines the beam profile for a given system, y(t) is the profile of tumor motion as seen in the jaw reference frame, and can be described as follows: [ka]

[0056] Integration over time represents the averaging of motion over a period of time as described in the paragraph above and is also depicted in FIG. 2B. Due to respiratory motion, the target region (e.g., a lung tumor) may shift in front of, behind, inside, or outside the jaw window (200), resulting in irregular dose delivery to that target region. The dose at a given point y may be directly proportional to the tumor's residence time inside the jaw window (200). The dwell time variation leads to dose modulation and dose distribution irregularities. FIG. 2C depicts the planned dose distribution (e.g., an IMRT planned dose profile) for the clinical target volume (CTV) and planning target volume (PTV), outlined by solid black lines. Ideal radiation delivery delivers a sufficient amount of homogeneous dose distribution within the boundaries of the target region. However, when the target region moves as radiation is being delivered (e.g., due to patient breathing, patient platform movement through the treatment plane, and / or therapeutic radiation source rotation around the patient), the delivered dose may deviate from the planned distribution. Figure 2D depicts a simulated dose distribution resulting from radiation delivery to a target region as it moves in a manner similar to the respiratory motion described and depicted in Figures 2A and 2B. As shown there, there are regions of over-irradiation ("hot spots") (202) and under-irradiation ("cold spots") (204).

[0057] Shuttle Mode A method that can help address dose modulation due to patient or target region motion may include introducing a predetermined and known motion into a radiation therapy system having frequency components uncorrelated with respiratory motion (e.g., having frequency components outside a frequency band around 2 Hz). One variation of the method may include moving a patient platform (or couch) and / or beam-shaping elements (such as jaws) in a repeated or cyclical manner so that the patient target region passes through the treatment plane multiple times during a treatment session. For example, during a treatment session, the patient platform may be moved from a first predetermined location to a second predetermined location and back to the first predetermined location so that the target region crosses the treatment plane at least twice. Such repeated couch motion may be referred to as couch shuttle, where one couch shuttle cycle or pass includes moving from a first location to a second location while delivering radiation from the therapeutic radiation source. Successive shuttle passes may include moving the couch from a second location back to the first location while delivering radiation from the therapeutic radiation source. The couch may be moved continuously as radiation is delivered, or may be moved stepwise to a series of couch locations along the longitudinal axis (along IEC-Y) such that radiation is delivered only when the couch is stopped at these predetermined locations (or beam stations). Alternatively, or in addition, during a treatment session, the jaws may be moved from a first predetermined jaw location to a second predetermined jaw location (i.e., in a first jaw shuttle pass) and back to the first predetermined jaw location (i.e., in a second jaw shuttle pass) such that a treatment plane defined at least in part by the jaws sweeps across the target region at least twice in two jaw passes. Such repeated jaw motion may be referred to as jaw shuttling, where one jaw shuttle cycle or pass includes moving from a first jaw location to a second jaw location while delivering radiation from the therapeutic radiation source.Successive jaw shuttle passes may include moving the jaws from the second jaw location back to the first jaw location while delivering radiation from the therapeutic radiation source. The jaw opening or aperture may remain constant as the jaws shuttle. In other variations, the jaw opening or aperture may change as the jaws shuttle. Adjusting the speed of couch and / or jaw movement during couch and / or jaw shuttle mode may help address dose modulation artifacts resulting from respiratory motion by sweeping the treatment plane across the target region at a frequency uncorrelated with the frequency peak of respiratory motion. For example, oscillating the couch and / or jaws on a time scale of approximately 70 seconds may help mitigate artifacts resulting from respiratory motion having a frequency peak or component (e.g., approximately 0.2 Hz) on a time scale of approximately 5 seconds. Figures 3A and 3B are plots illustrating target region movement over a 300-second treatment time interval or session with one couch or jaw shuttle pass in Figure 3A and eight couch shuttle passes in Figure 3B. In shuttle mode, the couch or jaws return to their original position approximately every 70 seconds (although the couch or jaw speed may be adjusted so that the couch completes a reciprocating orbit (i.e., a pair of passes) approximately every 80 seconds, 90 seconds, 100 seconds, etc.). As shown in the table of FIG. 3C, a treatment session including multiple shuttle cycles (e.g., eight shuttle passes) results in a dose distribution that is closer to the planned dose than a treatment session with a single shuttle cycle (e.g., one shuttle pass). The resulting dose distribution is depicted in FIG. 3E (while the planned dose distribution is reproduced in FIG. 3D). The CTV and PTV (both of which may include the target region or radiation delivery zone) are outlined with solid black lines. As can be seen, the dose distribution in FIG. 3E is more similar to the planned dose distribution than the dose distribution in FIG. 2D.

[0058] While the couch shuttle mode and jaw shuttle mode may be described separately, it should be understood that both the couch and jaws may be shuttled simultaneously and / or continuously during a treatment session (e.g., first pass in jaw shuttle mode, second pass in couch shuttle mode, etc.). A combination of motion between the couch and jaws may be used to achieve the motion curve of FIG. 3B. This combined couch and jaw shuttle may be beneficial, especially when shuttle passes are increased, as it can be used to significantly reduce patient acceleration. For example, at the "peak" of FIG. 3B (where the shuttle changes direction), the shuttle effect may be achieved by jaw shuttling (so most of the acceleration is at the jaws and acceleration at the couch is near zero). These methods may be used in conjunction with radiation therapy systems configured for continuous couch motion and / or staged-fire couch motion.

[0059] Couch Shuttle One variation of a method for couch shuttling is represented by the flowchart diagram of FIG. 4. The method (400) may optionally include loading a patient onto a radiation therapy system platform (402) and acquiring an image of the patient (404). The acquired image may be used to align the patient's position and location with the coordinate system of the radiation therapy system and / or normalize the treatment plan before turning on the beam. The method (400) may also include moving the patient platform from a first predetermined platform location to a second predetermined platform location (406) so that all of the target region within the patient intersects the treatment plane and is irradiated by the therapeutic radiation source. In some variations, the therapeutic radiation source, beam shaping module (e.g., jaws and dynamic binary MLC), and gantry may apply a fluence to the patient based on the detected LOR data convolved or multiplied with the treatment plan RFM. Optionally, the method (400) may include updating (407) radiation delivery parameters based on the acquired PET data and / or MV detector data. For example, updating the radiation delivery parameters may include normalizing the radiation fluence derived by multiplying the acquired PET data by the RFM, recalculating the RFM based on the delivered dose or fluence calculation, and / or updating the jaw, MLC, couch, and / or gantry commands, and / or adjusting or modifying the radiation fluence for delivery using one or more scaling factors, such as one or more normalization factors, one or more attenuation factors, etc. The emitted fluence and / or delivered dose (e.g., of a single shuttle pass and / or cumulative) may optionally be calculated. The method (400) may include moving (408) the patient platform from a second predetermined platform location to a first predetermined platform location while providing therapeutic radiation within the treatment plane as the target region intersects the treatment plane.Method (400) may include step (410) of repeating steps (406) and (408) any number of times (e.g., one or more times), with or without optional step (407). In some variations, steps (406) and (408) may be repeated an even number of shuttle cycles or times (e.g., 2, 4, 6, 8, 10 times) during a treatment session.

