Neutron capture therapy (NCT) treatment planning and delivery

Abstract

Methods and systems for exposing a patient to a neutron beam according to a treatment plan for treating a tumor in the patient using boron neutron capture therapy (NCT) are disclosed.

Description

[0001] NEUTRON CAPTURE THERAPY (NCT) TREATMENT PLANNING AND DELIVERY

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS

[0003] This application is an International Application which claims priority to U.S. Provisional Patent Application No. 63 / 541,690, filed September 29, 2023. The disclosure of the foregoing application is hereby incorporated by reference in its entirety.

[0004] TECHNICAL FIELD

[0005] This specification relates to systems, devices, and methods for Neutron Capture Therapy (NCT) treatment planning and delivery.

[0006] BACKGROUND

[0007] Neutron capture therapy (NCT) is a modality of treatment of a variety of types of cancer, including some of the most difficult types. NCT is a technique that selectively aims to treat tumor cells while sparing the normal cells using a compound with a relatively high neutron capture cross-section, such as boron. In Boron NCT (BNCT), the boron compound allows for efficient uptake by a variety of cell types and selective drug accumulation at target sites, such as tumor cells. Boron loaded cells 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 when other isotopes are used. Examples of other isotopes with neutron capture cross-sections that are like or larger than Boron include3He,113Cd,135Xe,149Sm,151Eu,155Gd,157Gd, and147Hf. At least some of these isotopes, such as157Gd, can be useful for NCT.

[0008] 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 nuclei in the target to emit a beam of raw neutrons that can be used for NCT. The NCT patient treatment process often involves a sequence of exposures the neutron beam (simply referred to as “beams”) entering the patient at different angles and from different directions, to spread out entrance dose across more of the patient’s anatomy. However, patient treatment platforms are typically designed to with limited ranges of motion about various degrees of freedom, with ranges that can differ for different degrees of freedom. Moreover, it can be necessary to securely arrange the patient in atypical position on the platform (e.g., platforming a non-supine position) for one or more of the beams. This can result in numerous challenges for the NCT treatment planning and delivery process, e.g., this can necessitate obtaining multiple tomographic scans of the patient during treatment planning, procedures that are time consuming, expensive, and hazardous for the patient. Accordingly, there exists a need for a streamlined NCT treatment process that can ensure efficiency, reduce costs, and maximize patient safety.

[0009] SUMMARY

[0010] The subject matter described herein relates generally to systems, devices, and methods for Neutron Capture Therapy (NCT) treatment planning and delivery.

[0011] The details of one or more embodiments of the subject matter of this specification are set forth in the accompanying drawings and the description below. Other features, aspects, and advantages of the subject matter will become apparent from the description, the drawings, and the claims. In no way should the features of the example embodiments be construed as limiting the appended claims, absent express recitation of those features in the claims.

[0012] BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The details of the subject matter set forth herein, both as to its structure and operation, may be apparent by study of the accompanying figures. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the subject matter. Moreover, all illustrations are intended to convey concepts, where relative sizes, shapes and other detailed attributes may be illustrated schematically rather than literally or precisely.

[0014] FIG. 1 A is a flow diagram of an example treatment planning and delivery dataflow.

[0015] FIG. IB is a schematic diagram of an example NCT facility for NCT treatment planning and delivery.

[0016] FIG. 2 is a flow diagram of an example simulation planning stage of the treatment planning and delivery dataflow in more detail.

[0017] FIG. 3 is a flow diagram of an example simulation stage of the treatment planning and delivery dataflow in more detail.

[0018] FIG. 4 is a flow diagram an example treatment planning stage of the treatment planning and delivery dataflow in more detail.

[0019] FIG. 5 is a block diagram of an example treatment planning and delivery system.

[0020] FIG. 6 is a flow diagram of an example process for treatment planning and delivery. FIG. 7A is a schematic diagram of an example of a neutron beam system suitable for

[0021] NCT.

[0022] FIG. 7B is a more detailed schematic diagram of the example neutron beam system shown in FIG. 7A.

[0023] FIG. 8 is a flow diagram of an example computer system.

[0024] Like reference numbers and designations in the various drawings indicate like elements.

[0025] DETAILED DESCRIPTION

[0026] Before the present subject matter is described in detail, it is to be understood that this disclosure is not limited to the embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing embodiments only, and is not intended to be limiting, since the scope of the present disclosure will be limited only by the appended claims.

[0027] Example embodiments of systems, devices, and methods are described herein for Neutron Capture Therapy (NCT) treatment planning and delivery.

[0028] The NCT patient treatment process delivers a beam of epithermal neutrons (e.g., with an energy spectrum between one electronvolt (eV) and thirty kiloelectronvolts (keV)) to a patient for cancer treatment. In NCT, the neutrons are typically generated based on nuclear reactions of protons (e.g., a proton beam) colliding with either a beryllium or a lithium target device. The generated neutron beam has a broad range of energies and is emitted in a variety of 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.

[0029] Before the patient is treated with the neutron beam, the patient is infused with a delivery agent (e.g., a boron drug for BNCT, or drug based on another isotope where therapy is based on a different isotope). The delivery agent ensures a relatively high tumor uptake and a relatively low normal (e.g., non-cancerous) tissue uptake in the patient’s body. In this manner, when the patient is irradiated with the neutron beam during NCT treatment, radiation dose is preferentially delivered to the tumor while sparing surrounding tissue. Because the patient infusion with the delivery agent is time-sensitive, a precise and efficient NCT treatment plan that can streamline the treatment process and ensure the patient’s safety is desired. NCT treatment planning is a process that precedes treatment delivery and determines a set of treatment parameters for the NCT treatment delivery. The set of parameters can include, for example, the patient’s position on a treatment platform in a NCT treatment room with respect to a beam port through which the neutron beam is delivered, set of immobilization instructions of the patient with respect to the treatment platform, and quantity of neutrons to deliver for the neutron beam. The NCT treatment planning process generally involves determining the set of treatment parameters based on, among other information, one or more initial tomographic images of the patient’s anatomy.

