Planning and delivery of neutron capture therapy (NCT) treatments

Abstract

Methods and systems for exposing a patient to a neutron beam in accordance with a treatment plan for treating tumors in the patient using boron neutron capture therapy (NCT) are disclosed. Exemplary embodiments of systems, devices, and methods for neutron capture therapy (NCT) treatment plans and delivery are described herein. The NCT patient treatment process delivers a beam of epithermal neutrons (e.g., having an energy spectrum of 1 electron volt (eV) to 30 kiloelectron volts (keV)) to a patient for cancer treatment. In NCT, neutrons are typically produced based on nuclear reactions in which protons (e.g., a proton beam) collide with either a beryllium or lithium target device.

Description

TECHNICAL FIELD

[0001] Cross-Reference to Related Applications This application is an international application claiming priority to U.S. Provisional Patent Application No. 63 / 541,690 filed on September 29, 2023. The disclosure of the foregoing application is hereby incorporated by reference in its entirety into the present specification.

[0002] Technical Field The present specification relates to systems, devices, and methods for neutron capture therapy (NCT) treatment planning and delivery.

BACKGROUND ART

[0003] Neutron capture therapy (NCT) is a treatment modality for various types of cancer, including some of the most difficult types. NCT is a technology that aims to selectively treat tumor cells without harming normal cells by using a compound with a relatively high neutron capture cross-section such as boron. In boron NCT (BNCT), the boron compound enables efficient uptake by various cell types and selective drug accumulation at target sites, for example, tumor cells. Cells loaded with boron can be irradiated with neutrons (e.g., in the form of a neutron beam). The neutrons react with the boron to eradicate the tumor cells. The principle of neutron capture therapy is the same as when other isotopes are used. Examples of other isotopes having a neutron capture cross-section equal to or greater than that of boron include 3 He, 113 Cd, 135 Xe, 149 Sm, 151 Eu, 155 Gd, 157 Gd, and 147 Hf. At least some of these isotopes, for example 157 Gd, may be useful for NCT.

[0004] Neutron beams for NCT can be generated by irradiating a suitable target with a charged particle beam, such as a proton beam. The ions react with atomic nuclei in the target, emitting a beam of untreated neutrons that can be used for NCT. The NCT patient treatment process often involves a series of exposures where the neutron beam (simply referred to as the "beam") enters the patient from different angles and directions to spread the incident dose over a greater portion of the patient's anatomical structure. However, patient treatment platforms are typically designed with a limited range of motion for various degrees of freedom, with different ranges that may vary. Furthermore, for one or more of the beams, it may be necessary to ensure the patient is positioned on the platform in an atypical position (e.g., not supine). This can present many challenges to the NCT treatment planning and delivery process; for example, it may be necessary to obtain multiple tomographic scan images of the patient during treatment planning, which is a time-consuming, expensive, and potentially dangerous procedure for the patient. Thus, there is a need for a streamlined NCT treatment process that can ensure efficiency, reduce costs, and maximize patient safety. [Overview of the Initiative] [Means for solving the problem]

[0005] The subject matter described herein generally relates to systems, devices, and methods for neutron capture therapy (NCT) treatment planning and delivery.

[0006] Details of one or more embodiments of the subject matter of this specification are described in the accompanying drawings and the following description. Other features, aspects, and advantages of the subject matter will become apparent from the description, drawings, and claims. Unless those features are expressly described in the claims, the features of the exemplary embodiments should not be construed as limiting the claims of the appendix.

[0007] Details of the subject matter described herein, both in terms of its structure and operation, can be revealed by examining the accompanying diagrams. The components in the diagrams are not necessarily to scale, and instead the emphasis is on illustrating the principles of the subject matter. Furthermore, all diagrams are intended to convey concepts, and relative sizes, shapes, and other detailed attributes may be illustrated schematically rather than literally or precisely. [Brief explanation of the drawing]

[0008] [Figure 1A] A flowchart illustrating an exemplary treatment plan and delivery data flow. [Figure 1B] Schematic diagram of an exemplary NCT ​​facility for NCT treatment planning and delivery. [Figure 2] A more detailed flowchart illustrating the treatment plan and delivery data flow during the simulation planning phase. [Figure 3] A more detailed flowchart illustrating the treatment planning and delivery data flow during the simulation phase. [Figure 4] A flowchart illustrating a more detailed treatment planning and delivery data flow, showing the treatment planning stages. [Figure 5] An illustrative block diagram of a treatment plan and delivery system. [Figure 6] A flowchart illustrating an exemplary process for treatment planning and delivery. [Figure 7A] A schematic diagram of an example of a neutron beam system suitable for NCT. [Figure 7B] A more detailed schematic diagram of an exemplary neutron beam system shown in Figure 7A. [Figure 8] A flowchart illustrating an exemplary computer system. [Modes for carrying out the invention]

[0009] Similar reference numbers and symbols in various drawings refer to the same element.

[0010] Before describing the subject matter in more detail, it should be understood that this disclosure is not limited to the embodiments described and is therefore naturally subject to change. It should also be understood that the terms used herein are for illustrative purposes only and not to limit the scope of this disclosure, as the scope is limited only by the appended claims.

[0011] Exemplary embodiments of systems, devices, and methods for neutron capture therapy (NCT) treatment planning and delivery are described herein.

[0012] The NCT patient treatment process delivers a beam of epithermal neutrons (e.g., with an energy spectrum ranging from 1 electron volt (eV) to 30 kiloelectron volts (keV)) to the patient for cancer treatment. In NCT, neutrons are typically generated based on nuclear reactions in which protons (e.g., a proton beam) collide with either a beryllium or lithium target device. The generated neutron beam has a wide range of energies and is emitted in various directions. A neutron beam converter (NBC) converts the generated neutron beam into a generally forward-directed beam within the desired epithermal energy range to which the patient is exposed.

[0013] Before the patient is treated with a neutron beam, a delivery agent (e.g., a boron drug for BNCT, or a drug based on a different isotope depending on the therapy) is injected into the patient. The delivery agent ensures relatively high tumor uptake and relatively low normal (e.g., non-cancerous) tissue uptake within the patient's body. In this way, when the patient is irradiated with a neutron beam during NCT treatment, the radiation dose is preferentially delivered to the tumor without harming surrounding tissues. Because the injection of the delivery agent into the patient is time-constrained, an accurate and efficient NCT treatment plan is desired that can streamline the treatment process and ensure patient safety.

[0014] An NCT treatment plan is a process of determining a set of treatment parameters for NCT treatment delivery prior to treatment delivery. The set of parameters can include, for example, the position of the patient on a treatment platform in the NCT treatment room relative to the beam port through which the neutron beam is delivered, a set of patient immobilization instructions relative to the treatment platform, and the amount of neutrons to be delivered for the neutron beam. The NCT treatment planning process generally includes determining the set of treatment parameters based on, among other information, one or more initial tomographic images of the patient's anatomy.

[0015] The treatment process for NCT patients often involves sequentially exposing the patient to multiple beams, each incident on the patient at a different angle and from a different direction. Such beam delivery distributes the incident dose over a larger portion of the patient's body than delivering the entire dose in a single beam. During treatment, the patient is positioned on a treatment platform in the NCT treatment room and immobilized using a set of immobilization instruction devices. This set of immobilization instruction setups ensures that the predetermined NCT beam angles relative to the patient are satisfied for accurate and precise dose delivery when the patient is irradiated with the neutron beam.

[0016] However, patient treatment platforms are typically designed to provide limited movement, which can vary by different amounts due to different degrees of freedom. For example, a patient treatment platform may provide relatively small amounts of pitch (e.g., up / down of the patient's head) and roll (e.g., right / left of the patient's head) adjustments to the patient, but relatively large amounts of yaw (e.g., clockwise / counterclockwise rotation) adjustments to the patient on the treatment platform. Often, the amount of movement is constrained to prevent gravity from substantially altering or shifting the patient's organs when the patient is immobilized on the treatment platform for NCT treatment. Furthermore, the neutron beam port is typically in a fixed location, and the patient must be positioned relatively close to the beam port to minimize the air gap between the patient and the neutron beam and ensure an effective penetration depth of the neutron beam.

[0017] As a result, conventional NCT treatment planning may involve requiring patients to visit the treatment facility multiple times to ensure they are properly positioned for each of the multiple beams during NCT treatment, making the overall process expensive and inefficient. Furthermore, conventional NCT treatment planning may involve obtaining multiple tomographic images of the patient (e.g., computed tomography (CT) scans) as part of the process, adding to the cost and complexity of the treatment, in addition to posing further risks to the patient's health.

[0018] This specification describes a streamlined NCT treatment planning and delivery process that efficiently and accurately determines the position of a patient on a treatment platform with only a single tomographic scan, while at the same time ensuring that all neutron beam angles for treatment are safely delivered to the tumor. The treatment planning can be accomplished with only one visit of the patient to the treatment facility prior to treatment delivery. In operating facilities where the availability of facility resources for planning purposes, rather than for the treatment itself, is limited, limiting the number of times a patient needs to visit the facility for planning can allow more patients to be treated, as the facility downtime associated with planning is reduced.

[0019] In general, NCT treatment planning and delivery involves a data flow implemented by a system comprising a combination of hardware, software, and firmware, including one or more servers, a tomography facility, and a boron neutron capture therapy (NCT) facility. The server(s) include one or more software application programs for controlling the operations for treatment planning and delivery described herein. The tomographic imaging sub-facility includes an imaging system (e.g., a CT scanner) for obtaining scans of a patient, and any other components and devices necessary for image acquisition. The NCT sub-facility includes a treatment room that contains a neutron beam system for delivering neutron beams, and a treatment platform for positioning a patient relative to a neutron beam port, together with other suitable components and devices required for NCT treatment delivery. The tomographic imaging subsystem, the NCT subsystem, and the server(s) are communicatively coupled via a network, for example, a local area network (LAN), a wide area network (WAN), the Internet, or a combination thereof. A user of the treatment planning and delivery system (e.g., a clinician or a team of clinicians collectively referred to as the "clinical team") can use the system to implement various aspects of the treatment planning and delivery data flow described below.