[0060] Joe Shuttle One variation of a method for jaw shuttling is represented by the flowchart diagram of Figure 5. The method (500) may optionally include loading a patient onto a radiation therapy system platform (502) and acquiring images of the patient (504). The acquired images may be used to align the patient's position and location with the coordinate system of the radiation therapy system and / or normalize the treatment plan before turning on the beam. The method (500) may also include moving the patient platform from a first predetermined platform location to a second predetermined platform location while simultaneously moving the jaws from a first predetermined jaw position to a second predetermined jaw position and back to the first predetermined jaw position n times (506) such that all of the target region within the patient traverses the treatment plane and is irradiated by the therapeutic radiation source. n may be any number (e.g., 1, 2, 3, 4, 5, 7, 9, 11, etc.), and in some variations, n may be an even number, e.g., 2, 4, 6, 8, 10, etc., and the rate or speed at which the jaws move may be about 0.25 cm / sec to about 2 cm / sec, e.g., about 0.5 cm / sec, about 1 cm / sec. In some variations, the therapeutic radiation source, beam shaping module (e.g., jaws and dynamic binary MLC), and gantry may apply a fluence to the patient based on detected LOR data convolved or multiplied with the treatment planning RFM. While the jaws are shuttled between a first predetermined jaw position and a second predetermined jaw position, the configuration of the MLC may change (i.e., the leaves may transition between open and closed states) according to a fluence map derived from multiplying or convolving the RFM with the LOR data (e.g., based on instructions from segmenting the fluence map). Optionally, the method (500) may include updating (507) radiation delivery parameters based on the acquired PET data and / or MV detector data.For example, updating the radiation delivery parameters may include normalizing the RFM, recalculating the RFM based on a delivered dose or fluence calculation, and / or updating the jaw, MLC, couch, and / or gantry commands, and / or adjusting or modifying the radiation fluence for delivery using one or more scaling factors, such as one or more normalization factors, one or more attenuation factors, etc. Optionally, the emitted fluence and / or delivered dose (e.g., of a single shuttle pass and / or cumulative) may be calculated. The method (500) may include moving (508) the jaws from the first predetermined jaw position to the second predetermined jaw position and back to the first predetermined jaw position n' times while moving the patient platform from the second predetermined platform location to the first predetermined platform location such that all of the target region within the patient traverses the treatment plane and is irradiated by the therapeutic radiation source. n' may be any number (e.g., n' = 1, 2, 3, 4, 5, 7, 9, 11, etc.), and in some variations, n' may be an even number, e.g., 2, 4, 6, 8, 10, etc., which may or may not be identical to n. Method (500) may optionally include step (510) of repeating steps (506) and (508) for an even number of shuttle cycles or times (e.g., 2, 4, 6, 8, 10 times) in a treatment session, with or without optional step (507). Including optional step (510) combines both couch shuttling and jaw shuttling. As described above, the jaws may be moved at a rate of about 0.25 cm / sec to about 2 cm / sec, e.g., about 0.5 cm / sec or about 1 cm / sec, and the distance between the first and second predetermined jaw positions may be about 1 cm to about 4 cm, e.g., about 1 cm or about 2 cm. The frequency of jaw shuttling may be about 4 to about 5 times the dominant frequency component of respiratory motion.

[0061] Delivery and interaction artifact reduction As briefly described above, radiation delivery parameters may optionally be updated during a treatment session. Updating the delivery parameters can help mitigate dose modulation artifacts due to patient motion. In some variations, the method may include calculating the fluence delivered to the patient during a shuttle pass (couch and / or jaw shuttle pass), comparing the delivered fluence to the treatment plan fluence and calculating the fluence difference, and updating the RFM of the treatment plan and delivering the fluence difference in subsequent shuttle passes. The fluence calculation may be an average fluence over one or more target regions. The fluence difference can be calculated / estimated in a static patient reference frame and delivered in one or more subsequent passes without requiring any additional imaging data (e.g., without any PET imaging data, CT imaging data, or MV detector data). Alternatively, it can be calculated in a tumor point of view (POV) reference frame. In some variations, the method may include calculating the cumulative delivered fluence across all previous shuttle passes in a treatment session (rather than just the fluence delivered in a single shuttle pass). Alternatively, or in addition, the method may include calculating the dose delivered to the patient during a shuttle pass (couch and / or jaw shuttle pass), comparing the delivered dose to the treatment plan dose and calculating the dose difference, and updating the RFM of the treatment plan to deliver the dose difference in subsequent shuttle passes. The dose calculation may be an average dose across one or more target regions. These methods may also help compensate for or correct dose modulation artifacts due to radiation therapy system limitations / constraints. System limitations / constraints may include noise resulting from dynamic binary MLC configurations or radiation beam shapes that do not closely match filtered subimages (e.g., fluence maps calculated based on RFM-multiplied LOR data), noise in imaging systems (e.g., PET, CT, MRI imaging systems), etc.Updating the RFM and / or delivery parameters (e.g., delivered fluence maps, segmented machine instructions, etc.) during a treatment session based on real-time delivery values / metrics (e.g., imaging data such as fluence, dose, PET LOR, etc.) can facilitate continuous artifact correction during the session. Regular updates of the RFM and / or delivery parameters can help adjust each successive radiation delivery segment (or shuttle pass) so that the cumulative delivered fluence or dose converges toward the planned / prescribed fluence or dose delivery distribution.

[0062] FIG. 6 depicts a flowchart representation of a method for updating the RFM during a treatment session. The method (600) may include calculating (602) the fluence delivered to the target region after a first shuttle pass. The shuttle pass may be a jaw shuttle and / or a couch shuttle. The delivered fluence may be calculated based on therapeutic radiation source dose chamber measurements and / or radiation beam pulse parameters (e.g., frequency, duration, duty cycle, number of pulses, etc.), and / or MLC leaf configuration, and / or jaw configuration. Optionally, the delivered fluence may be calculated using MV detector data. The method (600) may include comparing a delivered fluence to the target region (e.g., an average delivered fluence across the target region) with a treatment planning fluence to the target region (e.g., an average planned fluence across the target region) and calculating (604) a fluence difference Δf (e.g., an average fluence difference across the target region), and calculating (606) a new or updated radiation firing matrix (RFM) based on the fluence difference Δf. After updating the RFM, the radiation therapy system may use the updated RFM to deliver (608) the fluence difference Δf to the target region during a subsequent shuttle pass. For example, in biologically guided radiation therapy, the fluence difference Δf may be delivered by multiplying imaging data (e.g., partial images) obtained during a treatment session by the updated RFM. In emission-guided radiation therapy (a type of biologically guided radiation therapy), the updated RFM may be multiplied by one or more detected LORs to generate a delivered fluence map. The delivered fluence map may then be segmented into machine instructions (e.g., MLC, linac, gantry, patient platform / couch, and / or jaw instructions) that deliver radiation to the patient according to the fluence map. Method (600) may also be used to update the RFM across multiple target regions. For example, the fluence (e.g., average fluence) delivered to multiple target regions may be calculated, and the difference per target region (Δf for the i-th target region) may be calculated. TRiThe RFM may be compared to the planned fluence (e.g., average planned fluence) for each of multiple target regions to calculate a fluence difference (RFM), and the fluence differences across all target regions may be averaged together (or otherwise normalized) to update the RFM. In some variations, the RFM may be updated or optimized so that the fluence or dose delivery metric is met for the maximum number of target regions. Method (600) may also be performed using dose calculations instead of fluence calculations. In emission-induced radiotherapy, method (600) may be performed using PET or LOR data (e.g., average PET intensity across the target region).

[0063] Pipeline Normalization In typical radiation delivery, corrections or adjustments to the treatment plan and / or radiation delivery parameters are applied once before treatment begins. That is, corrections or adjustments based on acquired pre-treatment session scan images are calculated once and applied to the treatment plan and / or radiation delivery parameters once before turning on the beam. However, because this update occurs only once at the beginning of the treatment session, any dose modulation artifacts may not be corrected. In the couch and / or jaw shuttle modes described herein, corrections or adjustments to the treatment plan and / or radiation delivery parameters may be calculated and applied between shuttle passes. At each pass, data acquired from the previous pass (e.g., PET imaging data or LOR, MV detector data, etc.) may be used to estimate the fluence or amount of dose delivered to the target region. That is, the previous imaging data may be used to predict the future dose in the next pass. The next shuttle pass can be corrected by the radiation fluence or dose delivered in the treatment session to that point, for example, by adjusting the RFM and / or by scaling or shifting the emitted fluence for the current shuttle pass using a normalization factor that can be dynamically updated based on the fluence and / or dose delivered in the previous shuttle pass. This dynamic or pipeline normalization can help correct for errors or changes in image noise detected during delivery, including changes in attenuation artifacts from moving structures that may be outside the target region. In some variations where multiple tumor regions are to be irradiated, normalization factors may be calculated for each region, and each region-specific normalization factor may incorporate factors and variations specific to that particular tumor region. Each normalization factor for each region may be calculated using any of the methods described herein. Alternatively, there may be a single global normalization factor for all tumor regions.

[0064] An illustrative method for dynamically updating an RFM during an emission-guided radiation therapy session is depicted in FIG. 7. While these methods (and others included herein) are described in the context of delivering radiation based on PET image (e.g., LOR) data, it should be understood that these methods may be used for any biologically guided radiation therapy imaging modality, including, but not limited to, radiation delivery based on CT partial image data, MRI partial image data, etc. The method (700) may optionally include loading a patient onto a radiation therapy system patient platform or couch (702) and acquiring an image of the patient (704) including one or more target regions within the patient. In emission-guided radiation therapy, a PET tracer (e.g., one that accumulates in the tumor region) may be introduced into the patient, and the pre-scan may be a PET image.

[0065] The method (700) may include calculating (706) a normalization factor (NF) based on the pre-scan image and the image used to generate the treatment plan. The NF may be calculated by calculating the average PET imaging signal of the pre-scan within the target region (i.e., treatment field or radiation firing area) and calculating the average PET signal of the treatment plan image within the same target region (i.e., treatment field or radiation firing area). The NF may be the ratio of the average planning PET imaging signal to the average pre-scan PET imaging signal.