[0030] The NCT patient treatment process often involves sequentially exposing the patient to multiple beams, each entering the patient at different angles and from different directions. Such beam delivery spreads out the entrance dose across more of the patient’s body than delivering the entire dose to a single beam. During treatment, the patient is positioned on the treatment platform in the NCT treatment room and immobilized using a set of immobilization instructions devices. This set of immobilization instructions setup ensures that the predetermined NCT beam angles with respect to the patient are satisfied for accurate and precise dose delivery when the patient is irradiated with the neutron beam.

[0031] However, patient treatment platforms are typically designed to provide limited movement, by amounts that can be different for different degrees of freedom. For example, patient treatment platforms can provide a relatively small amount of pitch (e.g., patient head up / down) and roll (e.g., patient head right / left) adjustment of the patient, but a relatively large amount of yaw (e.g., clockwise / counterclockwise rotations) adjustment of 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. Further, the neutron beam port is typically at a fixed location, and the patient has to be positioned relatively close to the beam port to minimize the air gap between the patient and the neutron beam and ensure effective penetration depth of the neutron beam.

[0032] As a result, conventional NCT treatment planning can include having the patient visit the treatment facility multiple times to ensure the patient is appropriately positioned for each of the multiple beams during NCT treatment, making the overall process expensive and inefficient. Moreover, conventional NCT treatment planning can include acquiring multiple tomographic images (e.g., computerized tomography (CT) scans) of the patient as part of the process, adding to the expense and complexity of the treatment, in addition to presenting further risks to the patient’s health. This specification describes a streamlined NCT treatment planning and delivery process that involves as few as just a single tomography scan to efficiently and accurately determine the patient’s position on the treatment platform 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 as few as a single visit to the treatment facility by the patient prior to treatment delivery. In active facilities where availability of the facility for planning purposes, rather than treatment itself, is limited, limiting the number of times a patient needs to visit the facility for planning can allow for more patients to be treated because the facility down time associated with planning is reduced.

[0033] In general, NCT treatment planning and delivery includes a flow of data implemented by a system that includes a combination of hardware, software, and firmware, including one or more servers, a tomographic imaging facility, and a Boron Neutron Capture Therapy (NCT) facility. The server(s) include one or more software application programs to control operations for treatment planning and delivery described in this specification. The tomographic imaging sub-facility includes an imaging system (e.g., a CT scanner) that obtains a scan of the patient, and any other components and devices necessary for image acquisition. The NCT sub-facility includes neutron beam system for delivering the neutron beam, and a treatment room that includes a treatment platform for positioning the patient relative to a neutron beam port along with other appropriate components and devices required for NCT treatment delivery. The tomographic imaging sub-system, the NCT sub-system, and the server(s) are communicatively coupled through a network, e.g., a local area network (LAN), a wide area network (WAN), the Internet, or a combination thereof. A user (e.g., a clinician or team of clinicians, referred to collectively as a “clinical team”) of the treatment planning and delivery system can use the system to implement various aspects of the treatment planning and delivery dataflow described below.

[0034] Referring to FIG. 1 A, an example treatment planning and delivery dataflow 100 includes a sequence of stages implemented by the clinical team to determine a final treatment plan 108 for treating one or more tumors in the patient using NCT. Throughout this specification, the term “treatment plan” generally refers to a set of treatment parameters used for treating the patient using NCT at a treatment facility. The set of treatment parameters generally includes: a position of the patient on a treatment platform, directions and entrance angles of neutron beams, a dose delivered by the neutron beams, and / or any other appropriate parameters that can be used for treating the patient using NCT at the facility. The treatment planning and delivery dataflow 100 includes the following stages: (i) a simulation planning stage 120, (ii) a simulation stage 130, (iii) a treatment planning stage 140, and (iv) a treatment delivery stage 150. Generally, the stages of the dataflow 100 can take place over any appropriate window of time. For example, in some cases, all stages of the dataflow 100 can be implemented on the same day and / or during the same visit of the patient to the clinical facility. However, in some cases, the stages of the dataflow 100 are implemented over an extended period of time and / or multiple patient visits. In some other cases, each of the stages of the dataflow 100 are implemented on a separate day. Some or all stages of the dataflow 100 can be performed at different locations / facilities, e.g., in a NCT treatment room, a tomography scan room, a treatment emulation room, or any other appropriate location / facility. As a particular example, in some cases, the simulation planning stage 120 and the simulation stage 130 are performed, e.g., in a treatment emulation room that includes mock versions of equipment used to deliver NCT treatment to the patients such as a treatment platform and beam port. For example, treatment emulation room can include a treatment platform emulator that is accruable through similar ranges of motion as the treatment platform and a beam port emulator located similarly to the treatment platform emulator as the beam port in the treatment room is to the treatment platform.

[0035] The treatment delivery stage 150 is performed in the NCT treatment room. Moreover, each of the stages of the dataflow 100 can be implemented by one, or a combination, of the components of the treatment planning and delivery system.

[0036] At the simulation planning stage 120, the clinical team obtains an initial tomographic image 102 of the patient and generate a simulation plan 104 based on the initial tomographic image 102. Throughout this specification, the term “tomographic image” generally refers to an image that includes information about the patient’s anatomy obtained by means of any appropriate medical imaging modality, e.g., Computer Tomography (CT), Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), or any other appropriate medical imaging modality.