[0020] Referring to Figure 1A, an exemplary treatment plan and delivery data flow 100 includes a series of steps implemented by the clinical team to determine a final treatment plan 108 for treating one or more tumors in a patient using NCT. Throughout this specification, the term “treatment plan” generally refers to a set of treatment parameters used to treat a patient using NCT at a treatment facility. The set of treatment parameters generally includes the patient’s position on the treatment platform, the direction and angle of incidence of the neutron beam, the dose delivered by the neutron beam, and / or any other appropriate parameters that can be used to treat a patient using NCT at a facility.

[0021] The treatment planning and delivery data flow 100 includes the following stages: (i) simulation planning stage 120, (ii) simulation stage 130, (iii) treatment planning stage 140, and (iv) treatment delivery stage 150. Generally, the stages of the data flow 100 can be performed over any appropriate time window. For example, in some cases, all stages of the data flow 100 can be performed during the same patient visit to the clinical facility and / or on the same day. However, in some cases, the stages of the data flow 100 are performed over a longer period and / or multiple visits. In some other cases, each stage of the data flow 100 is performed on separate days. Some or all stages of the data flow 100 can be performed in different locations / facilities, for example, in an NCT treatment room, a tomography scanning room, a treatment emulation room, or any other appropriate location / facility. In specific cases, the simulation planning phase 120 and simulation phase 130 are performed in a treatment emulation room that includes simulated versions of the equipment used to deliver NCT treatment to the patient, such as a treatment platform and beamports. For example, the treatment emulation room may include a treatment platform emulator that can operate with a similar range of motion to that of a treatment platform, and a beamport emulator that is located in the treatment platform emulator as beamports in the treatment room are located in the treatment platform emulator.

[0022] The treatment delivery phase 150 is performed within the NCT treatment room. Furthermore, each phase of the data flow 100 can be performed by one or a combination of components of the treatment planning and delivery system.

[0023] In simulation planning stage 120, the clinical team obtains an initial tomographic image 102 of the patient and generates a simulation plan 104 based on the initial tomographic image 102. Throughout this specification, the term “tomographic image” generally refers to an image containing information about the patient’s anatomical structure, obtained by any appropriate medical imaging modality such as computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), or any other appropriate medical imaging modality.

[0024] In some cases, initial tomographic images 102 are acquired as part of the patient selection process, for example, during the initial diagnosis and / or evaluation of a patient as a candidate for NCT treatment. In some cases, the patient selection process can be performed by the clinical team before implementing the data flow 100 using the treatment planning and delivery system. In this way, the data flow 100 can leverage existing tomographic images acquired during the patient selection process without requiring, for example, the acquisition of new initial tomographic images during the simulation planning phase 120. As a specific example of the patient selection process, a clinician at a clinical facility may inject or administer any suitable delivery agent (e.g., a boron drug containing boron that interacts with a neutron beam) into a patient and acquire one or more initial tomographic images 102, for example, by performing a PET or CT scan of the patient's anatomical structure to confirm the uptake of the boron drug within a target area of ​​the patient's anatomical structure (e.g., a tumor) and the non-uptake of the boron drug in surrounding tissue or organs at risk. In some cases, the delivery agent is a surrogate agent that, for example, has similar pharmacokinetic behavior to the delivery agent but offers improved imaging quality compared to the actual delivery agent.

[0025] The clinical team uses these images to evaluate patients as candidates for NCT treatment. Generally, one or more initial tomographic images102 can be obtained at any other appropriate time, not necessarily during the patient selection process.

[0026] In the simulation planning stage 120, the clinical team determines the simulation plan 104 using the treatment planning and delivery system and the initial tomographic images 102. Throughout this specification, the term “simulation plan” generally refers to an initial or preliminary set of treatment parameters for NCT treatment. The clinical team can determine an initial set of treatment parameters based on the initial tomographic images 102 by providing user input through the user interface of the treatment planning and delivery system 100.

[0027] The initial treatment parameter set may include, for example, a set of immobilization instructions for the patient regarding the NCT treatment platform and a preliminary beam selection including one or more neutron beams. The clinician provides user input through the user interface of the treatment planning and delivery system to perform the preliminary beam selection, for example, by selecting one or more beams for the simulation plan 104, by selecting one or more neutron beam angles suitable for NCT treatment.

[0028] Throughout this specification, the term “set of immobilization instructions” for a patient refers to the patient’s fixed position and / or orientation relative to the NCT treatment platform. For example, a simple set of immobilization instructions is instructions for positioning the patient in a supine position on the treatment platform. However, in many cases, such positioning of the patient does not allow for a beam incidence angle that minimizes the depth the beam must travel before reaching the tumor, making it difficult or impossible to position the patient relative to multiple different beam neutron beam axes and neutron beam ports. Generally, the patient will need to be positioned in a non-supine position, e.g., with one or more body parts supported on the treatment platform, and / or with the patient lying on their side, prone, or in some other awkward position, in order to be treated by multiple beams without requiring the patient to be repositioned and immobilized between beams.

[0029] After the patient is positioned according to a set of immobilization instructions and fixed in this position relative to the treatment platform, the incident angle of the neutron beam can be determined by the axis of the neutron beam and the position of the patient on the treatment platform relative to the neutron beam port, for example by moving the treatment platform relative to the axis of the neutron beam.

[0030] Generally, the patient's position on the NCT treatment platform can be fixed using one or more immobilization devices worn by the patient, e.g., a mask, cast, mold, vacuum-cured bag (e.g., Vac-Lok® bag), or any other suitable immobilization device. Immobilization can also involve supporting or otherwise supporting parts of the patient while the patient is positioned on the treatment platform, according to a set of immobilization instructions. For example, the patient may be supported by a headrest, pillow, foam wedge, etc. Thus, in addition to instructions on how to position the patient relative to the treatment platform, the set of immobilization instructions can also include instructions for configuring one or more immobilization devices to fix the patient in the appropriate position relative to the treatment platform. Next, the selection of the preliminary beam is determined by the patient's position on the treatment platform (e.g., while the patient is immobilized relative to the treatment platform) relative to the axis of the neutron beam and the distance from the neutron beam port.

[0031] Generally, the set of immobilization instructions is determined so that the patient's position relative to the treatment platform remains the same for each of multiple neutron beams (e.g., having different doses, diameters, and neutron fluxes for one or more different positions and orientations of the patient). To determine the selection of a preliminary beam, the clinical team can provide user input through the user interface of the treatment planning and delivery system to set degrees of freedom, including the pitch angle, roll angle, and / or yaw angle of the patient on the treatment platform relative to the axis of the neutron beam for each of the multiple neutron beam incidence angles, as well as / or linear displacement along the x, y, and / or z axes. In some cases, the clinical team can set the patient's position on the treatment platform relative to the axis of the neutron beam so that the pitch and roll angles of the treatment platform are substantially the same for each of the multiple neutron beam incidence angles. This allows the clinical team to position the patient on the treatment platform relative to the axis of the neutron beam using the treatment planning and delivery system so that only a single configuration of the immobilization device is required to fix the patient in that position on the treatment platform. In other words, the same configuration of the immobilization device can be used for different beam incidence angles. This ensures that when the patient is immobilized on the treatment platform using an immobilization device during NCT treatment, only the patient's yaw angle on the treatment platform relative to the axis of the neutron beam needs to be changed to accommodate different neutron beam incidence angles. The data flow simulation planning stage 120 is described in more detail below with reference to Figure 2 shown below.

[0032] Following the simulation planning phase 120, the data flow 100 proceeds to the simulation phase 130. In the simulation phase 130, the clinical team uses the system to simulate the treatment of the patient based on the simulation plan 104 determined in the simulation planning phase 120. That is, the clinical team verifies that the set of immobilization instructions and preliminary beam selection determined during the simulation planning phase are physically feasible, for example, based on initial tomographic images 102 of the patient's anatomical structure. Generally, it is not obvious to identify the relationship from a single patient to a platform that allows treatment with more than one beam. As previously mentioned, such a relationship often involves a non-supine position of the patient. Furthermore, the treatment platform generally has a limited range of motion in one or more degrees of freedom, and beam delivery requires positioning a specific part of the patient close to the beam port in a specific orientation relative to the beam axis.

[0033] Once the set of immobilization instructions and preliminary beam selection are established to be physically feasible, the clinical team acquires a primary tomographic image of the patient 106, which is a tomographic image of the tumor and surrounding tissue acquired while the patient is in the same position relative to the treatment platform validated during the simulation phase. The primary tomographic image is used by the clinical team to confirm the location of the tumor and associated at-risk healthy organs when the patient is immobilized according to the set of immobilization instructions and to determine the final treatment plan 108. The primary tomographic image may be acquired while the patient is immobilized for the simulation, or at some point later with the patient immobilized (e.g., in a different location) to ensure that the tumor is positioned within the body as it was during the simulation.

[0034] In addition to establishing the physical feasibility of setting immobilization instructions and preliminary beam selection, simulations can yield additional outputs. For example, simulations can provide the information necessary to construct the immobilization devices and / or assistive devices required for treatment. Alternatively, or additionally, simulations can be used to obtain measurements of the smallest reasonable gap between the beam port and the patient (referred to as SSD (source-to-skin distance)) by moving the patient as close as possible to the beam port for each preliminary beam and measuring the resulting gap. These measurements are later entered into treatment planning software to create the final treatment plan. These measurements are generally difficult to determine solely from tomographic images because they are not generally available in the software, and even when available, they are generally not suitable for intuitively assessing the risks of such small gaps.

[0035] In simulation phase 130, the patient is physically positioned on a treatment platform within the NCT treatment room or treatment emulation room. The clinical team uses the system to adjust the treatment platform so that the patient's position matches the position for each of the multiple beam angles specified by simulation plan 104, by varying the pitch angle, roll angle, and / or yaw angle of the patient on the treatment platform relative to the axis of the neutron beam. The clinical team also sets the distance of the treatment platform from the beam port that delivers the neutron beam to the treatment room for each of the multiple beam angles specified in simulation plan 104. The patient is physically immobilized using immobilization devices and / or supports configured according to a set of immobilization instructions specified in simulation plan 104. In simulation phase 130, the clinical team adjusts the patient's position on the treatment platform relative to the axis of the neutron beam for each of the multiple beam incidence angles and the configuration of the immobilization devices, as necessary.