[0066] Optionally, in some variations, the PET prescan image may be used to predict the dose or fluence that will be delivered in the shuttle pass immediately following the prescan. For example, the prescan image can be used to predict or estimate the real-time fluence or dose that will be delivered that will meet certain delivery metrics. The prescan image can be normalized by NF. Here, the prescan image can be used to estimate the dose of radiation delivery and can be significantly less sensitive to image noise in the PET image. A normalization factor can also be used to normalize the average treatment plan fluence or average treatment plan radiation dose to the target region.

[0067] The method (700) may include adjusting (708) the treatment plan RFM based on the calculated NF. Adjusting the RFM by the NF may include modifying the RFM using any linear operation or transformation based on the NF. Examples of linear operations may include multiplying, convolving, and / or scaling the RFM by the NF. In some variations, this may also include adding or subtracting a constant based on the NF to the RFM. The method (700) may then include moving (710) the patient platform from a first predetermined platform location to a second predetermined platform location (i.e., a first couch shuttle pass) and back to the first predetermined platform location (i.e., a second couch shuttle pass) such that all of the target regions within the patient intersect the treatment plane at least once (e.g., one or more times, two or more times, etc.). While moving the patient platform, the target regions may be irradiated based on the adjusted RFM and the PET LOR data acquired by the PET detector. When the patient platform returns to the first predetermined platform location, the NF may be updated (712) based on the fluence and / or dose delivered during the shuttle pass. In some variations, the NF may be updated based on PET LOR data acquired during the shuttle pass. For example, the updated NF may be calculated by determining the ratio of the planned fluence (e.g., average planned fluence) to the target region (e.g., treatment field, radiation launch area) to the actual delivered fluence (e.g., average delivered fluence) to that target region. Alternatively, or in addition, the updated NF may be calculated by determining the ratio of the planned dose (e.g., average planned dose) to the target region (e.g., treatment field, radiation launch area) to the actual delivered dose (e.g., average delivered dose) to that target region, where the delivered dose is calculated based on the delivered fluence and pre-scan images or treatment planning images.Updating the NF based on fluence calculations can aid in radiation delivery to meet fluence-based metrics such as overall monitor unit conservation, while updating the NF based on dose calculations can aid in radiation delivery to meet dose-based metrics (e.g., D95 coverage, maximum OAR dose). In emission-guided radiation therapy, the NF may be updated based on the PET intensity across the target region (e.g., the ratio of the average PET intensity of the target region based on the PET planning or pre-scan images to the average PET intensity of the target region based on LOR data obtained during the treatment session). The RFM may be updated using any linear operation or transformation based on the NF, as described above. Optionally, method (700) may include a step (714) of repeating steps (710) and (712) any number of times during the treatment session, in some variations an even number of times during the treatment session, and may be stopped when the delivered fluence or dose converges to the planned fluence or dose.

[0068] While method (700) provides an example of dynamic normalization using patient platform or couch shuttle, it should be understood that method (700) may also be used in jaw shuttle mode, where NF and RFM are updated after each jaw shuttle pass. In jaw shuttle mode, the jaws complete multiple shuttle passes over a single platform shuttle pass, so the patient platform may only complete one pass during a treatment session. Alternatively, or in addition, method (700) may be used in a combined couch and jaw shuttle mode.

[0069] In some variations, the method for radiation delivery may include adjusting the radiation fluence or dose to be emitted or delivered using one or more adjustment factors, such as one or more of a normalization factor, an attenuation factor, a weighting factor, and the like. The radiation fluence or dose to be emitted or delivered during a particular shuttle pass (e.g., couch / platform shuttle and / or jaw shuttle) may be scaled and / or shifted by the adjustment factor. In some variations, the adjustment factor may be adjusted and / or updated for each shuttle pass so that the adjustment factor may reflect the patient's current condition and the radiation to be delivered during the treatment session (e.g., using imaging data, and / or images, and / or other physiological data). For example, the adjustment factor may be updated or adjusted based on the radiation fluence emitted or delivered dose during a previous shuttle pass and the amount of fluence or dose as defined by the treatment plan. In one variation, the fluence (or dose) to be delivered in a shuttle pass may be scaled by a normalization factor (and / or optionally, an attenuation factor) that may be calculated at least in part based on the radiation delivered in the previous shuttle pass and the imaging data obtained during the previous shuttle pass (and / or any other imaging data obtained during the treatment session). Scaling the radiation fluence or dose by a normalization factor that is adjusted for each shuttle pass may facilitate convergence of the delivered cumulative radiation toward the planned radiation fluence or dose (i.e., the radiation fluence or dose prescribed by the treatment plan).In the case of emission-induced radiation therapy, where the radiation fluence or dose applied to a patient is calculated based on imaging data (e.g., PET imaging data) obtained during a treatment session, scaling or otherwise adjusting the radiation fluence or dose using a normalization factor that accounts for the cumulative fluence or dose already delivered during the session and the difference between the delivered radiation dose and the planned radiation dose (e.g., as defined by the treatment plan and / or clinician) can help compensate for any radiation delivery error, fluctuation, and / or unexpected or unintended variation due to tumor motion, patient motion, and / or variable tracer uptake, and the like. While the methods included herein are described in the context of emission-induced or biologically-induced radiation therapy using PET tracers and positron emission data, it should be understood that these methods can also be used in any radiation therapy modality that applies radiation using data obtained in real time during a treatment session. Additionally, while the methods described herein for calculating one or more normalization factors may use radiation fluence, the methods may alternatively or additionally use radiation dose to calculate the normalization factors. Radiation dose values ​​or profiles may be derived from fluence values ​​or profiles using a dose calculation matrix A, which may be a linear operator that maps fluence to dose in image space. Specific references to radiation fluence or dose in any of the methods described herein may refer more generally to the amount of radiation emitted or delivered to a target region.

[0070] Optionally, for any of the methods described herein, the treatment time and / or the number of couch shuttle passes N may be selected prior to radiation delivery (although these methods may also be adapted for use with jaw shuttling). The treatment time and / or the number of shuttle passes N may be determined or selected, for example, during treatment planning, before the patient is set up for a treatment session, or after the patient is set up for treatment but before the treatment beam is activated. Optionally, the attenuation coefficient α (from which a normalized attenuation coefficient β may be derived) may be selected according to a desired radiation delivery rate across multiple shuttle passes. Given the number of shuttle passes N and the attenuation coefficient α, the normalized attenuation coefficient β may be derived as follows: [ka]

[0071] For example, in some variations, the attenuation coefficient α may be selected so that a greater proportion of the prescribed or planned radiation fluence or dose is delivered in earlier shuttle passes than in later shuttle passes (i.e., the radiation fluence emitted in the first pass exceeds the radiation fluence emitted in the last pass). In such a manner, earlier shuttle passes serve to deliver the majority of the planned radiation dose, while later shuttle passes serve to deliver fluence corrections or adjustments to compensate for any errors, artifacts, and / or motion (e.g., interaction artifacts, patient or tumor motion) that may have occurred during the treatment session. In any of the methods included herein, the attenuation coefficient α may be between 0 and about 1, e.g., about 0.5, 0.6, 0.7, 0.75, 0.77, 0.8, 0.83, 0.85, 0.90, 0.91, 0.97, 1, etc. In addition to specifying the number of shuttle passes N, a treatment session duration may also be specified. In some variations, the treatment session duration may be held constant, and the time spent per shuttle pass may be adjusted according to the number of shuttle passes. That is, as the number of shuttle passes increases, the time per shuttle pass may decrease, and the dwell time of the target region in the therapeutic radiation beam plane for a particular shuttle pass may be reduced. The cumulative dwell time across the entire treatment session (e.g., across all N shuttle passes) may remain approximately constant regardless of the number of shuttle passes, as the dwell time is reduced accordingly. In the examples described herein, the number of shuttle passes, N, may be 4, and the attenuation coefficient α may be 0.83 (i.e., 1 / 1.2), although N and α (followed by β) may vary as desired. For example, in a treatment session where N=4 and α=(1 / 1.2) or 0.8333, the normalized attenuation coefficients for each of the four passes may be β1=0.33, β2=0.28, β3=0.23, and β4=0.19.Although a normalization factor and one or more attenuation coefficients (α, β) may be used to adjust the radiation fluence emitted to the target region during a shuttle pass, the radiation fluence may also be adjusted using only a normalization factor, multiple normalization coefficients, a single attenuation coefficient, and / or any other additional coefficients that adjust the emitted radiation to reflect patient and / or system conditions during a treatment session.