[0037] In some cases, the initial tomographic image 102 is acquired as part of a patient selection process, e.g., during an initial diagnosis and / or evaluation of the patient as a candidate for NCT treatment. In some cases, the patient selection process can be performed by the clinical team before they use the treatment planning and delivery system to implement the dataflow 100. In this manner, the dataflow 100 can leverage pre-existing tomographic images acquired during the patient selection process, e.g., without the need to acquire a new initial tomographic image during the simulation planning stage 120. As a particular example of the patient selection process, a clinician at a clinical facility can infuse or inject the patient with any appropriate delivery agent (e.g., a boron drug that contains boron that will interact with the neutron beam) and acquire one or more initial tomographic images 102, e.g., perform a PET or CT scan of the patient’s anatomy to confirm boron agent uptake in a target region of the patient’s anatomy (e.g., the tumor) and boron agent non-uptake in a surrounding tissue or organs-at-risk. In some cases, the delivery agent is, e.g., a surrogate agent that has similar pharmacokinetic behavior to the delivery agent but improved imaging qualities when compared to the actual delivery agent.

[0038] The clinical team uses these images to evaluate the patient as a candidate for the NCT treatment. Generally, the one or more initial tomographic images 102 can be obtained in any other appropriate manner, and not necessarily during the patient selection process.

[0039] At the simulation planning stage 120, the clinical team uses the treatment planning and delivery system and the initial tomographic image 102 to determine the simulation plan 104. Throughout this specification, the term “simulation plan” generally refers to a set of initial, or preliminary, treatment parameters for the NCT treatment. The clinical team can determine the set of initial treatment parameters based on the initial tomographic image 102 by providing user input through a user interface of the treatment planning and delivery system 100.

[0040] The set of initial treatment parameters can include, for example, a set of immobilization instructions for the patient with respect to the NCT treatment platform and a preliminary beam selection that includes 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 by selecting one or more beams for the simulation plan 104, e.g., selecting one or more neutron beam angles suitable for the NCT treatment.

[0041] Throughout this specification, the term “set of immobilization instructions” for the patient refers to a fixed position and / or orientation of the patient with respect to the NCT treatment platform. For example, a simple set of immobilization instructions would be instructions to position the patient supine on the treatment platform. However, in many instances, such positioning of the patient would not allow beam entrance angles that minimize the depth a beam must travel before reaching the tumor and would make difficult or impossible positioning patient relative to the neutron beam axis and neutron beam port for multiple different beams. Commonly, a patient will need to be positioned in a non-supine position, e.g., with one or more body parts propped up on the treatment platform and / or with the patient lying on their side, on their stomach, or in some contorted position, in order to be treated by multiple beams without the need to reposition and immobilize the patient between beams.

[0042] After the patient is positioned according to the set of immobilization instructions and immobilized in this position with respect to the treatment platform, an entrance angle of a neutron beam can be determined by the patient’s position on the treatment platform with respect to an axis of the neutron beam and the neutron beam port, e.g., by moving the treatment platform with respect to the axis of the neutron beam.

[0043] Generally, the position of the patient 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 hardened bag (e.g., Vac-Lok™ bag), or any other appropriate immobilization device. Immobilization can also involve propping up or otherwise supporting parts of the patient while they are positioned on the treatment platform according to the set of immobilization instructions. For example, the patient can be supported by a headrest, pillows, foam wedges, etc. Accordingly, in addition to instructions on how to position the patient relative to treatment platform, the set of immobilization instructions can also include instructions for configuring one or more immobilization devices to fix the patient with respect to the treatment platform in the appropriate position. The preliminary beam selection, in turn, is determined by a position of the patient on the treatment platform (e.g., while the patient is immobilized with respect to the treatment platform) with respect to an axis of the neutron beam and the distance from the neutron beam port.

[0044] In general, the set of immobilization instructions is determined so that the position of the patient with respect to the treatment platform remains the same for each of multiple neutron beams (e.g., having different doses, diameters, neutron fluxes for one or more different positions and orientations of the patient). To determine the preliminary beam selection, the clinical team can provide user input through a user interface of the treatment planning and delivery system to set degrees of freedom including a pitch angle, a roll angle, and / or a yaw angle, and / or a linear displacement along x, y, and / or z axes of the patient on the treatment platform with respect to an axis of the neutron beam for each of multiple neutron beam entrance angles. In some cases, the clinical team can set the patient’s position on the treatment platform with respect to an axis of the neutron beam such that the pitch and roll angles of the treatment platform are substantially the same for each of multiple neutron beam entrance angles. This can allow the clinical team to use the treatment planning and delivery system to position the patient on the treatment platform with respect to an axis of the neutron beam such that only a single configuration of the immobilization device is required to fix the patient to that position on the treatment platform. In other words, the same configuration of the immobilization device can be used for different beam entrance angles. This ensures that, when the patient is immobilized using the immobilization device on the treatment platform during NCT treatment, only the yaw angle of the patient on the treatment platform with respect to an axis of the neutron beam needs to be varied to satisfy different neutron beam entrance angles. The simulation planning stage 120 of the dataflow is described in more detail below with reference to FIG. 2, which is described below.

[0045] After the simulation planning stage 120, the dataflow 100 proceeds to the simulation stage 130. At the simulation stage 130, the clinical team uses the system to simulate a treatment of the patient based on the simulation plan 104 determined at the simulation planning stage 120. That is, the clinical team uses the set of immobilization instructions and the preliminary beam selection determined during the simulation planning stage, e.g., determined based on the initial tomographic image 102 of the patient’s anatomy, to confirm that the set of immobilization instructions and preliminary beam selection are physically feasible. Generally, it is non-trivial to identify a single patient-to-platform relationship that allows treatment with more than a single beam. As noted previously, such a relationship often involves a non-supine patient posture. Moreover, treatment platforms generally have limited ranges of motion in one or more degrees of freedom and beam delivery necessitates positioning a specific part of the patient in close proximity to the beam port with a specific orientation with respect to the beam axis.