[0036] After the simulation phase 130, the data flow 100 proceeds to the treatment planning phase 140. In the treatment planning phase 140, the clinical team uses the system to establish a final treatment plan 108 for the patient based on the primary tomography images 106, the simulation plan 104, the information determined during the simulation phase 130, and the initial tomography images 102.

[0037] For example, the clinical team uses the system to contour targets (e.g., tumors) within the patient's anatomical structure based on the primary tomography image 106 and to register the primary tomography image 106 against the initial tomography image 102. The clinical team uses the system to review the preliminary beam selection in the simulation plan 104 against the primary tomography image 106 and to verify that the preliminary beam selection delivers the desired NCT treatment. The clinical team uses the system to perform dose calculations and adjust the preliminary beam selection as needed to achieve the desired dose results. After performing all necessary adjustments, the clinical team uses the system to review and approve the final treatment plan 108. The treatment planning stage 140 of the data flow 100 is described in more detail below with reference to Figure 4.

[0038] Following treatment planning stage 140, the treatment plan and delivery data flow 100 proceeds to treatment delivery stage 150. In treatment delivery stage 150, the clinical team uses the system to deliver NCT therapy to the patient according to the final treatment plan 108. In treatment delivery stage 150, the clinician injects the delivery agent into the patient, takes a blood sample from the patient, and analyzes the sample to determine the blood concentration of the delivered drug.

[0039] An example of an NCT treatment facility 160 suitable for treatment using the final treatment plan 108 is schematically shown in Figure 1B. Facility 160 includes a treatment room 162 with a treatment platform 168 for positioning a patient 101 in proximity to a beam port 166 from which a beam system 164 delivers a neutron beam. Generally, the treatment platform can be a robotic platform mounted on the ceiling or floor. The neutron beam propagates along the beam axis 165 as described above. The treatment platform 168 can be moved relative to the beam axis 165 by an actuation station 169 to position a patient relative to a fixed neutron beam port for treatment of the head, neck, or body. The actuator module 169 includes actuators that can move the treatment platform 168 through a range of motion with multiple degrees of freedom, including, for example, rotation (e.g., pitch, roll, yaw) and / or translation (e.g., x, y, and / or z directions). In general, for any coordinate system, the axes are named x, y, and z, and the rotations are ψ, φ, and θ. ψ is the rotation around x, φ is the rotation around y, and θ is the rotation around z. Here, the coordinate system shown corresponds to a fixed coordinate system f established by the treatment room. According to the international standard for radiotherapy equipment, IEC61217:2011, for the fixed coordinate system, +Xu points into the beam port, +If points to the left toward the beam port, and +Zi points upwards. Another coordinate system t can be established by the treatment platform. In this system, +Xt points to the left of the cephalic supine (HFS) patient, +Yt points to the head of the HFS patient, and +Zt points upwards. Setting all platform rotation angles to zero, the rotation axes of coordinate systems f and t coincide.As used herein, pitch refers to a rotation around ψt, or x, in the tabletop coordinate system and is generally referred to as “head up” or “head down,” roll refers to a rotation around φt, or y, in the tabletop coordinate system and is generally referred to as “roll left” or “roll right,” direction assumes a supine patient position with the head leading, yaw refers to a rotation around θt, or z, in the tabletop coordinate system and is generally referred to as “clockwise” and “counterclockwise” when looking down at the tabletop from above.

[0040] Patient 101 is immobilized to the treatment platform using a set of immobilization guidance devices 167. The system includes a surface imaging guidance system 180 (a commercially available system, such as one sold by VisionRT, Somerset, New Jersey, for example) which includes a camera 182 installed in the treatment room 162 to track the patient's position. Ceiling and / or wall-mounted lasers (not shown) can also facilitate patient positioning.

[0041] The treatment facility 160 includes a control module 170 equipped with a user interface 172, which is used to control the surface image guidance system 180, the actuation station 169, and the beam system 164 during treatment delivery.

[0042] In some cases, the clinical team checks the collimator and beam port 166 attached to the beam shaping assembly of the beam system 164 against the collimator to deliver the neutron beam specified in the treatment plan. If necessary, the clinical team replaces one collimator with another to match the treatment plan. The clinical team positions the patient on the treatment platform in the NCT room using a surface imaging guidance system. For example, the clinical team can check a surface imaging guidance display positioned in the NCT treatment room showing a heatmap of the patient's position and adjust the patient's position on the platform accordingly (e.g., by adjusting one or more immobilization devices or assistive devices) to immobilize the patient according to the final treatment plan. In some cases, the clinical team determines the amount of exposure for each neutron beam based on the blood concentration level of the delivery agent. The clinical team exposes the patient to one or more neutron beams according to the neutron dose and the final treatment plan 108.

[0043] Figure 2 illustrates in more detail an exemplary simulation planning stage 200 of the data flow 100 in Figure 1. In the simulation planning stage 200, the clinical team determines a simulation plan for the patient, specifying the patient-to-beam relationship and therefore the patient-to-treatment platform relationship, using the treatment planning and delivery system, as well as the initial tomographic images 202, and immobilization devices and / or assistive devices used to immobilize the patient in that relationship. The patient-to-beam relationship is included in a set of immobilization instructions 204 and a preliminary beam selection 206 including one or more beams for NCT treatment. The treatment planning and delivery system can use one or more software applications, e.g., commercially available treatment planning software such as "RayStation" from RaySearch Laboratories (Sweden), or any other suitable software application, and includes a simulation planning engine 220 that interfaces with a surface image guidance platform to facilitate the precise positioning of the patient on the platform according to the set of immobilization instructions 204.

[0044] The clinical team imports the initial tomography images 202 into the simulation planning engine 220 and provides user input through the user interface of the simulation planning engine 220 to determine the simulation plan. For example, the clinical team uses the simulation planning engine 220 and the initial tomography images 202 to outline structures in the images 202, for example, using single points, ellipsoids, or rectangular volumes, and to mark areas of interest (e.g., tumors) in the images 202. In some cases, the clinical team uses the simulation planning engine 220 to identify, outline, or otherwise locate the patient's surface or skin structures.

[0045] The clinical team uses the simulation planning engine 220 to select one or more neutron beams, for example, one or more desired neutron beam angles estimated to provide sufficient dose measurement for treatment. In some cases, two or three beams are sufficient for treatment. In some cases, the clinical team can select one or more neutron beam incidence angles to minimize the distance from the patient's skin and target (e.g., tumor) within the patient's anatomical structure. In some cases, the clinical team selects one or more different neutron beam incidence angles and realizes treatment of the patient with multiple beams, each of which can be achieved by adjusting only the yaw of the treatment platform while the patient remains immobilized, while keeping the pitch and roll angles of the treatment platform fixed. In this way, the clinical team uses the simulation planning engine 220 to determine a single set of immobilization instructions for a patient that can satisfy multiple different neutron beam angles while the patient remains immobilized relative to the treatment platform, while allowing only the yaw angle of the treatment platform to change. The clinical team uses the simulation planning engine 220, for example, the engine 220's graphical user interface elements (e.g., the "RayStation" GUI tool), to adjust the pitch, roll, and yaw angles of the patient on the treatment platform relative to the axis of the neutron beam for each of the multiple beam angles.

[0046] In some cases, the clinical team uses the simulation planning engine 220 to perform preliminary dose calculations. For example, the clinical team provides user inputs through the user interface of the simulation planning engine 220 that roughly specify the materials and compositions in different regions of the patient's anatomical structure. The simulation planning engine 220 provides outputs that include an estimate of the neutron beam dose. After the preliminary dose estimation, the clinical team iteratively adjusts the beam angle and recalculates the dose estimates until the clinical team identifies a preliminary beam selection 206 for the patient that provides appropriate dosimetry with a single set of immobilization instructions for the patient to the treatment platform.

[0047] After the clinical team has determined the set of immobilization instructions 204 and the preliminary beam selection 206 using the simulation planning engine 220, the simulation planning engine 220 integrates the simulation planning information and exports the resulting information for use in subsequent stages of the process (e.g., in the simulation phase). For example, a script running on the simulation planning engine 220 can integrate different types of data, such as the position and orientation of the immobilized patient relative to the axis of the neutron beam for each of one or more beams in the preliminary beam selection included in the simulation plan. The script can provide this data to the treatment planning and delivery system, which can then use this data to determine initial candidate beam positions for the final treatment plan for the patient.

[0048] After the simulation planning phase 200 is completed, the treatment plan and delivery data flow proceed to the simulation phase, where the patient's treatment protocol is physically simulated by immobilizing the patient according to a set of immobilization instructions 204 and moving the treatment platform with the immobilized patient through a series of positions relative to the beam axis and beam port in response to beam exposure.

[0049] Referring to Figure 3, an exemplary simulation stage 300 of the treatment plan and delivery data flow 100 is schematically shown. As described above, in simulation stage 300, the clinical team uses the treatment plan and delivery system to perform a physical simulation of NCT treatment on the patient. The clinical team imports the simulation plan determined in the simulation planning stage (described above with reference to Figure 2) into the simulation engine 330 included in the treatment plan and delivery system. The clinical team uses the simulation engine 330 for the patient, the set of immobilization instructions 304 for the patient, and the preliminary beam selection 306 specified in the simulation plan to perform a simulation of NCT treatment on the patient in the NCT treatment room.

[0050] The simulation engine interfaces with the NCT facility 330 and the tomography facility 370 in order to perform the simulation. The NCT facility can be the facility 160 mentioned above. In particular, the simulation engine 330 interfaces with the actuator module 336 and the surface image guidance system 335 located within the NCT facility 330.

[0051] The simulation engine 330 may include a surface imaging guidance software package (e.g., a commercially available package from VisionRT, along with the surface imaging guidance system hardware) that, together with the surface imaging guidance system, assists the clinical team in accurately positioning the patient on the treatment platform according to a set of immobilization instructions 304 specified in the simulation plan.

[0052] In simulation phase 300, the clinical team physically positions the patient on a treatment platform within the BCNT facility 330 and immobilizes the patient according to a set of immobilization instructions 304 specified in the simulation plan. The simulation engine 330 can automatically provide the surface structure of the patient's skin from the simulation plan to the surface image guidance system. Using the surface image guidance system, the clinical team can position the patient on the treatment platform to match the pitch and roll angles specified in the simulation plan and set up the immobilization device.