[0072] 8A depicts one variation of a method by which radiation applied during a treatment session is adjusted with each shuttle pass. As previously described, a shuttle pass may involve moving a patient platform or couch from a first location to a second location so that one or more tumor regions within the patient pass through the therapeutic radiation beam plane once. The couch may be moved continuously as radiation is delivered (e.g., helical radiation delivery), or may be moved in steps so that radiation is delivered only when the couch is stopped at a predetermined couch location or step (e.g., beam station delivery, i.e., the therapeutic radiation beam is turned off while the couch is moving and turned on when the couch is stopped). While the method described below is in the context of couch shuttling, it should be understood that similar methods may be adapted for use in jaw shuttling. The method (800) may include moving the patient (802) from a first location to a second location (i.e., by moving the patient platform) so that the patient passes through the radiation treatment plane while acquiring imaging data, and applying a first radiation dose (804) as the patient passes through the radiation beam plane. This may be referred to as a first shuttle pass, and the first radiation dose is based, at least in part, on the treatment plan, the imaging data acquired during the first pass (e.g., a pre-scan image X of the patient acquired at the beginning of the treatment session), along with one or more adjustment factors (e.g., a first normalization factor and / or a first attenuation factor). prescanThe radiation dose may be determined based on a complete image, such as a full image, such as a ray from the second location, or a partial image, such as one or more LOR or positron annihilation emission pathways. The method (800) may then include moving the patient from the second location to the first location (i.e., by moving the patient platform) (806) while acquiring imaging data, such that the patient passes through the radiation treatment plane, and applying a second radiation dose (808) as the patient passes through the radiation beam plane, the second radiation dose being different from the first radiation dose. This may be referred to as a second shuttle pass, and the second radiation dose may be determined based, at least in part, on the treatment plan, imaging data acquired during the second pass (e.g., a pre-scan image X of the patient acquired at the start of the treatment session), along with one or more adjustment factors (e.g., a second normalization factor and / or a second attenuation factor) and the radiation dose delivered in the previous (first) pass. prescan The first normalization factor and / or the second attenuation coefficient may be determined based on a complete image, such as a full image, and / or one or more partial images, such as one or more LOR or positron annihilation emission pathways. The second normalization factor and / or the second attenuation coefficient may be different from the first normalization factor and / or the first attenuation coefficient. Steps (802-804) and / or (806-808) may be repeated as many times as desired or prescribed (e.g., up to N shuttle passes). The number N of shuttle passes may be odd or even, and therapeutic radiation may be applied as the patient is shuttled between the first and second locations. In some variations, the distance between the first and second locations may span a substantial length of the patient's body, for example, at least as long as the distance between the target regions furthest from each other (i.e., along the longitudinal IEC-Y axis) or at least as long as the largest dimension of a single target region (i.e., the length of the target region along the longitudinal IEC-Y axis).

[0073] In some variations, the radiation delivered to the target region may be determined, at least in part, by imaging data (and / or any patient or system data) obtained during the treatment session. The fluence emitted by the radiation therapy system cumulatively determines whether the delivered dose is greater than the prescribed dose (i.e., the dose or D prescribed by the treatment plan). plan ), the adjustment coefficients for a particular shuttle pass may be derived based on the acquired imaging data (and / or patient or system data), the amount of radiation already delivered, treatment plan parameters, and / or any other filters or scaling or weighting factors, and the adjustment coefficients may be calculated and / or updated for each shuttle pass.

[0074] 8B depicts one variation of a method in which the radiation applied during a shuttle pass is modified or adjusted according to a normalization factor that is calculated before the shuttle pass begins, and the normalization factor is updated for each shuttle pass (i.e., pipeline normalization). i and applying the i-th pass of radiation while acquiring imaging data (824), wherein the emitted radiation fluence is a function of the acquired imaging data and the calculated normalization factor k i The step and normalization factor k are calculated based on i+1 and applying the i-th pass of radiation while acquiring imaging data (828), wherein the emitted radiation fluence is a function of the acquired imaging data and the calculated normalization factor k i+1 and repeating (826-828) the calculation of the normalization factor and application of radiation for i=1, ..., N radiation delivery passes. i+1 is the cumulative planned radiation fluence or dose D planand the radiation fluence delivered so far (i.e., in all previous shuttle passes), and normalizing (e.g., dividing) the difference between the planned and delivered fluence by the predicted cumulative fluence (which may not be segmented into discrete fluence values ​​or levels) that would be applied to the target region if each future shuttle pass delivered the same amount of radiation as delivered in the previous shuttle pass. The cumulatively emitted radiation during previous shuttle passes may be calculated based on radiation therapy system commands and configurations (e.g., pulse parameters from the therapeutic radiation source, MLC configuration, gantry rotation, etc.) and / or sensor data (e.g., MV detector data, dose chamber data, position sensor data from the MLC, couch, gantry, etc.), and / or imaging data (e.g., PET data, CT data, MRI data, etc.). In emission-guided radiation therapy (e.g., biologically guided radiation therapy) where the imaging data includes positron annihilation emission data (i.e., LOR data), the radiation emitted by the radiation therapy system may be calculated based on the acquired PET emission data (x i ) is multiplied by the RFM from the treatment planning system, masked with a spatial filter (BFZ) that limits radiation delivery to the target region (i.e., biological firing zone), and optionally, one or more normalization factors (k i ) and / or damping coefficient (β i ) may be calculated by scaling the obtained PET release data (x i ) may include one or more LORs, but may not include a sufficient number of LORs for the generation of a complete or full PET image. For other radiation therapy systems, the imaging data may include 2-D projection x-ray images (for CT imaging systems) or MRI subsampling in k-space (for MRI imaging systems). The normalization factor for the first shuttle pass (k1) is the normalization factor for the first shuttle pass, which is the normalization factor for the first shuttle pass (X) obtained at the beginning of the treatment session. prescan ) may be calculated based on

[0075] In one variant, the normalization factor for shuttle pass index i (i=1, 2, . . . , N shuttle passes) may be calculated as follows: [ka] However, D plan is the radiation dose or fluence as defined in the treatment plan, and β i is the damping coefficient, and D i,raw is the radiation fluence delivered (or to be delivered) for shuttle passage i according to the treatment plan without any adjustments based on real-time treatment session data. i,raw may be a calculated radiation fluence (e.g., with continuous fluence values) or a segmented radiation fluence (e.g., with discrete fluence values ​​or levels), where the segmented radiation fluence may include fluence values ​​that represent fluence values ​​deliverable by the radiation therapy system. In some variations, with respect to radiation delivery based on imaging data obtained during a treatment session, [ka] where A is the dose calculation matrix generated based on radiation therapy system parameters that maps fluence to dose in image space, and X prescanis an image acquired at the beginning of a treatment session before any therapeutic radiation is delivered (e.g., a complete image such as a full PET image, a full CT image, and / or a full MRI image), RFM is a radiation firing matrix generated by a treatment planning system that specifies the transformation from image data (e.g., a partial image such as a set of LORs or 2-D X-ray projections or MRI subsampling in k-space, or incomplete image data) to radiation beamlet patterns and / or beamlet intensities, and BFZ is a spatial filter, including a bitmap that defines the target region while masking out non-target regions. "Treatment time" is the total treatment delivery time defined by the treatment planning system, which may be selected or determined by the clinician or user, and "pre-scan time" is the time it takes to deliver the pre-scan image X. prescan is the total time spent to obtain

[0076] term [ka] may represent the predicted cumulative fluence that would be applied to the target region if each future shuttle pass delivered the same amount of radiation as that delivered in the previous shuttle pass, and D i,predicted cumulative (which may not be segmented into fluence levels or values ​​deliverable by the radiation therapy system). i,predicted cumulative may be expressed as follows: [ka]

[0077] For shuttle passes (2<=i<=N) following the first shuttle pass, the normalization factor k i may also be written as follows: [ka]

[0078] However, xi represents the imaging data acquired during shuttle pass i. In method 820, steps 822 and 826 use the normalization factor k as described above. i and k i+1 may be calculated.

[0079] The radiation fluence delivered in the ith shuttle passage (D i,calc ) may be calculated as follows: [ka]

[0080] When applied to method 820, the radiation fluence emitted in 824 is [ka] and the radiation fluence emitted at (828) may be: [ka] where x i ,x i+1 are the time periods between shuttle passes i and i+1, respectively. This represents the imaging data obtained.