[0046] Upon establishing that the set of immobilization instructions and preliminary beam selection are physically feasible, the clinical team acquires a primary tomographic image 106 of the patient which is a tomographic image of the tumor and surrounding tissue acquired while the patient is in the same position with respect to the treatment platform verified during the simulation stage. The primary tomographic image is used by the clinical team to confirm the location of the tumor and relevant healthy organs at risk when the patient is immobilized according to the set of immobilization instructions and is used by the clinical team to determine the final treatment plan 108. The primary tomographic image can be acquired while the patient is immobilized for the simulation or at some time later (e.g., in a different location) with the patient similarly immobilized to ensure the tumor is positioned in the body as for the simulation.

[0047] In addition to establishing that the set of immobilization instructions and preliminary beam selection are physically feasible, the simulation can produce additional outputs. For example, the simulation can provide information needed to build immobilization devices and / or props needed for the treatment. Alternatively, or additionally, the simulation can be used to obtain measurements of the smallest reasonable gap between beam port and patient - called SSD (Source to Skin Distance) - by moving the patient as close to the beam port as feasible for each preliminary beam and measuring the resulting gap. These measurements are later input into the treatment planning software to create the final treatment plan. They are generally challenging to determine from a tomographic image alone, as accurate modeling of the patient / platform / immobilization devices and beam wall are not generally available in software and are not generally suitable for intuitively evaluating the risks of such small gaps when they are available.

[0048] At the simulation stage 130, the patient is physically positioned on the treatment platform in the NCT treatment room or treatment emulation room. The clinical team uses the system to adjust the treatment platform to vary a pitch angle, a roll angle, and / or yaw angle of the patient on the treatment platform with respect to an axis of the neutron beam, such that the position of the patient matches the position for each of multiple beam angles specified by the simulation plan 104. The clinical team also sets a distance of the treatment platform from the beam port that delivers the neutron beam to the treatment room for each of multiple beam angles specified in the simulation plan 104. The patient is physically immobilized using the immobilization devices and / or supports configured according to the set of immobilization instructions specified in the simulation plan 104. At the simulation stage 130, the clinical team adjusts the patients’ position on the treatment platform with respect to an axis of the neutron beam for each of multiple beam entrance angles and the configuration of the immobilization device, as necessary.

[0049] After the simulation stage 130, the dataflow 100 proceeds to the treatment planning stage 140. At the treatment planning stage 140, the clinical team uses the system to establish the final treatment plan 108 for the patient based on the primary tomographic image 106, the simulation plan 104, information determined during the simulation stage 130, and the initial tomographic image 102.

[0050] For example, the clinical team uses the system to contour a target (e.g., a tumor) in the patient’s anatomy based on the primary tomographic image 106 and registers the primary tomographic image 106 against the initial tomographic image 102. The clinical team uses the system to review preliminary beam selections in the simulation plan 104 against the primary tomographic image 106 and verify that the preliminary beam selections will deliver the desired NCT treatment. The clinical team uses the system to perform dose calculations and adjust preliminary beam selection as necessary to achieve desired dose results. After performing any necessary adjustments, the clinical team reviews and approve the final treatment plan 108 using the system. The treatment planning stage 140 of the dataflow 100 is described in more detail below with reference to FIG. 4.

[0051] After the treatment planning stage 140, the treatment planning and delivery dataflow 100 proceeds to the treatment delivery stage 150. At the treatment delivery stage 150, the clinical team uses the system to deliver the NCT treatment to the patient in accordance with the final treatment plan 108. The treatment delivery stage 150 the clinician infuses the patient with a delivery agent, acquires a blood sample from the patient and analyses the sample to determine delivery drug blood concertation.

[0052] An example of a NCT treatment facility 160 suitable for treatment using the final treatment plan 108 is shown schematically in FIG. IB. Facility 160 includes a treatment room 162 with a treatment platform 168 for positioning a patient 101 proximate to a beam port 166 through which a beam system 164 delivers a neutron beam. Generally, the treatment platform can be a robotic platform that is ceiling or floor mounted. The neutron beam propagates along a beam axis 165 as described previously. The treatment platform 168 is moved relative to the beam axis 165 by an actuation station 169 and can position the patient against the fixed neutron beam port for head, neck, or body treatments. The actuator module 169 includes actuators capable of moving the treatment platform 168 through a range of motion for multiple degrees of freedom including, for example, rotations (e.g., pitch, roll, yaw) and / or translations (e.g., in x, y, and / or z-directions). In general, for any coordinate system, axes are titled x, y, z, and rotations are y, cp, and 0. y is rotation around x, (p is rotation around y, 0 is rotation around z. Here, the coordinate system illustrated corresponds to a fixed coordinate system, f, established by the treatment room. In accordance with the International Standard for radiotherapy equipment, IEC 61217:2011, for the fixed coordinate system, +Xu points into the beam port, +If points to the left as one faces the beam port, +Zi points up. Another coordinate system, t, can be established by the treatment platform. In this system, +Xt points to a head-first supine (HFS) patient’s left, +Yt points to a HFS patient’s head, +Zt points up. With all platform rotation angles set to zero, the rotational axes of coordinate systems of f and t match. As used herein, pitch refers to yt, or rotation about x in the table top coordinate system, and commonly referred to as “head-up” or “head-down;” roll refers to (pt, or rotation about y in the table top coordinate system and commonly referred to as “roll left” or “roll right”, with the direction assuming a head-first supine patient position; yaw refers to 0t, or rotation about z in the table top coordinate system, and commonly referred to as “clockwise” and “counter-clockwise” when looking down at the tabletop from above.