[0053] For each beam specified in the preliminary beam selection 306, the clinical team can use a hand controller coupled to the actuator module 336 to move the treatment platform to a preparation position so that the patient's yaw angle matches the desired yaw angle specified in the simulation plan. In some cases, the preparation position can be approximately 10-15 cm away from the beam port. The clinical team uses the hand controller to move the patient slowly toward the beam port. Since effective neutron beam dosimetry is achieved only at a relatively short distance from the beam port, the clinical team can move the patient as close to the beam port as possible while avoiding any risk of collision. The clinical team uses the hand controller to mark the final position from the beam port 335 as the final treatment beam position and record the corresponding position of the treatment platform 336. Alternatively, or additionally, the clinical team can manually measure the distance from the beam port 335 to the treatment platform at this stage for later input into the simulation engine 340. The clinical team can perform this process for each beam in the preliminary beam selection 306 using the simulation engine 340 and the NCT subsystem 330. In some embodiments, the clinical team manually records the source-to-skin distance (SSD) for each beam included in the preliminary beam selection 206, using a set of patient immobilization instructions 204 with respect to the treatment platform and the preliminary beam selection 206. The clinical team then uses this information in the treatment planning phase, described in more detail below, to determine initial candidate beam positions for the final treatment plan for the patient.

[0054] Therefore, the clinical team can update the set of immobilization instructions 304 and the preliminary beam selection 306 and use this information in the treatment planning stages described below, with reference to Figure 4.

[0055] After performing a treatment simulation using the simulation engine 330 and the NCT facility 330, the clinical team can acquire a primary tomographic scan image 305 using the tomography facility 370. This step can be performed while the patient is still immobilized against the treatment platform, or the patient can be released from the treatment platform and repositioned and re-immobilized in the tomography facility for the purpose of acquiring the primary tomographic scan image 305. While the patient is immobilized against the treatment platform, the clinical team acquires a primary tomographic scan image 305 of the patient using a scanner 380 included in the tomography facility 370. The scanner 380 may be, for example, a portable scanner brought into the treatment room and used while the patient is immobilized on the treatment platform.

[0056] The tomography facility 370 is generally an optional component of the treatment planning and delivery system. In other words, the simulation phase 300 may include obtaining primary tomography scan images 305 (e.g., one or more CT images) of the patient using any suitable tomography facility located in any practical location that is not necessarily part of the overall treatment planning and delivery system. In such cases, the primary tomography scan images 305 are typically obtained using similar or the same immobilization devices or techniques following the simulation activity within the NCT facility.

[0057] The clinical team can use the simulation engine 330 to export primary tomographic scan images 305 for use in the next stage of the treatment planning and delivery data flow, for example, in the treatment planning stage, which is described in more detail below with reference to Figure 4.

[0058] Figure 4 illustrates in more detail an exemplary treatment planning stage 400 of Figure 1. As described above, in treatment planning stage 400, the clinical team uses the treatment planning and delivery system to establish a final treatment plan 412 for the patient based on primary tomographic images 404 and one or more beams from preliminary beam selection, as determined in the simulation stage described above with reference to Figure 3.

[0059] In the treatment planning stage 400, the clinical team can import the primary tomographic images 404 determined in the simulation stage described above (refer to Figure 3) into the treatment planning engine 410 included in the treatment planning and delivery system. In some cases, the clinical team additionally imports the initial tomographic images 402 obtained in the simulation planning stage described above (refer to Figure 2). The treatment planning engine 410 includes one or more software applications, such as the "RayStation" application, or any other suitable software application.

[0060] The clinical team can use the treatment planning engine 410 to fuse the primary tomography scan image 404 with the initial tomography image 402 (used, for example, in the simulation planning phase) to generate a fused image. In some cases, the clinical team imports any other initial tomography images of the patient into the treatment planning engine 410 and fuses these images with the primary tomography scan image 404 to generate a fused image. After generating the fused image, the clinical team provides user input through the user interface of the treatment planning engine 410 by contouring the fused image, for example, a target region (e.g., a tumor), and one or more structures of the patient's anatomical structures within any other structure or organ at risk. For example, the clinical team can assign each voxel contained in the fused image to its respective structure. As a specific example, each structure may specify a material including a general breakdown into elemental components and the relative weight or content of each component. As another example, each structure may specify a biological model including the concentration of the delivery agent relative to the blood and various biological scaling factors (e.g., RBE and CBE).

[0061] After contouring the fused image, the simulation plan 406 determined in the simulation planning stage described above with reference to Figure 2, and the simulation results 408, for example, the information generated in the simulation stage described above with reference to Figure 3, are imported into the treatment planning engine 410. The import can be facilitated using varying degrees of automation, for example, by using scripts or by manual input. The treatment planning engine 410 processes the simulation plan 406 and simulation information to generate a final treatment plan 412, for example, determining the final set of immobilization instructions and final beam selection to be used to perform NCT treatment on the patient.

[0062] After determining the patient's final position and, for example, performing the final beam selection of the final treatment plan 412 as described above, the clinical team can provide user input via the user interface of the treatment planning engine 410 to specify any other NCT-specific treatment parameters. For example, the clinical team can specify, for instance, the patient's estimated blood concentration of the delivery agent, or any other NCT-specific treatment parameters.

[0063] In treatment planning stage 400, the clinical team can use the treatment planning engine 410 to estimate the neutron beam dose to treat the patient. The clinical team can, if necessary, assess the estimated dose for acceptableness and modify the beam position in the final treatment plan 412. In this way, the clinical team can generate multiple candidates for the final treatment plan 412. The clinical team can review the candidate plans and select a particular candidate plan as the final treatment plan 412.

[0064] Figure 5 is a block diagram of an exemplary treatment planning and delivery system 500. As described above with reference to Figure 1, the clinical team can use the treatment planning and delivery system 500 to implement the treatment planning and delivery workflow 100.

[0065] The treatment planning and delivery system 500 includes a treatment planning and delivery server 540, a tomography facility 520, an NCT facility 535, and an end-user client 502. In some cases, the tomography facility 520 is an optional component of the treatment planning and delivery system 500. For example, the system 500 can receive and use patient scans or images acquired using any suitable tomography system located in any suitable location or facility and not necessarily forming part of the treatment planning and delivery system 500.

[0066] In some examples, the tomography facility 520 includes a CT scanner for obtaining CT scans of patients, and any other components and devices necessary for acquiring CT scan images. In some cases, the CT scanner is a portable CT scanner. The treatment planning and delivery server 540 includes one or more software application programs configured to perform the operations for treatment planning and delivery described herein. The tomography facility 520, the NCT facility 535, the end-user client 502, and the treatment planning and delivery server 540 are connected in a communicable manner through a network 508, e.g., a local area network (LAN), a wide area network (WAN), the internet, any other suitable network, or a combination thereof. Although shown separately, in some embodiments, the functions of two or more systems, devices, or servers may be provided by a single system or server. In some embodiments, the functions of one illustrated system, server, or engine may each be provided by multiple systems, servers, or engines.

[0067] NCT facility 535 may include the same components as the facility shown in Figure 1B above.

[0068] The end-user client device 502 is an electronic device capable of requesting and receiving data via the network 508. The end-user client device 502 can include any client computing device, such as a laptop or notebook computer, a wireless data port, a smartphone, a personal data assistant (PDA), a tablet computing device, one or more processors within these devices, or any other suitable processing device capable of sending and receiving data via the network 508. For example, the end-user client device 502 can include a computer with input devices, such as a keypad, a touchscreen, or other device capable of accepting user information, and output devices that transmit information related to the operation of the client device itself, such as a treatment plan and delivery server 540 containing digital data, visual information, or a graphical user interface (GUI) 512. The end-user client device 502 can include one or more client applications. A client application is any type of application that enables the end-user client device 502 to request and verify content on each client device. In some embodiments, a client application can access a specific set of data from the treatment plan and delivery server 540, for example, using parameters, metadata, and other information received at startup.

[0069] The end-user client device 502 typically includes one or more applications, such as a browser 580 or a native application 510, to facilitate the sending and receiving of content over the network 208. Examples of content presented in the client device 502 include patient information, a set of initial treatment parameters determined during the simulation planning phase, final treatment parameters determined for the final treatment plan, tomographic scans obtained from the tomography facility 520, and information obtained during NCT treatment of the patient using the NCT facility 535.

[0070] The clinical team can use an end-user client device 502 to provide user input to the treatment planning and delivery server 540 through a graphical user interface (GUI) 504. For example, the clinical team can use the simulation planning engine 551, simulation engine 552, and treatment planning engine 553 to perform one or more tasks associated with the data flow described above, with reference to Figure 1.

[0071] In some embodiments, the end-user client 502 can receive treatment plan and delivery data 518, for example, data generated during any of the stages included in the data flow described above with reference to Figure 1, from the database 544 of the treatment plan and delivery server 540. The end-user client 502 can store the treatment plan and delivery data 518 in memory 514, together with any other user files 516 contained in memory. Memory 514 may include any form of volatile or non-volatile memory, such as magnetic media, optical media, random access memory (RAM), read-only memory (ROM), removable media, or any other suitable local or remote memory component.

[0072] Figure 6 is a flowchart of an exemplary process 600 for treatment planning and delivery. The process can be carried out by a treatment planning and delivery system, for example, the treatment planning and delivery system 500 described above with reference to Figure 5.

[0073] The system obtains initial tomographic images of the patient (602). These initial tomographic images may contain information about the tumor within the patient's anatomical structure. The initial tomographic images may be, for example, magnetic resonance (MR) images, CT scan images, or PET scan images.

[0074] The system determines a simulation plan for the patient based on the initial tomographic images (604). The simulation plan includes a set of immobilization instructions for the patient and a preliminary beam selection including one or more beams for treatment.

[0075] The system simulates treatment for a patient based on a simulation plan (606). The simulation may include positioning the patient on a treatment platform in the treatment chamber, the treatment platform including actuators for changing the pitch angle, roll angle, and yaw angle of the treatment platform relative to the axis of the neutron beam for each of the beams of the preliminary beam selection, as well as the distance of the treatment platform from the beam port of the neutron beam in the treatment chamber. The simulation may further include immobilizing the patient against the treatment platform according to a set of immobilization instructions.