[0081] FIG. 8C depicts a variation of a pipeline normalization method in which radiation applied during a shuttle pass is modified or adjusted according to a normalization factor calculated based on the most recently acquired imaging data (e.g., partial and / or full image). Method (840) may be used in conjunction with any image-guided or emission-guided (e.g., biologically guided) radiation therapy in which imaging data and / or patient data and / or system data are acquired during a radiation therapy session and used to adapt, modify, or otherwise adjust radiation delivery. While the flowchart in FIG. 8C depicts the method as applied to the first and second shuttle passes of radiation delivery, it should be understood that the method may also be extended for additional shuttle passes as may be desired. Method (840) optionally includes steps of loading (842) the patient onto the radiation therapy system platform and acquiring patient images (e.g., pre-scan PET and / or CT images X). prescan ), and optionally selecting the number of passes (N) and the attenuation factor (α) to obtain the passes (β1, β 2、 …, β N ) normalized damping coefficient (β i ) and a step (846) of calculating the pre-scanned image X prescan and applying a first pass of radiation while acquiring imaging data x1 (850), where the emitted radiation fluence D 1,calc is calculated based on the acquired imaging data and a normalization factor k1. The calculation of the number of passes and the attenuation coefficient for each shuttle pass may be calculated at any time prior to the treatment session, for example, during treatment planning, before patient setup, and / or before the therapeutic radiation source is activated (i.e., beam turned on), as described above, and this step may be included in any of the other methods described herein. In this example, the normalization factor k1 may be calculated or determined as follows: [ka]

[0082] where the dose calculation matrix A, the radiation firing matrix RFM, and the biological firing zone bit mask BFZ are as described above. Based on the acquired imaging data, the radiation applied to the target region (e.g., the biological firing zone or the radiation firing zone) in the first pass may be calculated as follows: [ka]

[0083] The image data x1 acquired during the first shuttle pass may be sub-images, including, for example, one or more LORs (for image data acquired using a PET detector), one or more 2-D projection X-ray images (for image data acquired using a CT detector), and / or sub-sampling in k-space (for image data acquired using an MRI detector). Treatment planning parameters (e.g., RFM, BFZ) determine the radiation fluence D to the target region. 1,raw where the normalization and attenuation factors are specified as D 1,raw may be adjusted (i.e., scaled or normalized) to reflect real-time treatment conditions during the session and / or to compensate for variations and / or artifacts in the imaging data x1 acquired during the first shuttle pass. 1,raw may be a calculated radiation fluence (e.g., with continuous fluence values) or a segmented radiation fluence (e.g., with discrete fluence values ​​or levels), where the segmented radiation fluence may include fluence values ​​that represent fluence values ​​deliverable by the radiation therapy system.

[0084] The method (840) further calculates a predicted cumulative fluence (D) based on the imaging data obtained during the first pass by summing over N passes. 1,predicted cumulative ) (852); and calculating a normalization factor k2 for the second pass of radiation delivery (854), where k2 is Dplan and the total fluence emitted in the first pass and taking the ratio of the difference to the expected cumulative fluence; and applying (856) a second pass of radiation while acquiring imaging data, wherein the emitted radiation fluence D 2,calc is calculated based on the acquired imaging data and a normalization factor k2. A predicted cumulative fluence may be calculated (852) based on the imaging data acquired during the first shuttle pass. [ka]

[0085] A normalization factor k2 for the second shuttle pass may be calculated (854) by determining the difference between the planned radiation fluence or dose and the fluence delivered in the first shuttle pass, normalized over the predicted cumulative fluence. [ka]

[0086] Therefore, based on the imaging data obtained during the second shuttle pass, the radiation applied to the target area (e.g., biological launch area or radiation launch area) in the second shuttle pass may be calculated as follows: [ka]

[0087] However, the image data x2 acquired during the second shuttle pass may be a sub-image, including, for example, one or more LORs (for image data acquired using a PET detector), one or more 2-D projection x-ray images (for image data acquired using a CT detector), and / or a sub-sampling in k-space (for image data acquired using an MRI detector), as described throughout above. 2,rawmay be a calculated radiation fluence (e.g., with continuous fluence values) or a segmented radiation fluence (e.g., with discrete fluence values ​​or levels), where the segmented radiation fluence may include fluence values ​​that represent fluence values ​​deliverable by the radiation therapy system.

[0088] In some variations, the normalization factor for the first shuttle pass may be calculated using dose values ​​derived from prescan images, while the normalization factors for subsequent shuttle passes may be calculated using fluence values ​​(optionally segmented fluence values ​​including any fluence segmentation error). Dose calculations may be more computationally intensive than fluence calculations (because fluence may be calculated by multiplying image data by a radiation emission matrix, while dose calculations may involve additional multiplications by a dose calculation matrix). Therefore, some radiation therapy systems may prefer to calculate normalization factors during a treatment session using radiation fluence instead of radiation dose, so that the latency between obtaining imaging data and applying radiation is reduced. Because the first normalization factor is calculated before turning on the therapy beam, the radiation therapy system may be computationally available to calculate the first normalization factor based on dose values ​​derived from prescan images. Some variations of radiation therapy systems may include one or more processors with additional computing capabilities, in which case the normalization factors may be calculated using dose values ​​derived from imaging data acquired during a treatment session. Alternatively, or in addition, all normalization factors may be calculated based on fluence values ​​derived from image data acquired during a treatment session.

[0089] 9A-9D are simulated dose-volume plots or histograms (DVH) depicting the method of radiation delivery to the planning target region (PTV) and biological firing zone (BFZ) regions over four couch shuttle passes using one or more of the pipeline normalization methods described herein. The BFZ region includes the PTV and a margin around the PTV. FIG. 9A depicts the DVH curves after the first shuttle pass. The planned DVH for the PTV is represented by line (903), the maximum DVH boundary (i.e., the upper threshold acceptable for treatment) is represented by line (905), and the minimum DVH boundary (i.e., the lower threshold acceptable for treatment) is represented by line (907). The predicted delivered dose to the PTV is represented by the delivered DVH line (901). Similarly, the planned DVH for the BFZ region is represented by line (904), the maximum DVH boundary (i.e., the upper threshold acceptable for treatment) is represented by line (906), and the minimum DVH boundary (i.e., the lower threshold acceptable for treatment) is represented by line (908). The predicted delivered dose to the BFZ region is represented by delivered DVH line (902). After the first shuttle pass, the predicted DVH curve for the PTV (901) exceeds the planned DVH curve for the PTV (905) and falls outside the maximum DVH boundary (905). Similarly, the predicted DVH curve for the BFZ region (902) exceeds the planned DVH curve for the BFZ region (904) and falls outside the maximum DVH boundary (906). As the radiation delivered to the PTV and BFZ regions accumulates over multiple shuttle passes, FIG. 9B depicts the same DVH curve as FIG. 9A after the second shuttle pass, FIG. 9C depicts the DVH curve after the third shuttle pass, and FIG. 9D depicts the DVH curve after the fourth shuttle pass, with the delivered DVH curve (PTV It can be seen that the planned DVH curves (PTV DVH 909 and BFZ region DVH 910) converge towards the planning DVH curves (PTV DVH 903 and BFZ region DVH 904), respectively, and / or remain within the boundaries defined by the maximum and minimum DVH curves for the PTV and BFZ regions.

[0090] Pipeline normalization with negative fluence values In some variations, when calculating the radiation fluence for delivery, the calculated [ka] A negative value may result in a negative radiation fluence value. Negative radiation fluence values ​​may not be deliverable by the radiation therapy system in the same shuttle pass; however, if such negative fluence values ​​are zeroed out and / or ignored, the cumulative delivered radiation may deviate substantially from the planned fluence or dose value. One variation of a method for handling negative fluence values ​​resulting from one shuttle pass may include incorporating the negative fluence values ​​into the next shuttle pass, which may be combined with non-negative fluence values. The next fluence value may be positive and therefore deliverable in one or more subsequent shuttle passes. In some variations, the negative fluence value in one shuttle pass is incorporated into the calculation of the predicted cumulative fluence that will be delivered over the remaining shuttle passes, D plan and D i,calc (i.e., the total cumulative delivered radiation in the treatment session up to the next shuttle pass). FIG. 10 depicts one variation of a method in which the radiation applied during a shuttle pass is modified or adjusted according to a normalization factor calculated before the shuttle pass begins to incorporate negative fluence values ​​encountered during radiation delivery in previous passes. Method (1000) includes applying (1002) the ith pass of radiation while acquiring imaging data, wherein the emitted radiation fluence is adjusted according to the acquired imaging data and the calculated normalization factor k i and calculating (1004) a predicted cumulative fluence based on imaging data obtained during the first pass, including negative fluence values ​​(if present), by summing over N passes, and calculating a normalization factor k for the next pass based on the predicted cumulative fluence. i+1and applying the (i+1)th pass of radiation while acquiring imaging data (1008), wherein the emitted radiation fluence is a function of the acquired imaging data and the calculated normalization factor k i+1 Optionally, the method (1000) may further include repeating the calculation of the normalization factor and application of radiation (1004-1008) for i=1, ..., N. The predicted cumulative fluence may incorporate negative fluence values ​​as follows: [ka]