[0053] The patient 101 is immobilized relative to the treatment platform using a set of immobilization instructions device 167. The system includes a surface image guidance system 180 (e.g., a commercially available system such as those sold by VisionRT, Somerset, NJ) including cameras 182 installed in the treatment room 162 to track the patient’s position. Ceiling and / or wall mounted lasers (not illustrated) can facilitate patient positioning too.

[0054] The treatment facility 160 includes a control module 170 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.

[0055] In some cases, the clinical team checks a collimator attached to a beam shaping assembly of the beam system 164 and the beam port 166 against a collimator to deliver the neutron beams specified in the treatment plan. If necessary, the clinical team swaps one collimator for another so that it matches the treatment plan. The clinical team uses the surface image guidance system to position the patient on the treatment platform in the NCT room. For example, the clinical team can view a surface image guidance display positioned in the NCT treatment room that shows a heat map of the patient’s position and accordingly adjust the patient’s position on the platform (e.g., by adjusting one or more immobilization devices or props) to immobilize the patient according to the final treatment plan. In some cases, the clinical team determines a quantity of exposure for each neutron beam based on the delivery agent blood concentration levels. The clinical team exposes the patient to one or more neutron beams according to neutron quantity and the final treatment plan 108.

[0056] FIG. 2 illustrates an example simulation planning stage 200 of the dataflow 100 of FIG. 1 in more detail. At the simulation planning stage 200, the clinical team uses the treatment planning and delivery system and an initial tomographic image 202 to determine a simulation plan for the patient that specifies a patient-to-beam relationship and thus a patient- to-treatment platform relationship, and immobilization devices and / or props are used to fix the patient in that relationship. The patient-to-beam relationship is contained in a set of immobilization instructions 204 and a preliminary beam selection 206 including one or more beams for the NCT treatment. The treatment planning and delivery system includes a simulation planning engine 220 that can use one or more software applications, e.g., commercially-available treatment planning software, such as “RayStation” from RaySearch Laboratories (Sweden), or any other appropriate software applications, and interface with a surface image guidance platform to facilitate accurate positioning of the patient on the platform according to the set of immobilization instructions 204.

[0057] The clinical team imports the initial tomographic image 202 into the simulation planning engine 220 and provides user input through a 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 tomographic image 202 to contour structures in the image 202 using, e.g., a single point, an ellipsoid, or a rectangular volume to mark areas of interest (e.g., the tumor) in the image 202. In some cases, the clinical team uses the simulation planning engine 220 to identify, contour, or otherwise register the patient’s surface or skin structure.

[0058] The clinical team uses the simulation planning engine 220 to select one or more neutron beams, e.g., one or more desired neutron beam angles that are estimated to provide sufficient dosimetry for treatment. In some examples, two or three beams are sufficient for treatment. In some cases, the clinical team can select one or more neutron beam entrance angles to minimize a distance from the patient’s skin and the target (e.g., a tumor) in the patient’s anatomy. In some cases, the clinical team selects one or more different neutron beam entrance angles that treatment of the patient with multiple beams each of which can be achieved by only adjusting a yaw of the treatment platform while the patient is immobilized while the pitch and roll angles of the treatment platform remain fixed. In this manner, the clinical team uses the simulation planning engine 220 to determine a single set of immobilization instructions for the patient that can satisfy multiple different neutron beam angles with the patient immobilized with respect to the treatment platform while only the yaw angle of the treatment platform is allowed to vary. The clinical team uses the simulation planning engine 220, e.g., graphical user interface elements of the engine 220 (e.g., “RayStation” GUI tools) to adjust pitch angle, roll angle, and yaw angle of the patient on the treatment platform with respect to an axis of the neutron beam for each of multiple beam angles.

[0059] In some cases, the clinical team uses the simulation planning engine 220 to perform a preliminary dose calculation. For example, the clinical team provides user input through the user interface of the simulation planning engine 220 that approximately specifies materials and compositions in different regions of the patient’s anatomy. The simulation planning engine 220 provides an output that includes an estimate of neutron beam dose. After the preliminary dose estimation, the clinical team iteratively adjusts beam angles and recalculates the dose estimate until the clinical team identifies a preliminary beam selection 206 for the patient that provides appropriate dosimetry with a single set of immobilization instructions of the patient with respect to the treatment platform.

[0060] After the clinical team determines the set of immobilization instructions 204 and the preliminary beam selection 206 using the simulation planning engine 220 the simulation planning engine 220 consolidates the simulation plan information and export the resulting information for use in subsequent stages in the process (e.g., at the simulation stage). For example, a script run on the simulation planning engine 220 can consolidate different types of data, e.g., position and orientation of the immobilized patient with respect to an axis of the neutron beam for each of the 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 that can use this data to determine initial candidates for beam positions of the final treatment plan for the patient.

[0061] After the simulation planning stage 200 is complete, the treatment planning and delivery dataflow proceeds to a simulation stage in which the treatment protocol for the patient is physically simulated by immobilizing the patient according to set of immobilization instructions 204 and moving the treatment platform with the immobilized patient through a sequence of positions relative to the beam axis and beam port according the beam exposures.

[0062] Referring to FIG. 3, an example simulation stage 300 of the treatment planning and delivery dataflow 100 is shown schematically. As described above, at the simulation stage 300, the clinical team uses the treatment planning and delivery system to perform a physical simulation of the NCT treatment for the patient. The clinical team imports the simulation plan determined at the simulation planning stage (described above with reference to FIG. 2) into a simulation engine 330 included in the treatment planning and delivery system. The clinical team uses the simulation engine 330 and a set of immobilization instructions 304 for the patient and a preliminary beam selection 306 specified in the simulation plan, to perform the simulation of the NCT treatment for the patient in a NCT treatment room.