[0076] Following or simultaneously with the simulation, primary tomographic images are obtained with the patient positioned and fixed to the treatment platform or a similar platform (607), confirming that the tumor remains within the beam path when the patient is positioned in this manner.

[0077] The system establishes a treatment plan for the patient based on the primary tomographic image and one or more beams from the preliminary beam selection (608).

[0078] The system treats the patient by exposing them to a neutron beam according to a treatment plan (610).

[0079] The aforementioned examples of treatment facilities include an actuated treatment platform, but other embodiments are possible. For example, a treatment facility may include a static or manually adjustable platform, such as a stretcher. In some cases, the patient sits in a chair (e.g., an actuated or static chair) during simulation and treatment. In certain cases, the patient stands (e.g., with some form of postural support) rather than sitting or lying down. In each case, the patient is immobilized in some way to ensure the patient's precise positioning relative to the beam port and beam axis, and to reduce or control any movement made by the patient during treatment delivery.

[0080] Generally, neutron beams used in NCT are generated using a beam system that includes a charged particle beamline and a target for generating neutrons from the charged particle beam, and delivered to the treatment room. Figure 7A is a schematic diagram of an example beam system 10 for use in embodiments of the present disclosure. In Figure 7A, the beam system 10 includes a source 12, a low-energy beamline (LEBL) 14, an accelerator 16 coupled to the low-energy beamline (LEBL) 14, and a high-energy beamline (HEBL) 16 extending from the accelerator 16 to a target 99. The LEBL 14 is configured to transport the beam from the source 12 to the input of the accelerator 16, which is then configured to generate the beam by accelerating the beam transported by the LEBL 14, and the HEBL 18 transports the beam from the output of the accelerator 40 to the target 99. The target 99 can be a structure configured to produce a desired result in response to stimuli applied by the projected beam, or the properties of the beam can be modified. The target 99 can be a component of system 10, or a workpiece that is at least partially modified or manufactured by system 10.

[0081] Figure 7B is a schematic diagram illustrating another exemplary embodiment of a neutron beam system 10 for use in NCT. Here, the source 12 is an ion source and the accelerator 16 is a tandem accelerator. The neutron beam system 10 includes a pre-accelerator system 20 that functions as a charged particle beam injector, a high-voltage (HV) tandem accelerator 16 coupled to the pre-accelerator system 20, and a HEBL 18 extending from the tandem accelerator 16 to a neutron target assembly 95 housing a target 99 (not shown). In this example, the target 99 is configured to generate neutrons in response to a shock from protons of sufficient energy and can be referred to as a neutron-generating target.

[0082] The pre-accelerator system 20 is configured to transport an ion beam from the ion source 12 to the input (e.g., the input aperture) of the tandem accelerator 16, and therefore also functions as the LEBL 14. The tandem accelerator 16 is powered by a coupled high-voltage power supply 42 and can produce a proton beam having energy approximately twice the voltage applied to the accelerating electrodes positioned within the accelerator 16. The energy level of the proton beam can be achieved by accelerating a beam of negative hydrogen ions from the input of the accelerator 16 to the innermost high-potential electrode, removing two electrons from each ion, and then accelerating the resulting protons downstream by the same applied voltage.

[0083] HEBL18 can transfer a proton beam from the output of accelerator 16 to a target in a neutron target assembly 95 positioned at the end of a beamline branch 70 extending into a patient treatment room. System 10 can be configured to direct the proton beam to any number of one or more targets and associated treatment areas. In this embodiment, HEBL18 includes three branches 70, 80, and 90 that can extend into three different patient treatment rooms, each branch being terminated in a target assembly 95 and a downstream beam shaping device (not shown). HEBL18 may include a pump chamber 51, quadrupole magnets 52 and 72 for preventing beam defocusing, deflection magnets 56 and 58 for guiding the beam into the treatment room, a beam corrector 53, diagnostics such as current monitors 54 and 76, a fast beam position monitor 55 section, and a scanning magnet 74.

[0084] The design of HEBL18 depends on the configuration of the treatment facility (e.g., a single-story treatment facility, a two-story treatment facility, etc.). The beam can be delivered to a target assembly 95 (e.g., located near the treatment room) using a deflection magnet 56. Quadrupole magnets 72 can then be included to focus the beam to a specific size on the target. The beam then passes through one or more scanning magnets 74, which provide lateral movement of the beam onto the target surface in a desired pattern (e.g., spiral, curved, stepped in rows and columns, and combinations thereof). Lateral movement of the beam can help achieve a smooth and uniform time-averaged distribution of the proton beam on the lithium target, prevent overheating, and make neutron production as uniform as possible within the lithium layer.

[0085] After entering the scanning magnet 74, the beam can be delivered to a current monitor 76 that measures the beam current. The target assembly 95 can be physically separated from the HEBL volume using a gate valve 77. The main function of the gate valve is to separate the beamline vacuum volume from the target while loading the target and replacing used targets with new ones. In the example, the beam may not be bent 90 degrees by the deflection magnet 56, but rather travels straight to the right in Figure 7B and then enters the quadrupole magnet 52 located in the horizontal beamline. The beam can then be bent to the required angle by another deflection magnet 58, depending on the building and room configuration. Otherwise, the deflection magnet 58 can be replaced with a Y-shaped magnet to split the beamline into two directions for two different treatment rooms located on the same floor. Each beamline direction may include a corresponding NCT subsystem that can deliver the therapeutic beam to the patient.

[0086] The treatment and delivery plans and various aspects of delivery described above are carried out using a computer system. Figure 8 is a block diagram of an exemplary computer system 800 that can be used to perform the operations described above. The system 800 includes a processor 810, memory 820, storage device 830, and input / output device 840. Each of the components 810, 820, 830, and 840 can be interconnected using, for example, a system bus 850. The processor 810 can process instructions for execution within the system 800. In some embodiments, the processor 810 is a single-threaded processor. In other embodiments, the processor 810 is a multi-threaded processor. The processor 810 can process instructions stored in memory 820 or storage device 830.

[0087] Memory 820 stores information within the system 800. In one embodiment, memory 820 is a computer-readable medium. In some embodiments, memory 820 is a volatile memory unit. In another embodiment, memory 820 is a non-volatile memory unit.

[0088] The storage device 830 can provide the system 500 with a large-capacity storage device. In some embodiments, the storage device 830 is a computer-readable medium. In various embodiments, the storage device 830 may include, for example, a hard disk device, an optical disk device, a storage device shared over a network by multiple computing devices (e.g., a cloud storage device), or some other large-capacity storage device.

[0089] The input / output device 840 provides input / output operation to the system 800. In some embodiments, the input / output device 840 may include one or more of the following: a network interface device, e.g., an Ethernet® card; a serial communication device, e.g., an RS-232 port; and / or a wireless interface device, e.g., an 802.11 card. In another embodiment, the input / output device may include a driver device configured to receive input data and send output data to other input / output devices, e.g., a keyboard, a printer, and a display device 860. However, other embodiments, e.g., mobile computing devices, mobile communication devices, set-top box television client devices, etc., may also be used.

[0090] While Figure 8 illustrates an exemplary processing system, the subject matter and functional operating embodiments described herein can be implemented in other types of digital electronic circuits, or in computer software, firmware, or hardware, or a combination of one or more thereof, including the structures disclosed herein and their structural equivalents.

[0091] The subjects and embodiments of operation described herein can be implemented in digital electronic circuits, or in computer software, firmware, or hardware, or in one or more combinations thereof, including the structures disclosed herein and their structural equivalents. Embodiments of the subjects described herein can be implemented as one or more computer programs, i.e., one or more modules of computer program instructions encoded in a computer storage medium to control the execution or operation of a data processing device. Alternatively, or in addition, the program instructions can be encoded on artificially generated propagating signals, such as machine-generated electrical, optical, or electromagnetic signals generated to encode information for transmission to a receiver suitable for execution by a data processing device. The computer storage medium can be or may be a computer-readable storage device, a computer-readable storage board, a random or serial access memory array or device, or one or more combinations thereof. Furthermore, the computer storage medium can be the source or destination of computer program instructions encoded in artificially generated propagating signals, although the computer storage medium is not a propagating signal itself. Computer storage media can also consist of or be comprised of one or more separate physical components or media (e.g., multiple CDs, disks, or other storage devices).

[0092] The operations described herein can be implemented by a data processing device as operations performed on data stored in one or more computer-readable storage devices or on data received from other sources.

[0093] The term "data processing device" encompasses all types of devices, machines, and equipment for processing data, including, for example, programmable processors, computers, systems-on-chips, or a combination of several of the above. Devices may include specialized logic circuits, such as FPGAs (Field-Programmable Gate Arrays) or ASICs (Application-Specific Integrated Circuits). In addition to hardware, devices may include code that creates an execution environment for computer programs, such as processor firmware, protocol stacks, database management systems, operating systems, cross-platform runtime environments, virtual machines, or a combination of one or more of these. Devices and execution environments can realize various computing model infrastructures, such as web services, distributed computing, cloud-based computing, and grid computing infrastructure.

[0094] Computer programs (also known as programs, software, software applications, scripts, or code) can be written in any form of programming language, including compiled or interpreted languages, declarative or procedural languages, and can be deployed as standalone programs or in any form, including modules, components, or subroutines, objects, or other components suitable for use in a computing environment. Computer programs may, though not required, correspond to files in a file system. A program may be stored in part of a file that maintains other programs or data (e.g., one or more scripts stored within a markup language document), in a single file dedicated to the program, or in multiple interconnected files (e.g., a file storing one or more modules, subprograms, or parts of code). Computer programs may be run on a single computer, or deployed and run on multiple computers, which may be located in one site or distributed across multiple sites and interconnected by a communication network, including cloud-based computing hardware provided by third parties.

[0095] The processes and logic flows described herein can be executed by one or more programmable processors that run one or more computer programs that perform a function by acting on input data and producing an output. The processes and logic flows can also be executed by special-purpose logic circuits, such as FPGAs (Field-Programmable Gate Arrays) or ASICs (Application-Specific Integrated Circuits), or the device can be implemented as such a circuit.