[0091] Negative fluence values ​​are D i,predicted cumulative By incorporating it into D i,predicted cumulative is used to normalize the difference between the planned and delivered radiation fluences, such negative fluences are related to the k i is taken into account in the generation of

[0092] 11A-11B are simulated DVH plots depicting the results of two methods of radiation delivery to the planned target region (PTV) and biological launch zone (BFZ) over four couch shuttle passes. FIG. 11A depicts the results of radiation delivery to the PTV and BFZ regions (as described above) when negative fluence values ​​are incorporated into the predicted cumulative fluence values ​​and included in the calculation of the normalization factor k. The planned DVH curve for the PTV is represented by line (1101), the maximum DVH curve is represented by line (1103), and the minimum DVH curve is represented by line (1105). The delivered DVH curve for the PTV is represented by line (1107), and as seen along the falling edges of the DVH curves, the delivered DVH curve for the PTV lies within the minimum and maximum DVH boundaries. Similarly, for the BFZ region, the planned DVH curve for the BFZ region is represented by line (1102), the maximum DVH curve is represented by line (1104), and the minimum DVH curve is represented by line (1106). The delivered DVH curve for the BFZ region is represented by line (1108), and as seen along the falling edges of the DVH curves, the delivered DVH curve for the BFZ lies within the minimum and maximum DVH boundaries. In contrast, FIG. 11B depicts the results of radiation delivery to the PTV and BFZ region (as described above) when negative fluence values ​​are ignored. The planned DVH curve for the PTV is represented by line (1101′), the maximum DVH curve is represented by line (1103′), and the minimum DVH curve is represented by line (1105′). The delivery DVH curve for the PTV is represented by line (1107'), and as can be seen in the plot, the delivery DVH curve for the PTV does not lie within the boundary defined by the minimum and maximum DVH curves. Similarly, for the BFZ region, the planning DVH curve for the BFZ region is represented by line (1102'), the maximum DVH curve is represented by line (1104'), and the minimum DVH curve is represented by line (1106'). The delivery DVH curve for the BFZ region is represented by line (1108'), and as can be seen in the plot, the delivery DVH curve for the BFZ does not lie within the boundary defined by the minimum and maximum DVH curves.The step of including negative fluence values ​​in the calculation of the normalization factor may be incorporated into any of the methods described herein.

[0093] The pipeline normalization method for radiation delivery described herein may use the average of the planned fluence (or dose) to constrain the average of the delivered fluence (or dose). This can help the radiation therapy system deliver radiation with an average fluence that converges to the average planned fluence, which can help address motion and / or imaging artifacts encountered during a treatment session. Figures 12A-12C, 13A-C, and 14A-C depict multiple views of the planned dose distribution from multiple planes, the delivered dose distribution over four shuttle passes, and the gamma metric, respectively. The gamma (gamma) metric may be calculated as the square root of the sum of the squares of the agreement distance (DTA) and the percentage dose difference (DD) between two dose distributions. One of the dose distributions may be defined as the reference dose distribution (typically ground truth), and the other may be defined as the evaluated dose distribution. The established value for DTA may be 3 mm, and the DD may be 3%. A gamma metric may first be calculated for all pairs of voxels in the two dose distributions, with a pass value defined as a value of gamma <= 1 and a fail defined as a value of gamma > 1. The gamma pass rate may be calculated as the percentage of voxels in the treatment volume that pass the gamma evaluation. The treatment volume may typically be defined as voxels in the reference dose distribution that receive more than 10% of the prescribed dose. Figures 12A, 13A, and 14A depict projections of dose distributions on the IEC-Z / IEC-X plane (i.e., the plane orthogonal to the direction of couch motion), Figures 12B, 13B, and 14B depict projections of dose distributions on the IEC-Z / IEC-Y plane, and Figures 12C, 13C, and 14C depict projections of dose distributions on the IEC-Y / IEC-X plane (i.e., the plane orthogonal to the treatment beam, i.e., the "eye view of the beam"). As can be seen in Figures 14A-C, the gamma metric pass rate (i.e., gamma values ​​less than or equal to 1) exceeds 99% when radiation delivery based on imaging data obtained during a treatment session is adjusted or corrected using a normalization factor generated using one or more of the methods described herein.The region where the gamma metric exceeds 1 (as indicated by arrow (1400)) constitutes less than 1% of the total distribution depicted in Figures 14A-14C. Figure 14D is a plot depicting cumulative fluence as a function of beam station for a treatment session involving four shuttle passes. Each predicted pass is calculated as the sum of the predicted fluence for the remaining passes and the delivered fluence. The delivered fluence is the final fluence delivered to the tumor site. Each beam station is a predetermined couch location or step along the IEC-Y axis where the couch can be deactivated while the therapeutic radiation beam is activated and applies radiation to the patient. The therapeutic radiation beam is off (i.e., not activated) while the couch moves between beam stations. The line with squares represents the planned fluence, and the line with crosses represents the delivered fluence after four shuttle passes. As depicted there, the average delivered cumulative fluence converges toward the average of the planned fluence with each additional shuttle pass. Although the examples described herein include applying radiation over four shuttle passes, it should be understood that the number of shuttle passes over a treatment session can vary and can be from 2 shuttle passes to 100 shuttle passes, e.g., 4 shuttle passes, 6 shuttle passes, 7 shuttle passes, 8 shuttle passes, 10 shuttle passes, 12 shuttle passes, etc.

[0094] Treatment interruption If a treatment session is not completed or interrupted (e.g., due to patient discomfort or illness, system component malfunction, etc.), a “make-up” portion may be implemented. The make-up portion may be an entirely new treatment session or portion (e.g., requiring a new patient setup) or may simply be a continuation of the incomplete portion from the point where the interruption occurred (e.g., without requiring a new patient setup). If the make-up portion requires a new patient setup, different setup errors may cause so-called field bonding errors, which may result in under- or over-dosing portions of the tumor target region and / or critical structures. Bonding errors may be mitigated using methods similar to those described above and depicted in FIG. 6. The fluence or dose delivered to the patient before the interruption occurs may be calculated. This calculated delivered fluence and / or dose may be compared to the planned fluence and / or dose. The fluence and / or dose difference Δf between the delivered and planned fluence and / or dose may be used to update the RFM. The fluence Δf may then be delivered to the patient using the updated RFM in a later treatment session or portion.

[0095] A variation of a method for continuing radiation therapy after an interruption, in which the patient remains on the platform or couch before and after the interruption (i.e., continuing the interrupted treatment session using the same patient setup parameters and pre-scan images), may include continuing the interrupted shuttle pass by moving the patient platform to the beam station where the interruption occurred and resuming radiation delivery using the same normalization factor used before the interruption, and calculating a normalization factor for the next shuttle pass based on imaging data obtained before and after the interruption. The normalization factor for the shuttle pass following the interruption is D planand the sum of the radiation delivered during the completed shuttle pass, the partial shuttle pass before the interruption, and the resumed partial shuttle pass after the interruption, and normalizing the difference over the predicted cumulative fluence that would be delivered if each future shuttle pass delivered the same amount of radiation as that delivered in the interrupted pass (i.e., the radiation delivered during the partial shuttle pass before the interruption and the resumed partial shuttle pass after the interruption). For example, a normalization factor k for a treatment session with N total shuttle passes and an interruption that occurred in the mth pass is i may be calculated as follows:

[0096] D i-1,calc is defined as the delivered dose for the i-1 pass as defined above. The numerator is D plan and D for all previous passages i-1,calc It is calculated as the difference of the sum of [ka]

[0097] however, [ka] and D plan , D i,calc etc. are calculated as explained above.