[0063] The simulation engine interfaces with a NCT facility 330 and a tomography facility 370 to implement the simulation. The NCT facility can be the facility 160 described above. In particular, the simulation engine 330 interfaces with an actuator module 336 and a surface image guidance system 335 that are in the NCT facility 330.

[0064] The simulation engine 330 can include a surface image guidance software package (e.g., a commercially-available package from VisionRT, along with the surface image guidance system hardware) that, together with the surface image guidance system, assists the clinical team in accurately positioning the patient on the treatment platform in accordance with the set of immobilization instructions 304 specified in the simulation plan.

[0065] At the simulation stage 300, the clinical team physically positions the patient on the treatment platform in the BCNT facility 330 and immobilizes the patient according to the set of immobilization instructions 304 specified in the simulation plan. The simulation engine 330 can automatically provide a surface structure of the patient’s skin from the simulation plan to the surface image guidance system. The clinical team can use the surface image guidance system to position the patient on the treatment platform to match the pitch and roll angles and setup immobilization devices as specified in the simulation plan.

[0066] 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 ready position such that the patient’s yaw angle matches the desired yaw angle as specified in the simulation plan. In some cases, the ready position can be approximately 10 cm - 15cm away from the beam port. The clinical team uses the hand controller to slowly move the patient closer towards the beam port. Because effective neutron beam dosimetry is achieved only for relatively short distances from the beam port, the clinical team can move the patient as close as possible to the beam port while avoiding any risk of collision. The clinical team uses the hand controller to mark a final position from the beam port 335 as a final treatment beam position and records the corresponding position of the treatment platform 336. Alternatively, or additionally, the clinical team can manually measure the distances from the beam port 335 to the treatment platform at this stage for later input into the simulation engine 340. The clinical team can use the simulation engine 340 and the NCT sub-system 330 to perform this process for each beam in the preliminary beam selection 306. In some implementations, the clinical team uses the set of immobilization instructions 204 of the patient with respect to the treatment platform and the preliminary beam selection 206 to manually record source-to-skin distance (SSD) for each beam included in the preliminary beam selection 206. Then, the clinical team uses this information at the treatment planning stage described in more detail below to determine initial candidates for beam positions of the final treatment plan for the patient.

[0067] The clinical team can accordingly update the set of immobilization instructions 304 and the preliminary beam selection 306 and use this information at a treatment planning stage described below with reference to FIG. 4.

[0068] After performing the treatment simulation using the simulation engine 330 and the NCT facility 330, the clinical team can use the tomography facility 370 to acquire a primary tomography scan 305. This step can be performed while the patient is still immobilized with respect to the treatment platform or the patient can be released from the treatment platform and re-positioned and re-immobilized at the tomography facility for purposes acquiring the primary tomography scan 305. The clinical team uses a scanner 380 included in the tomography facility 370 to acquire the primary tomography scan 305 for the patient while the patient is immobilized with respect to the treatment platform. The scanner 380 can be a portable scanner, e.g., that is brought into the treatment room and used while the patient is immobilized on the treatment platform. the tomography facility 370 is, generally, an optional component of the treatment planning and delivery system. In other words, the simulation stage 300 can include obtaining the primary tomography scan 305 (e.g., one or more CT images) of the patient using any appropriate tomography facility located at any practical location that is not necessarily a part of the overall treatment planning and delivery system. In such cases, the primary tomography scan 305 is typically obtained following simulation activities in the NCT facility but using similar or the same immobilization devices or technique.

[0069] The clinical team can use the simulation engine 330 to export the primary tomography scan 305 for use at a next stage in the treatment planning and delivery dataflow, e.g., at the treatment planning stage described in more detail below with reference to FIG. 4.

[0070] FIG. 4 illustrates an example treatment planning stage 400 of the 100 of FIG. 1 in more detail. As described above, at the 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 the primary tomographic image 404 and one or more beams from the preliminary beam selection, as determined at the simulation stage described above with reference to FIG. 3

[0071] At the treatment planning stage 400, the clinical team can import the primary tomographic image 404 determined at the simulation stage described above with reference to FIG. 3 into a treatment planning engine 410 included in the treatment planning and delivery system. In some cases, the clinical team additionally imports an initial tomographic image 402 obtained at the simulation planning stage described above with reference to FIG. 2. The treatment planning engine 410 includes one or more software applications, e.g., “Ray Station” application or any other appropriate software applications.

[0072] The clinical team can use the treatment planning engine 410 to fuse the primary tomography scan 404 with the initial tomographic image 402 (e.g., used at the simulation planning stage) to generate a fused image. In some cases, the clinical team imports any other initial tomographic images of the patient into the treatment planning engine 410 and fuses these images with the primary tomography scan 404 to generate the fused image. After generating the fused image, the clinical team provides user input through a user interface of the treatment planning engine 410 by contouring one or more structures of the patient’s anatomy in the fused image, e.g., a target region (e.g., tumor), and any other structures or organs-at-risk. For example, the clinical team can assign each voxel included in the fused image to a respective structure. As a particular example, each structure specifies a material, including general decomposition into elemental components, and a relative weight or prevalence of each component. As another example, each structure can specify a biological model, including delivery agent concentration relative to blood and various biological scaling factors (e.g., RBE and CBE).

[0073] After contorting the fused image, the simulation plan 406 determined at the simulation planning stage described above with reference to FIG. 2 and simulation results 408, e.g., information generated at the simulation stage described above with reference to FIG. 3, are imported into the treatment planning engine 410. Importation can be facilitated using various degrees of automation, e.g., using a script, or entered manually. The treatment planning engine 410 processes the simulation plan 406 and the simulation information to generate the final treatment plan 412, e.g., to determine a final set of immobilization instructions and a final beam selection that are used to perform the NCT treatment for the patient.