[0096] Processors suitable for executing computer programs include, for example, both general-purpose and specialized microprocessors. Generally, a processor receives instructions and data from read-only memory, random-access memory, or both. The most important elements of a computer are the processor for performing actions according to instructions, and one or more memory devices for storing instructions and data. Generally, a computer also includes, or is operablely connected to, one or more mass storage devices for storing data, such as magnetic disks, magneto-optical disks, or optical disks, in order to receive data from them, transfer data, or both. However, a computer is not required to have such devices. Furthermore, a computer can be incorporated into other devices, for example, a mobile phone, a personal digital assistant (PDA), a portable audio or video player, a game console, a Global Positioning System (GPS) receiver, or a portable storage device, such as a Universal Serial Bus (USB) flash drive. Devices suitable for storing computer program instructions and data include all forms of non-volatile memory, media, and memory devices, including, for example, semiconductor memory devices such as EPROM, EEPROM, and flash memory devices; magnetic disks such as internal hard disks or removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks. Processors and memory may be supplemented by or incorporated into special-purpose logic circuits.

[0097] To provide user interaction, embodiments of the subject matter described herein can be implemented on a computer having a display device for displaying information to the user, such as a CRT (cathode ray tube) or LCD (liquid crystal display) monitor, and a keyboard and pointing device, such as a mouse or trackball, on which the user can provide input to the computer. Other types of devices can also be used to provide user interaction, for example, feedback provided to the user may be any form of sensory feedback, such as visual feedback, auditory feedback, or tactile feedback, and input from the user may be received in any form, including acoustic input, speech input, or tactile input. In addition, the computer can interact with the user by sending documents to and receiving them from the user's device, for example, by sending a web page to a web browser on the user's client device in response to a request received from a web browser.

[0098] Embodiments of the subject matter described herein can be implemented in a computing system that includes, for example, a data server as a backend component, a middleware server as a middleware server, or a client computer having a graphical user interface or web browser that allows a user to interact with the embodiment of the subject matter described herein, or any combination of one or more such backend, middleware, or frontend components. The components of the system can be interconnected by any form or medium of digital data communication, such as a communication network. Examples of communication networks include local area networks ("LANs") and wide area networks ("WANs"), internetworks (e.g., the Internet), and peer-to-peer networks (e.g., ad-hoc peer-to-peer networks).

[0099] A computing system can include clients and servers. Clients and servers are generally remote from each other and typically interact through a communication network. The relationship between the client and server arises from computer programs running on each computer that have a client-server relationship with each other. In some embodiments, the server transmits data (e.g., an HTML page) to the client device (for example, to display data to a user interacting with the client device and to receive user input from there). Data generated on the client device (e.g., the results of user interactions) can be received from the client device by the server.

[0100] Numbered paragraphs In some embodiments, the inventions provided in this disclosure may be described by reference to the following numbered paragraphs. 1. A method for exposing a patient to a neutron beam in accordance with a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the method comprising: obtaining a first tomographic image of the patient, the first tomographic image comprising information relating to the tumor; determining a simulation plan for the patient based on the first tomographic image, the simulation plan comprising: a set of immobilization instructions for immobilizing the patient to a treatment platform in a treatment room from which the patient is exposed to the neutron beam through a beamport; and a preliminary beam selection comprising one or more beams for the treatment; and simulating the treatment of the patient based on the simulation plan, the simulation being performed in either the treatment room or a treatment emulation room comprising a treatment platform emulator and a beamport emulator. A method comprising: simulating within a treatment platform or treatment platform emulator in accordance with the set of immobilization instructions; changing the relative position between the treatment platform and the beam port, or between the treatment platform emulator and the beam port emulator, for each of the beams of the preliminary beam selection while the patient is immobilized; and verifying the preliminary beam selection based on the relative position between the treatment platform and the beam port, or between the treatment platform emulator and the beam port emulator, while the patient is immobilized; establishing a final treatment plan for the patient based on the verification of the preliminary beam selection; and treating the patient by exposing the patient to the neutron beam in the treatment chamber in accordance with the treatment plan. 2. The method according to paragraph 1, further comprising obtaining a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions. 3. The method described in paragraph 2, wherein the second tomographic image is obtained as part of the simulation. 4. The method according to paragraph 2, wherein the second tomographic image is acquired while the patient is immobilized against the treatment platform or the treatment platform emulator. 5. The method according to paragraph 2, wherein the second tomographic image is acquired while the patient is immobilized on a platform different from the treatment platform or the treatment platform emulator. 6. The method according to paragraph 2, wherein the second tomographic image is acquired in a facility separate from the facility where the patient is being treated. 7. The method according to paragraph 1, wherein changing the relative position between the simulation platform and the simulation port includes changing a degree of freedom selected from the group consisting of lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle. 8. The method according to paragraph 1, wherein the set of immobilization instructions specifies a setup of one or more immobilization devices and / or assistive devices, and immobilizing the patient to the treatment platform or the treatment platform emulator includes using the setup of the one or more immobilization devices and / or assistive devices to fix the patient to the treatment platform or the treatment platform emulator. 9. The method according to paragraph 8, wherein the one or more immobilization devices include at least one of a thermoplastic mask and a vacuum curing bag. 10. The method according to paragraph 8, wherein the setup of the one or more immobilization devices is the same for each of the one or more beams of the preliminary beam selection. 11. The method according to paragraph 1, wherein establishing the treatment plan for the patient based on the one or more beams from the preliminary beam selection comprises, for each of the one or more beams of the preliminary beam selection, setting a single pitch angle of the treatment platform for the one or more beams, setting a single roll angle of the treatment platform for the one or more beams, and setting different yaw angles of the treatment platform for each of the one or more beams. 12. The method according to paragraph 11, wherein the one or more beams include a total of two beams or a total of three beams. 13. The method according to paragraph 1, wherein treating the patient by exposing the patient to the neutron beam in accordance with the treatment plan comprises selecting a collimator for the beam port in accordance with the one or more beams specified by the treatment plan. 14. The method according to paragraph 1, wherein each of the one or more beams of the preliminary beam selection includes a different beam incidence angle to the patient. 15. The method of paragraph 2, wherein acquiring the second tomographic image of the patient while the patient is immobilized comprises acquiring the second tomographic image of the patient using a portable CT scanner while the patient is immobilized against the treatment platform or the treatment platform emulator. 16. The method according to paragraph 1, wherein the first tomographic image is a magnetic resonance (MR) image or a computed tomography (CT) scan image. 17. The method according to paragraph 1, wherein determining the simulation plan includes specifying the point and / or shape contour of the neutron beam for a preliminary dose assessment for the treatment, and making the preliminary beam selection based on the preliminary dose assessment. 18. The method according to paragraph 1, wherein determining the simulation plan includes estimating the dose for each beam of the preliminary beam selection. 19. The method according to paragraph 1, wherein the simulation includes immobilizing the patient according to the set of immobilization instructions using surface image guidance. 20. The method according to paragraph 1, wherein determining the simulation plan further includes specifying the surface structure of the patient's skin surface, and simulating includes positioning the patient on the treatment platform or the treatment platform emulator using surface image guidance and according to the surface structure of the patient's skin surface specified by the simulation plan. 21. The method according to paragraph 1, wherein the simulation includes checking that the distance from the patient's surface to the source to the beam port or beam port emulator is within a threshold distance for each of the beam exposure settings. 22. The method according to paragraph 1, wherein the simulation includes determining the distance from the patient's surface to the source to the beam port or beam port emulator, and the final treatment plan is established based on the distance from the surface to the source. 23. The method according to paragraph 1, wherein the simulation includes verifying that the patient or the treatment platform does not collide with any object for each of the beam exposure settings. 24. The method according to paragraph 1, wherein the patient is immobilized in a non-supine position. 25. The method according to paragraph 2, wherein establishing the treatment plan includes fusing the second tomographic image with the first tomographic image to generate a fused image. 26. The method according to paragraph 25, comprising contouring the fused image by assigning each voxel of the fused image to a structural type among a plurality of structural types. 27. The method according to paragraph 26, wherein the plurality of structural types include a tumor or target and one or more organs at risk. 28. The method according to paragraph 1, wherein establishing the treatment plan includes calculating the final neutron beam dose for the treatment based on the material properties of the patient's anatomical structure. 29. The method according to paragraph 1, wherein establishing the treatment plan includes estimating the blood boron concentration for the patient. 30. The method according to paragraph 1, wherein positioning the patient on the treatment platform or the treatment platform emulator for each of the preliminary beam selections includes operating actuators coupled to the treatment platform or the treatment platform emulator to change one or more of the lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle of the treatment platform in order to determine the position of the treatment platform or the treatment platform emulator relative to the axis of the neutron beam, and marking the position of the treatment platform or the treatment platform emulator as the treatment position for the neutron beam. 31. The method according to paragraph 30, wherein each of the one or more beams of the preliminary beam selection includes a different beam incidence angle to the patient, and positioning the patient on the treatment platform or the treatment platform emulator involves operating the actuator to change one or more of the lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle of the treatment platform such that the treatment positions of the one or more beams of the preliminary beam selection share the same pitch angle and the same roll angle. 32. The method according to paragraph 1, wherein positioning the patient on the treatment platform or the treatment platform emulator for each of the preliminary beam selections includes acting an actuator coupled to the treatment platform or the treatment platform emulator to change one or more of the lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle of the treatment platform or the treatment platform emulator in order to determine the position of the treatment platform or the treatment platform emulator relative to the axis of the neutron beam, and recording the distance from the source to the skin (SSD) of the patient as the treatment position of the neutron beam. 33. The method according to paragraph 1, wherein treating the patient by exposing the patient to the neutron beam in accordance with the treatment plan comprises positioning the patient on the treatment platform in the treatment chamber, immobilizing the patient against the treatment platform in accordance with the set of immobilization instructions, and exposing the patient to one or more beams specified by the treatment plan. 34. The method according to paragraph 1, wherein determining the simulation plan for the patient based on the first tomographic image comprises determining the estimated neutron beam dose corresponding to one or more beams of the preliminary beam selection; determining the desired neutron beam dose for the treatment; and adjusting the one or more beams of the preliminary beam selection such that the estimated neutron beam dose matches the desired neutron beam dose for the treatment. 35. The method according to paragraph 34, further comprising adjusting the set of fixing instructions after adjusting the one or more beams of the preliminary beam selection. 36. The method according to paragraph 1, wherein treating the patient by exposing the patient to the neutron beam in accordance with the treatment plan comprises injecting the patient with a delivery agent, determining the concentration of the delivery agent in the patient's blood, and, based on the concentration, selecting an exposure sequence of one or more neutron beams to expose the patient during treatment. 37. The method according to paragraph 1, wherein treating the patient by exposing the patient to the neutron beam in accordance with the treatment plan comprises performing dose modeling for each of the one or more beams to determine the beam exposure to the neutron beam. 38. The method according to paragraph 37, wherein performing the dose modeling includes incorporating information about the uptake of the delivery agent within the patient obtained during or after the administration of the delivery agent to the patient. 39. The method according to paragraph 1, wherein the NCT is boron neutron capture therapy. 40. The method according to paragraph 2, wherein the first tomographic image is an initial tomographic image and the second tomographic image is a primary tomographic image. 41. A system for exposing a patient to a neutron beam in accordance with a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the system comprising: a treatment platform, which is a treatment chamber configured to support the patient and is coupled to actuators to change the relative position of the treatment platform with respect to a beam port for the neutron beam; and a treatment planning and delivery subsystem communicatively coupled to the treatment platform, the treatment planning and delivery subsystem comprising: (i) receiving a first tomographic image of the patient, wherein the first tomographic image includes information relating to the tumor; and (ii) receiving the first tomographic image A system configured to: (iii) determine a simulation plan for the patient based on tomographic images, wherein the simulation plan includes a set of immobilization instructions and a preliminary beam selection including one or more beams for the treatment; (iii) perform a simulation of the treatment for the patient based on the simulation plan using the treatment platform or treatment platform emulator to verify the preliminary beam selection for the treatment; and (iv) establish a final treatment plan for the patient based on the simulation and a second tomographic image taken while the patient is immobilized according to the set of immobilization instructions. 42. The system according to paragraph 40, further comprising a surface imaging guidance subsystem including one or more cameras positioned within the treatment chamber, wherein the surface imaging guidance subsystem is communicably coupled to the treatment planning and delivery subsystem and is configured to generate data characterizing the position of the patient on the treatment platform relative to the beam port. 43. A method of exposing a patient to a neutron beam in accordance with a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the method comprising: obtaining a first tomographic image of the patient, the first tomographic image comprising information relating to the tumor; determining a simulation plan for the patient based on the first tomographic image, the simulation plan comprising a preliminary beam selection including a set of immobilization instructions for immobilizing the patient to a beam port and one or more beams for the treatment; and simulating the treatment of the patient based on the simulation plan, the simulation including (i) the treatment room or a treatment emulator including a beam port emulator. A method comprising: (ii) immobilizing the patient in any of the treatment rooms according to the set of immobilization instructions; (ii) changing the relative position between the patient and the beam port or between the patient and the beam port emulator for each of the beams of the preliminary beam selection while the patient is immobilized; and (iii) verifying the preliminary beam selection based on the relative position between the patient and the beam port or between the patient and the beam port emulator while the patient is immobilized; establishing a final treatment plan for the patient based on the verification of the preliminary beam selection; and treating the patient by exposing the patient to the neutron beam in the treatment room according to the treatment plan. 44. The method according to paragraph 43, wherein the patient is immobilized while being positioned on a support device. 45. The method according to paragraph 44, wherein the support device is selected from the group consisting of a treatment platform and a chair. 46. ​​The patient is immobilized while standing, as described in paragraph 43. 47. A system comprising one or more memory devices storing instructions, and one or more data processing devices configured to interact with the one or more memory devices, wherein, upon execution of the instructions, the one or more data processing devices perform the following operations: in a simulation planning engine, receive a first tomographic image of the patient containing information about a tumor within the patient; use the simulation planning engine to determine a simulation plan based on the first tomographic image, wherein the simulation plan includes a set of immobilization instructions for immobilizing the patient against a treatment platform in a treatment chamber where the patient is exposed to a neutron beam through a beam port, and a preliminary beam selection including one or more beams for the treatment; output the simulation plan; in a treatment planning engine, receive the results of a simulation based on the simulation plan and a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions; and establish a final treatment plan for the patient to treat the tumor using neutron capture therapy (NCT) based on the results of the simulation. 48. A computer-aided implementation method comprising: a simulation planning engine receiving a first tomographic image of a patient containing information about a tumor within the patient; determining a simulation plan based on the first tomographic image using the simulation planning engine, the simulation plan including a set of immobilization instructions for immobilizing the patient to a treatment platform in a treatment chamber where the patient is exposed to a neutron beam through a beam port, and a preliminary beam selection including one or more beams for the treatment; outputting the simulation plan; a treatment planning engine receiving the results of a simulation based on the simulation plan and a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions; and establishing a final treatment plan for the patient to treat the tumor using neutron capture therapy (NCT) based on the results of the simulation. 49. A non-temporary computer-readable medium for storing instructions, wherein, when executed by one or more data processing devices, the instructions enable one or more data processing devices to perform operations including: receiving a first tomographic image of the patient containing information about a tumor within the patient in a simulation planning engine; determining a simulation plan based on the first tomographic image using the simulation planning engine, the simulation plan including a set of immobilization instructions for immobilizing the patient against a treatment platform in a treatment chamber where the patient is exposed to a neutron beam through a beam port, and a preliminary beam selection including one or more beams for the treatment; outputting the simulation plan; receiving the results of a simulation based on the simulation plan and a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions in the treatment planning engine; and establishing a final treatment plan for the patient to treat the tumor using neutron capture therapy (NCT) based on the results of the simulation.