[0098] FIG. 15A depicts one variation of a method of radiation delivery when there is an interruption between shuttle passes and the patient remains on the platform and continues the interrupted treatment session (i.e., without any new pre-scan images). The method (1500) calculates the cumulative radiation dose (D) applied to the patient until treatment is interrupted at the mth pass of N total shuttle passes. delivered_before_interrupt ) and a step (1502) of calculating the cumulative radiation dose D delivered_before_interrupt , the normalization factor k for the mth pass mand storing in system memory (1504) the patient platform location at which treatment was interrupted; and resuming radiation delivery for the mth pass by moving the patient platform to the location where treatment was interrupted (e.g., a beam station) and emitting a radiation fluence (1506), wherein the emitted fluence is k m The radiation delivered in the resumed mth partial pass may be calculated as follows: [ka]

[0099] The method (1500) includes calculating (1508) a predicted cumulative fluence based on the imaging data obtained during the mth pass by summing over N passes, and calculating a normalization factor k for the next pass based on the predicted cumulative fluence. m+1 and applying the (m+1)th pass of radiation while acquiring imaging data (1512), wherein the emitted radiation fluence is a function of the acquired imaging data and the calculated normalization factor k m+1 The step and normalization factor k are calculated based on m+2 and applying (1514) the (m+2)th pass of radiation based on imaging data obtained during the (m+2)th pass until N passes are completed. The predicted cumulative fluence may be calculated (1508) as follows: [ka]

[0100] normalization factor k m+1 may be calculated 1510 as follows: [ka]

[0101] For example, if radiation delivery is interrupted in the second shuttle pass (without the need for new settings or new pre-scan images), the second shuttle pass may be resumed using a normalization factor k2 (i.e., the same as before the interruption), and the normalization factor for the subsequent shuttle pass may be calculated as follows: [ka]

[0102] FIG. 16 is a plot depicting cumulative fluence as a function of beam station for a treatment session with four shuttle passes, in which treatment was interrupted at the second shuttle pass, with various interruption characteristics to evaluate and characterize the accuracy of the above-described method for handling treatment interruptions compared to a treatment session without any interruptions (line with crosses). The attenuation coefficient value used for this simulation is (α=1 / 1.2). The line with squares represents the planned fluence, and the line with crosses represents the fluence delivered after four shuttle passes without any interruptions. The line with diamonds represents the fluence delivered after four shuttle passes with a single interruption midway through the second shuttle pass. The line with stars represents the fluence delivered after four shuttle passes with a single interruption at the end of the second shuttle pass as the couch changes direction between the second and third passes. The line with circles represents the fluence delivered after four shuttle passes with three interruptions. As depicted in the plot, updating the normalization factor with the fluence delivered before and after the interruption helps the average cumulative delivered radiation fluence converge toward the average planned radiation fluence regardless of the interruption in the treatment session. The fluence curve for the treatment session with the interruption (i.e., the line with the diamond, star, and circle symbols) closely follows the curve for the treatment session without the interruption (i.e., the line with the cross symbols).

[0103] In some variations, radiation delivery may not be possible (or desirable) to resume in the same session, and the patient may be removed from the system and scheduled to resume treatment at another time. For example, a patient may be ill and unable to proceed with radiation delivery on a particular day, and / or radiation therapy system components may not function within specified tolerances and cannot be calibrated with the patient in the bunker. When the patient returns to resume radiation delivery, new settings and new prescan images may be obtained. In some variations, the patient platform may be moved to the location and / or beam station where the interruption occurred in the previous treatment. The radiation delivery method may take into account the new settings and / or prescan images and the radiation fluence delivered in the previous interrupted session when calculating a normalization factor for resuming radiation delivery. FIG. 15B depicts a variation of a radiation delivery method in which the delivered radiation may be adjusted, at least in part, by a normalization factor derived based on the radiation fluence delivered in the previous treatment session; a prescan image obtained for the current session is depicted in FIG. 15B. The method (1520) calculates the cumulative radiation dose (D) applied to the patient until treatment is discontinued at the mth pass of N total passes. delivered_before_interrupt ) and a step (1522) of calculating the cumulative radiation dose D delivered_before_interrupt , the normalization factor k for the mth pass m , and storing in system memory (1524) the patient platform location (e.g., location along the IEC-Y axis and / or beam station index) when treatment was interrupted, and storing new pre-scan images (e.g., PET and / or CT images X) of the patient after the patient returns to the radiation therapy system. p_prescan ) and X p_prescan Based on the normalization factor k p_mand resuming radiation delivery at the mth pass by moving the patient platform to the location where treatment was interrupted and emitting a radiation fluence (1528), wherein the emitted fluence is k p_m and a step, where the normalization factor k is p_m may be calculated (1526) as follows: [ka]

[0104] However, D plan , β j is as explained above, and D prescan New pre-scanned image X p_prescan The radiation fluence to be delivered to resume the interrupted mth shuttle pass (1528) may be determined (1528) as follows: [ka]

[0105] However, x m,post-interrupt is the imaging data acquired in the mth shuttle pass after the interruption. The method (1520) also includes calculating (1530) a predicted cumulative fluence based on the imaging data acquired during the mth pass by summing over N passes, and calculating a normalization factor k for the next pass based on the predicted cumulative fluence. m+1 and applying the (m+1)th pass of radiation while acquiring imaging data (1534), wherein the emitted radiation fluence is a function of the acquired imaging data and the calculated normalization factor k m+1 and optionally a normalization factor k m+2and applying (1536) the (m+2)th pass of radiation based on imaging data obtained during the (m+2)th pass until N passes are completed. The predicted cumulative fluence may be calculated (1530) as follows: [ka]

[0106] However, x m,pre-interrupt contains the imaging data acquired during the mth shuttle pass before the interruption, and x m,post-interrupt contains the imaging data acquired in the mth shuttle pass after the interruption (i.e., resuming the interrupted shuttle pass). m+1 may be calculated (1532) as follows: [ka]

[0107] However, D delivered_before_interrupt is the cumulative radiation fluence delivered before the aborted shuttle pass, and D partial mth pass is the radiation fluence delivered during the interrupted pass that is resumed (e.g., the portion of the mth pass that was not delivered due to the interruption).

[0108] controller A system (e.g., a treatment planning system, a radiation therapy system) that may be configured to deliver therapeutic radiation to a patient may include a controller in communication with the imaging system and / or the therapeutic radiation source and / or the multi-leaf collimator and / or the gantry of the radiation therapy system. The controller may include one or more processors that may be configured to execute or implement any of the methods described herein (e.g., the methods described and depicted in Figures 4, 5, 6, 7, 8A-8C, 10, 15A-15B) and one or more machine-readable memories in communication with the one or more processors. The controller of the radiation therapy system may be connected to other systems by wired or wireless communication channels. In some variations, the controller of the treatment planning system may be located in the same or a different room as the patient. For example, the controller may be coupled to the patient platform or located on a trolley or medical cart adjacent to the patient and / or operator.

[0109] The controller may be implemented consistently with numerous general-purpose or special-purpose computing systems or configurations. Various exemplary computing systems, environments, and / or configurations that may be suitable for use with the systems and devices disclosed herein may include, but are not limited to, software or other components embodied in or on personal computing devices, network appliances, servers or server computing devices such as routing / connectivity components, portable (e.g., handheld) or laptop devices, multiprocessor systems, microprocessor-based systems, and distributed computing networks.

[0110] Examples of portable computing devices include smartphones, mobile phones, tablet PCs, phablets (personal computing devices that are larger than smartphones but smaller than tablets), and the like.

[0111] Processor In some embodiments, the processor may be any suitable processing device configured to run and / or execute a set of instructions or code and may include one or more data processors, image processors, graphics processing units, physical processing units, digital signal processors, and / or central processing units. The processor may be, for example, a general-purpose processor, a field-programmable gate array (FPGA), an application-specific integrated circuit (ASIC), or the like. The processor may be configured to run and / or execute application processes and / or other modules, processes, and / or functions associated with the system and / or its associated network. The underlying device technology may be provided in various component types, for example, metal-oxide-semiconductor field-effect transistor (MOSFET) technology such as complementary metal-oxide-semiconductor (CMOS), bipolar technology such as emitter-coupled logic (ECL), polymer technology (e.g., silicon-conjugated polymer and metal-conjugated polymer-metal structures), mixed analog and digital, or the like.

[0112] memory In some embodiments, the memory may include a database, such as random access memory (RAM), a memory buffer, a hard drive, erasable programmable read-only memory (EPROM), electrically erasable read-only memory (EEPROM), read-only memory (ROM), flash memory, etc. The memory may store instructions for causing the processor to execute modules, processes, and / or functions associated with the system, such as one or more treatment plans, full or high SNR images, partial or low SNR images, calculation of a fluence map based on the treatment plan and / or clinical goals, segmentation of the fluence map into radiation therapy system instructions (which may direct the operation of, for example, the gantry, therapeutic radiation source, multi-leaf collimator, and / or any other components of the radiation therapy system and / or diagnostic or treatment planning system), normalization coefficients, attenuation coefficients, calculated and / or measured amounts of delivered or emitted radiation fluence or dose, patient platform or couch position, and image and / or data processing associated with treatment planning and / or delivery.