[0074] After determining the final position of the patient and performing the final beam selection for the final treatment plan 412, e.g., as described above, the clinical team can provide user input through the user interface of the treatment planning engine 410 that specifies any other NCT-specific treatment parameters. For example, the clinical team can specify, e.g., an estimated delivery agent blood concentration for the patient, or any other NCT-specific treatment parameters.

[0075] At the treatment planning stage 400, the clinical team can use the treatment planning engine 410 to estimate a neutron beam dose for treating the patient. The clinical team can assess the estimated dose for acceptability and modify the beam positions of the final treatment plan 412, if necessary. In this manner, the clinical team can generate multiple candidates for the final treatment plan 412. The clinical team can review candidate plans and select a particular candidate plan as the final treatment plan 412. FIG. 5 is a block diagram of an example treatment planning and delivery system 500. As described above with reference to FIG. 1, a clinical team can use the treatment planning and delivery system 500 to implement the treatment planning and delivery workflow 100.

[0076] The treatment planning and delivery system 500 includes a treatment planning and delivery server 540, a tomography facility 520, 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 scans or images of the patient that were acquired using any appropriate tomography system located in any appropriate location or facility and not necessarily forming a part of the treatment planning and delivery system 500.

[0077] In some examples, the tomography facility 520 includes a CT scanner that obtains a CT scan of the patient, and any other components and devices required for CT scan acquisition. 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 operations for treatment planning and delivery described in this specification. The tomography facility 520, the NCT facility 535, the end user client 502, and the treatment planning and delivery server 540 are communicatively coupled through a network 508, e.g., a local area network (LAN), a wide area network (WAN), the Internet, any other appropriate network or a combination thereof. Although shown separately, in some implementations, functionality of two or more systems, devices, or servers may be provided by a single system or server. In some implementations, the functionality of one illustrated system, server, or engine may be provided by multiple systems, servers, or engines, respectively.

[0078] The NCT facility 535 can include the same components as the facility described in FIG. IB above.

[0079] The end-user client device 502 is an electronic device that can request and receive data over the network 508. The end-user client device 502 can include any client computing device such as a laptop or notebook computer, wireless data port, smart phone, personal data assistant (PDA), tablet computing device, one or more processors within these devices, or any other suitable processing device that can send and receive data over the network 508. For example, the end-user client device 502 can include, e.g., a computer that includes an input device, such as a keypad, touch screen, or other device that can accept user information, and an output device that conveys information, e.g., associated with the operation of the treatment planning and delivery server 540, or the client device itself, including 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 allows the end-user client device 502 to request and view content on a respective client device. In some implementations, a client application can use parameters, metadata, and other information received, e.g., at launch, to access a particular set of data from the treatment planning and delivery server 540.

[0080] The end-user client device 502 typically includes one or more applications, such as a browser 580 or a native application 510, to facilitate sending and receiving of content over the network 208. Examples of content presented at the client device 502 include information about the patient, a set of initial treatment parameters determined during the simulation planning stage, final treatment parameters determined for the final treatment plan, tomography scans obtained from the tomography facility 520, and information obtained during NCT treatment of the patient using the NCT facility 535.

[0081] The clinical team can use the end user client device 502 to provide user input to the treatment planning and delivery server 540 through the graphical user interface (GUI) 504. For example, the clinical team can use the simulation planning engine 551, the simulation engine 552, and the treatment planning engine 553 to carry out one or more tasks associated with the dataflow described above with reference to FIG. 1.

[0082] In some implementations, the end user client 502 can receive treatment planning and delivery data 518, e.g., data generated during any of the stages included in dataflow described above with reference to FIG. 1, from a database 544 of the treatment planning and delivery server 540. The end user client 502 can store the treatment planning and delivery data 518 in a memory 514, together with any other user files 516 included in the memory. The memory 514 can include any form of volatile or non-volatile memory, e.g., magnetic media, optical media, random access memory (RAM), read-only memory (ROM), removable media, or any other suitable local or remote memory component.

[0083] FIG. 6 is a flow diagram of an example process 600 for treatment planning and delivery. The process can be performed by a treatment planning and delivery system, e.g., the treatment planning and delivery system 500 described above with reference to FIG. 5.

[0084] The system obtains an initial tomographic image of the patient (602). The initial tomographic image can include information about the tumor in the patient’s anatomy. The initial tomographic image can be, e.g., a magnetic resonance (MR) image, a CT scan image, or a PET scan image.

[0085] The system determines a simulation plan for the patient based on the initial tomographic image (604). The simulation plan includes a set of immobilization instructions for the patient and a preliminary beam selection including one or more beams for the treatment.

[0086] The system simulates a treatment of the patient based on the simulation plan (606). The simulation can include: positioning the patient on a treatment platform in the treatment room, the treatment platform including actuators to vary a pitch angle, a roll angle, and yaw angle of the treatment platform with respect to an axis of the neutron beam, and a distance of the treatment platform from a beam port for the neutron beam in the treatment room for each of the beams of the preliminary beam selection. The simulation can further include immobilizing the patient with respect to the treatment platform according to the set of immobilization instructions.

[0087] After or contemporaneous to the simulation, a primary tomographic image is obtained (607) with the patient positioned and immobilized with respect to the treatment platform or a similar platform to confirm that the tumor remains in the beam path when the patient is so positioned.

[0088] The system establishes a treatment plan for the patient based on the primary tomographic image and the one or more beams from the preliminary beam selection (608).

[0089] The system treats the patient by exposing the patient to the neutron beam according to the treatment plan (610).