[0101] Other Embodiments It should be noted that all features, elements, components, functions, and steps described in relation to any embodiment provided herein are intended to be freely combined and substituted with those of other embodiments. If a particular feature, element, component, function, or step is described in relation to only one embodiment, unless expressly stated otherwise, that feature, element, component, function, or step can be used in all other embodiments described herein. Thus, this paragraph serves as a prior foundation and written support for introducing the claims, at any point in time, even if the following description does not explicitly state that such combinations or substitutions are possible in a particular example, by combining features, elements, components, functions, and steps from different embodiments, or substituting features, elements, components, functions, and steps from one embodiment with features, elements, components, functions, and steps from another embodiment. In particular, it is explicitly recognized that explicitly describing all possible combinations and substitutions would be unduely burdensome, given that the permissibility of each such combination and substitution is readily apparent to those skilled in the art.

[0102] To the extent that embodiments disclosed herein include or operate in relation to memory, storage, and / or computer-readable media, such memory, storage, and / or computer-readable media are non-temporary. Therefore, to the extent that memory, storage, and / or computer-readable media are covered by one or more claims, such memory, storage, and / or computer-readable media are merely non-temporary.

[0103] As used herein and in the appended claims, the singular forms "a," "an," and "the" refer to multiple subjects unless the context clearly indicates otherwise.

[0104] While various modifications and alternative forms are possible for this embodiment, specific examples are shown in the drawings and described in detail herein. However, it should be understood that these embodiments are not limited to the disclosed forms, but rather encompass all modifications, equivalents, and alternatives that fall within the spirit of this disclosure. Furthermore, any feature, function, step, or element of the embodiment may be described or added to the claims, and any feature, function, step, or element not included in the claims may also be described or added to the claims as a negative limitation that defines the inventive scope of the claims.

[0105] Other embodiments are within the scope of the following claims.

Claims

1. A method of exposing a patient to a neutron beam in accordance with a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), wherein the method is: To obtain a first tomographic image of the patient, wherein the first tomographic image includes information about the tumor. Determining a simulation plan for the patient based on the first tomographic image, wherein the simulation plan includes a set of immobilization instructions for immobilizing the patient to a treatment platform in a treatment room from which the patient is exposed to the neutron beam through a beamport, and a preliminary beam selection including one or more beams for the treatment. The simulation involves simulating the treatment of the patient based on the simulation plan, and the simulation involves, (i) Immobilizing the patient on the treatment platform or the treatment platform emulator in either the treatment room or a treatment emulation room equipped with a treatment platform emulator and a beamport emulator, in accordance with the set of immobilization instructions. (ii) while the patient is immobilized, changing the relative position between the treatment platform and the beam port, or between the treatment platform emulator and the beam port emulator, for each of the beams of the preliminary beam selection, and (iii) Simulating, including verifying the preliminary beam selection based on the relative position between the treatment platform and the beam port, or between the treatment platform emulator and the beam port emulator, while the patient is immobilized. Based on the verification of the preliminary beam selection, a final treatment plan for the patient will be established. A method comprising treating the patient by exposing the patient to the neutron beam in the treatment room in accordance with the treatment plan.

2. The method according to claim 1, further comprising obtaining a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions.

3. The method according to claim 2, wherein the second tomographic image is obtained as part of the simulation.

4. The method according to claim 2, wherein the second tomographic image is acquired while the patient is immobilized to the treatment platform or the treatment platform emulator.

5. The method according to claim 2, wherein the second tomographic image is acquired while the patient is immobilized on a platform different from the treatment platform or the treatment platform emulator.

6. The method according to claim 2, wherein the second tomographic image is acquired in a facility separate from the facility where the patient is treated.

7. The method according to claim 1, wherein changing the relative position between the simulation platform and the simulation port includes changing a degree of freedom selected from the group consisting of lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle.

8. The set of immobilization instructions specifies the setup of one or more immobilization devices and / or assistive devices, and immobilizes the patient to the treatment platform or the treatment platform emulator, The method according to claim 1, comprising fixing the patient to the treatment platform or the treatment platform emulator using the setup of one or more immobilization devices and / or assistive devices.

9. The method according to claim 8, wherein the one or more immobilization devices comprises at least one of a thermoplastic mask and a vacuum curing bag.

10. The method according to claim 8, wherein the setup of the one or more immobilization devices is the same for each of the one or more beams of the preliminary beam selection.

11. Establishing the treatment plan for the patient based on one or more beams from the preliminary beam selection means that for each of the one or more beams of the preliminary beam selection, Setting a single pitch angle of the treatment platform for one or more of the aforementioned beams, Setting a single roll angle of the treatment platform for one or more of the aforementioned beams, The method according to claim 1, comprising setting different yaw angles of the treatment platform for each of the one or more beams.

12. The method according to claim 11, wherein the one or more beams include a total of two beams or a total of three beams.