[0113] Some embodiments described herein relate to computer storage products with non-transitory computer-readable media (which may also be referred to as non-transitory processor-readable media) having instructions or computer code thereon for performing various computer-implemented operations. The computer-readable media (or processor-readable media) is non-transitory in the sense that it does not itself contain transient propagating signals (e.g., propagating electromagnetic waves that carry information over a transmission medium such as space or a cable). The media and computer code (which may also be referred to as code or algorithms) may be designed and constructed for a specific purpose or purposes. Examples of non-transitory computer-readable media include, but are not limited to, magnetic storage media such as hard disks, floppy disks, and magnetic tape, optical storage media such as compact disks / digital video disks (CD / DVDs), compact disk read-only memories (CD-ROMs) and holographic devices, magneto-optical storage media such as optical disks, solid-state storage devices such as solid-state drives (SSDs) and solid-state hybrid drives (SSHDs), carrier wave signal processing modules, and hardware devices specially configured to store and execute program code such as application specific integrated circuits (ASICs), programmable logic devices (PLDs), read-only memory (ROM), and random access memory (RAM) devices. Other embodiments described herein relate to computer program products, which may include, for example, the instructions and / or computer code disclosed herein.

[0114] A user interface may serve as a communications interface between an operator or clinician and the radiation therapy system. The user interface may include input and output devices (e.g., a touchscreen and a display) and be configured to receive input and output data from one or more of the support arm, external magnet, sensor, delivery device, input device, output device, network, database, and server. Sensor data from one or more sensors may be received by the user interface and output by one or more output devices visually, audibly, and / or through tactile feedback. As another example, operator control of an input device (e.g., a joystick, keyboard, touchscreen) may be received by a user and then processed by a processor and memory for the user interface to output control signals to radiation therapy system components (e.g., a gantry, MLC, therapeutic radiation source, imaging system, PET detector, etc.).

[0115] Some variations of radiation therapy systems for delivering therapeutic radiation may include a display device that may enable an operator to view graphical and / or textual representations of fluence maps, dose distributions, regions of interest, volumes of interest, patient anatomical images, and / or patient data (e.g., physiological and / or biological), DVH curves, dose plots, and the like. In some variations, the output device may include a display device including at least one of a light-emitting diode (LED), a liquid crystal display (LCD), an electroluminescent display (ELD), a plasma display panel (PDP), a thin film transistor (TFT), an organic light-emitting diode (OLED), an e-paper / e-ink display, a laser display, and / or a holographic display.

[0116] communication In some embodiments, the treatment planning system and / or radiation therapy system may communicate with other computing devices via one or more networks, each of which may be any type of network (e.g., wired network, wireless network). A wireless network may refer to any type of digital network that is not connected by any type of cable. Examples of wireless communication in a wireless network include, but are not limited to, cellular, radio, satellite, and microwave communications. However, a wireless network may connect to a wired network to interface with the Internet, other carrier voice and data networks, business networks, and personal networks. Wired networks are typically carried via copper twisted pair, coaxial cable, and / or fiber optic cable. Many different types of wired networks exist, including wide area networks (WANs), metropolitan area networks (MANs), local area networks (LANs), Internet area networks (IANs), campus area networks (CANs), global area networks (GANs), Internet-like networks, and virtual private networks (VPNs). Hereinafter, a network refers to any combination of wireless, wired, public, and private data networks that are interconnected, typically through the Internet, to provide a unified networking and information access system.

[0117] Cellular communications may encompass technologies such as GSM, PCS, CDMA or GPRS, W-CDMA, EDGE or CDMA2000, LTE, WiMAX, and 5G networking standards. Some wireless network deployments combine networks from multiple cellular networks or use a mixture of cellular, Wi-Fi, and satellite communications. In some embodiments, the systems, apparatus, and methods described herein may include radio frequency receivers, transmitters, and / or optical (e.g., infrared) receivers and transmitters to communicate with one or more devices and / or networks.

[0118] While various inventive variations have been described and illustrated herein, those skilled in the art will readily envision various other means and / or structures for performing the functions and / or obtaining the results and / or one or more of the advantages described herein, and each such variation and / or modification is deemed to be within the scope of the inventive embodiments described herein. More generally, those skilled in the art will readily appreciate that all parameters, dimensions, materials, and configurations described herein are meant to be exemplary, and that the actual parameters, dimensions, materials, and / or configurations will depend on the specific application or applications in which the inventive teachings are used. Those skilled in the art will recognize, or be able to ascertain using no more than routine experimentation, many equivalents to the specific inventive variations described herein. Accordingly, the foregoing variations are presented by way of example only, and it should be understood that, within the scope of the appended claims and their equivalents, the inventive variations may be practiced otherwise than as specifically described and claimed. The inventive variations of the present disclosure are directed to each individual feature, system, article, material, kit, and / or method described herein. Additionally, any combination of two or more such features, systems, articles, materials, kits, and / or methods is included within the inventive scope of the present disclosure, provided that such features, systems, articles, materials, kits, and / or methods are mutually consistent.

Claims

1. A system for updating a treatment planning fluence map, the system comprising: a PET detector configured to obtain PET imaging data from the target region; A controller, the controller comprising: identifying a location of the target region from the acquired PET imaging data; updating a treatment plan fluence map for irradiating the target region using the identified locations, wherein updating the treatment plan fluence map includes scaling a plan fluence using one or more of a normalization factor, an attenuation factor, and a weighting factor; a controller configured to: wherein the normalization factor, attenuation factor, and weighting factor are calculated based on a fluence previously delivered to the target area.

2. The system described in claim 1, wherein the PET detector comprises a time-of-flight PET detector.

3. The system of claim 1, further comprising an MV detector configured to acquire MV detector data, and the controller configured to update the treatment planning fluence map using the acquired MV detector data.

4. The system of claim 1, further comprising a therapeutic radiation source, the therapeutic radiation source configured to deliver radiation to the target area in accordance with the updated treatment plan fluence map.

5. The system described in claim 4, wherein the controller is further configured to adjust the speed of the couch while the therapeutic radiation source is emitting radiation.

6. The system described in claim 1, further comprising a therapeutic radiation source, and wherein delivering radiation occurs in at least two separate passes of the couch through the radiation emitted by the therapeutic radiation source.

7. The system described in claim 6, wherein the controller is configured to update the treatment plan fluence map after a first couch passes and to update the treatment plan fluence map after a second couch passes.

8. The system described in claim 7, wherein the normalization coefficient is dynamically updated for the second couch pass based on the radiation delivered during the first couch pass.

9. The system of claim 1, wherein updating the treatment plan fluence map includes updating radiation therapy system instructions, the radiation therapy system instructions comprising one or more of jaw, multi-leaf collimator, couch, and / or gantry instructions.

10. The system of claim 1, wherein the controller is further configured to calculate the fluence previously delivered to the target region and compare the previously delivered fluence with the treatment plan fluence map to calculate a fluence difference, and updating the treatment plan fluence map includes adjusting radiation delivery to deliver the calculated fluence difference.

11. The system of claim 10, wherein the controller is further configured to determine dose artifacts at the previously delivered fluence, and updating the treatment plan fluence map includes adjusting radiation delivery to correct for the dose artifacts.

12. The system of claim 1, wherein obtaining PET imaging data, identifying the location of the target region, and updating the treatment planning fluence map occur during a single treatment session.

13. The system described in claim 1, wherein the fluence previously delivered to the target region is determined based on the intensity of the PET imaging data derived from the target region.

14. A system for updating a treatment planning fluence map, the system comprising: a PET detector configured to obtain PET imaging data from the target region; A controller, the controller comprising: calculating a fluence previously delivered to the target area; comparing the previously delivered fluence with a treatment plan fluence map to determine dose artifacts in the previously delivered fluence; updating the treatment planning fluence map by adjusting radiation delivery to correct for the dose artifact; a controller configured to: A system comprising:

15. The system described in claim 14, wherein the PET detector comprises a time-of-flight PET detector.

16. The system described in claim 14, further comprising an MV detector configured to acquire MV detector data, and the controller configured to update the treatment planning fluence map using the acquired MV detector data.

17. The system of claim 14, further comprising a therapeutic radiation source, the therapeutic radiation source configured to deliver radiation to the target area in accordance with the updated treatment plan fluence map.

18. The system described in claim 17, wherein the controller is further configured to adjust the speed of the couch while the therapeutic radiation source is emitting radiation.

19. The system described in claim 17, wherein delivering radiation occurs in at least two separate passes of the couch through the radiation emitted by the therapeutic radiation source.

20. The system described in claim 19, wherein the controller is configured to update the treatment plan fluence map after a first couch passes and to update the treatment plan fluence map after a second couch passes.

Images