13. Treating the patient by exposing him to the neutron beam in accordance with the treatment plan is, The method according to claim 1, comprising selecting a collimator for the beam port according to the one or more beams specified by the treatment plan.

14. The method according to claim 1, wherein each of the one or more beams of the preliminary beam selection includes a different beam incidence angle to the patient.

15. Acquiring the second tomographic image of the patient while the patient is immobilized is, The method according to claim 2, comprising using a portable CT scanner to acquire a second tomographic image of the patient while the patient is immobilized against the treatment platform or the treatment platform emulator.

16. The method according to claim 1, wherein the first tomographic image is a magnetic resonance (MR) image or a computed tomography (CT) scan image.

17. The method according to claim 1, wherein determining the simulation plan includes specifying a point and / or shape contour of the neutron beam for a preliminary dose assessment for the treatment, and performing the preliminary beam selection based on the preliminary dose assessment.

18. The method according to claim 1, wherein determining the simulation plan includes estimating the dose for each beam of the preliminary beam selection.

19. The method according to claim 1, wherein the simulation includes immobilizing the patient according to the set of immobilization instructions using surface image guidance.

20. Determining the simulation plan further includes specifying the surface structure of the patient's skin surface, and simulating is The method according to claim 1, comprising positioning the patient on the treatment platform or the treatment platform emulator using surface image guidance and according to the surface structure of the patient's skin surface as specified by the simulation plan.

21. The method according to claim 1, wherein the simulation includes checking that the distance from the patient's surface to the source to the beamport or beamport emulator is within a threshold distance for each of the beam exposure settings.

22. The method according to claim 1, wherein the simulation includes determining the distance from the patient's surface to the source to the beamport or beamport emulator, and the final treatment plan is established based on the distance from the surface to the source.

23. The method according to claim 1, wherein the simulation includes verifying that the patient or the treatment platform does not collide with any object for each of the beam exposure settings.

24. The method according to claim 1, wherein the patient is immobilized in a non-supine position.

25. The method according to claim 2, wherein establishing the treatment plan includes fusing the second tomographic image with the first tomographic image to generate a fused image.

26. The method according to claim 25, comprising contouring the fused image by assigning each voxel of the fused image to a structural type among a plurality of structural types.

27. The method according to claim 26, wherein the plurality of structural types include a tumor or target and one or more organs at risk.

28. The method according to claim 1, wherein establishing the treatment plan includes calculating the final neutron beam dose for the treatment based on the material properties of the patient's anatomical structure.

29. The method according to claim 1, wherein establishing the treatment plan includes estimating the blood boron concentration in the patient.

30. Positioning the patient on the treatment platform or the treatment platform emulator for each of the preliminary beam selections is: In order to determine the position of the treatment platform or the treatment platform emulator relative to the axis of the neutron beam, actuators coupled to the treatment platform or the treatment platform emulator are operated to change one or more of the lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle of the treatment platform. The method according to claim 1, comprising marking the position of the treatment platform or the treatment platform emulator as the treatment position of the neutron beam.

31. Each of the one or more beams of the preliminary beam selection includes a different beam incidence angle to the patient, and positioning the patient on the treatment platform or the treatment platform emulator is The method according to claim 30, comprising operating the actuator to change one or more of the lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle of the treatment platform such that the treatment positions of one or more beams of the preliminary beam selection share the same pitch angle and the same roll angle.

32. Positioning the patient on the treatment platform or the treatment platform emulator for each of the preliminary beam selections is: In order to determine the position of the treatment platform or the treatment platform emulator relative to the axis of the neutron beam, actuators coupled to the treatment platform or the treatment platform emulator are operated to change one or more of the lateral position, vertical position, longitudinal position, pitch angle, roll angle, and yaw angle of the treatment platform or the treatment platform emulator. The method according to claim 1, comprising recording the distance from the radiation source to the patient's skin (SSD) as the treatment position of the neutron beam.

33. Treating the patient by exposing him to the neutron beam in accordance with the treatment plan is, Positioning the patient on the treatment platform within the treatment room, To immobilize the patient to the treatment platform according to the set of immobilization instructions, The method according to claim 1, comprising exposing the patient to one or more beams specified by the treatment plan.

34. Determining the simulation plan for the patient based on the first tomographic image is: Determining the estimated neutron beam dose corresponding to one or more beams in the preliminary beam selection, To determine the desired neutron beam dose for the aforementioned treatment, The method according to claim 1, comprising adjusting one or more beams of the preliminary beam selection so that the estimated neutron beam dose matches the desired neutron beam dose for treatment.

35. The method according to claim 34, further comprising adjusting the set of fixing instructions after adjusting the one or more beams of the preliminary beam selection.

36. Treating the patient by exposing him to the neutron beam in accordance with the treatment plan is, Injecting the delivery agent into the aforementioned patient, To determine the concentration of the delivery agent in the blood of the patient, The method according to claim 1, comprising selecting an exposure sequence of one or more neutron beams to expose the patient during treatment, based on the concentration.

37. Treating the patient by exposing him to the neutron beam in accordance with the treatment plan is, for each of the one or more beams, The method according to claim 1, comprising performing dose modeling to determine the beam exposure amount to the neutron beam.

38. The method according to claim 37, wherein performing the dose modeling includes incorporating information about the uptake of the delivery agent within the patient obtained during or after the administration of the delivery agent to the patient.

39. The method according to claim 1, wherein the NCT is boron neutron capture therapy.

40. The method according to claim 2, wherein the first tomographic image is an initial tomographic image and the second tomographic image is a primary tomographic image.

41. A system for exposing a patient to a neutron beam in accordance with a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), wherein the system is A treatment platform in a treatment room configured to support the patient, the treatment platform being coupled to an actuator to change the relative position of the treatment platform with respect to a beam port for the neutron beam, The treatment platform comprises a treatment planning and delivery subsystem that is communicatively coupled to the treatment platform, and the treatment planning and delivery subsystem is (i) Receiving a first tomographic image of the patient, wherein the first tomographic image includes information relating to the tumor. (ii) Determining a simulation plan for the patient based on the first tomographic image, wherein the simulation plan includes a set of immobilization instructions and a preliminary beam selection including one or more beams for the treatment, (iii) To verify the preliminary beam selection for the treatment, to perform a simulation of the treatment of the patient based on the simulation plan using the treatment platform or treatment platform emulator, (iv) A system configured to establish a final treatment plan for the patient based on the simulation and a second tomographic image taken while the patient is immobilized according to the set of immobilization instructions.

42. The system according to claim 40, further comprising a surface imaging guidance subsystem having one or more cameras positioned within the treatment chamber, wherein the surface imaging guidance subsystem is communicably coupled to the treatment planning and delivery subsystem and is configured to generate data characterizing the position of the patient on the treatment platform relative to the beam port.

43. A method of exposing a patient to a neutron beam in accordance with a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), wherein the method is: To obtain a first tomographic image of the patient, wherein the first tomographic image includes information about the tumor. Determining a simulation plan for the patient based on the first tomographic image, wherein the simulation plan includes a set of immobilization instructions for immobilizing the patient to a beamport, and a preliminary beam selection including one or more beams for the treatment. The simulation involves simulating the treatment of the patient based on the simulation plan, and the simulation involves, (i) Immobilizing the patient in either the treatment room or a treatment emulation room including a beamport emulator, according to the set of immobilization instructions. (ii) While the patient is immobilized, change the relative position between the patient and the beamport, or between the patient and the beamport emulator, with respect to each of the beams of the preliminary beam selection, and (iii) Simulating, including verifying the preliminary beam selection based on the relative position between the patient and the beamport, or between the patient and the beamport emulator, while the patient is immobilized. Based on the verification of the preliminary beam selection, a final treatment plan for the patient will be established. A method comprising treating the patient by exposing the patient to the neutron beam in the treatment room in accordance with the treatment plan.

44. The method according to claim 43, wherein the patient is immobilized while being positioned on a support device.

45. The method according to claim 44, wherein the support device is selected from the group consisting of a treatment platform and a chair.

46. The method according to claim 43, wherein the patient is immobilized while standing.

47. It is a system, One or more memory devices that store instructions, The system comprises one or more data processing devices configured to interact with one or more memory devices, and the one or more data processing devices, when executing the instruction, In the simulation planning engine, the first tomographic image of the patient containing information about tumors within the patient is received, Determining a simulation plan based on the first tomographic image using the simulation planning engine, wherein the simulation plan includes a set of immobilization instructions for immobilizing the patient to a treatment platform within a treatment platform in a treatment room where the patient is exposed to a neutron beam through a beam port, and a preliminary beam selection including one or more beams for the treatment. Outputting the aforementioned simulation plan, The treatment planning engine receives the results of a simulation based on the simulation plan, and a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions. A system that performs operations including establishing a final treatment plan for the patient to treat the tumor using neutron capture therapy (NCT) based on the results of the simulation.

48. A computer implementation method, In the simulation planning engine, the first tomographic image of the patient containing information about tumors within the patient is received, Determining a simulation plan based on the first tomographic image using the simulation planning engine, wherein the simulation plan includes a set of immobilization instructions for immobilizing the patient to a treatment platform within a treatment platform in a treatment room where the patient is exposed to a neutron beam through a beam port, and a preliminary beam selection including one or more beams for the treatment. Outputting the aforementioned simulation plan, The treatment planning engine receives the results of a simulation based on the simulation plan, and a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions. A computer-aided method comprising establishing a final treatment plan for the patient to treat the tumor using neutron capture therapy (NCT) based on the results of the simulation.

49. A non-temporary computer-readable medium for storing instructions, wherein when an instruction is executed by one or more data processing devices, the one or more data processing devices shall In the simulation planning engine, the first tomographic image of the patient containing information about tumors within the patient is received, Determining a simulation plan based on the first tomographic image using the simulation planning engine, wherein the simulation plan includes a set of immobilization instructions for immobilizing the patient to a treatment platform within a treatment platform in a treatment room where the patient is exposed to a neutron beam through a beam port, and a preliminary beam selection including one or more beams for the treatment. Outputting the aforementioned simulation plan, The treatment planning engine receives the results of a simulation based on the simulation plan, and a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions. A non-temporary computer-readable medium that performs an operation including establishing a final treatment plan for the patient to treat the tumor using neutron capture therapy (NCT) based on the results of the simulation.

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