[0090] While the foregoing examples of a treatment facility include an actuated treatment platform, other implementations are possible. For example, the treatment facility can include a static or manually adjustable platform, such as a gurney. In some cases, the patient sits on a chair during the simulation and treatment (e.g., an actuable or static chair). In certain cases, the patient stands (e.g., with some form of posture support), rather than sits or lies. In each case, the patient is immobilized in some manner to ensure accurate positioning of the patient relative to the beam port and beam axis, and to reduce or control any motion made by the patient during the treatment delivery.

[0091] Generally, the neutron beam used for NCT is generated and delivered to the treatment room using a beam system that includes a charged particle beam line and a target for generating neutrons from the charged particle beam. FIG. 7A is a schematic diagram of an example of a beam system 10 for use with implementations of the present disclosure. In FIG. 7 A, 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. LEBL 14 is configured to transport a beam from source 12 to an input of accelerator 16, which in turn is configured to produce a beam by accelerating the beam transported by LEBL 14, HEBL 18 transfers the beam from an output of accelerator 40 to target 99. Target 99 can be a structure configured to produce a desired result in response to the stimulus applied by the incident beam or can modify the nature of the beam. Target 99 can be a component of system 10 or can be a workpiece that is conditioned or manufactured, at least in part, by system 10.

[0092] FIG. 7B is a schematic diagram illustrating another example embodiment of a neutron beam system 10 for use in NCT. Here, source 12 is an ion source and accelerator 16 is a tandem accelerator. Neutron beam system 10 includes a pre-accelerator system 20, serving as a charged particle beam injector, high voltage (HV) tandem accelerator 16 coupled to preaccelerator system 20, and HEBL 18 extending from tandem accelerator 16 to a neutron target assembly 95 housing target 99 (not shown). In this example, target 99 is configured to generate neutrons in response to impact by protons of a sufficient energy, and can be referred to as a neutron generation target.

[0093] Pre-accelerator system 20 is configured to transport the ion beam from ion source 12 to the input (e.g., an input aperture) of tandem accelerator 16, and thus also acts as LEBL 14. Tandem accelerator 16, which is powered by a high voltage power supply 42 coupled thereto, can produce a proton beam with an energy generally equal to twice the voltage applied to the accelerating electrodes positioned within accelerator 16. The energy level of the proton beam can be achieved by accelerating the beam of negative hydrogen ions from the input of accelerator 16 to the innermost high-potential electrode, stripping two electrons from each ion, and then accelerating the resulting protons downstream by the same applied voltage.

[0094] HEBL 18 can transfer the proton beam from the output of accelerator 16 to the target within neutron target assembly 95 positioned at the end of a branch 70 of the beamline 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, the HEBL 18 includes three branches 70, 80 and 90 that can extend into three different patient treatment rooms, where each branch can terminate in a target assembly 95 and downstream beam shaping apparatus (not shown). HEBL 18 can include a pump chamber 51, quadrupole magnets 52 and 72 to prevent de-focusing of the beam, dipole or bending magnets 56 and 58 to steer the beam into treatment rooms, beam correctors 53, diagnostics such as current monitors 54 and 76, a fast beam position monitor 55 section, and a scanning magnet 74.

[0095] The design of HEBL 18 depends on the configuration of the treatment facility (e.g., a single-story configuration of a treatment facility, a two-story configuration of a treatment facility, and the like). The beam can be delivered to target assembly (e.g., positioned near a treatment room) 95 with the use of bending magnet 56. Quadrupole magnets 72 can be included to then focus the beam to a certain size at the target. Then, the beam passes one or more scanning magnets 74, which provides lateral movement of the beam onto the target surface in a desired pattern (e.g., spiral, curved, stepped in rows and columns, combinations thereof, and others). The beam lateral movement can help achieve smooth and even time- averaged distribution of the proton beam on the lithium target, preventing overheating and making the neutron generation as uniform as possible within the lithium layer.

[0096] After entering scanning magnets 74, the beam can be delivered into a current monitor 76, which measures beam current. Target assembly 95 can be physically separated from the HEBL volume with a gate valve 77. The main function of the gate valve is separation of the vacuum volume of the beamline from the target while loading the target and exchanging a used target for a new one. In examples, the beam may not be bent by 90 degrees by a bending magnet 56, it rather goes straight to the right of FIG. 7B, then enters quadrupole magnets 52, which are located in the horizontal beamline. The beam can be subsequently bent by another bending magnet 58 to a needed angle, depending on the building and room configuration. Otherwise, bending magnet 58 could be replaced with a Y-shaped magnet in order to split the beamline into two directions for two different treatment rooms located on the same floor. Each beamline direction can include a corresponding NCT sub-system capable of delivery a therapeutic beam to a patient.

[0097] Various aspects of the treatment and delivery planning and delivery described above are implemented using a computer system. FIG. 8 is block diagram of an example computer system 800 that can be used to perform operations described above. The system 800 includes a processor 810, a memory 820, a storage device 830, and an input / output device 840. Each of the components 810, 820, 830, and 840 can be interconnected, for example, using a system bus 850. The processor 810 is capable of processing instructions for execution within the system 800. In some implementations, the processor 810 is a single-threaded processor. In another implementation, the processor 810 is a multi -threaded processor. The processor 810 is capable of processing instructions stored in the memory 820 or on the storage device 830.

[0098] The memory 820 stores information within the system 800. In one implementation, the memory 820 is a computer-readable medium. In some implementations, the memory 820 is a volatile memory unit. In another implementation, the memory 820 is a non-volatile memory unit. The storage device 830 can provide mass storage for the system 500. In some implementations, the storage device 830 is a computer-readable medium. In various implementations, the storage device 830 can include, for example, a hard disk device, an optical disk device, a storage device that is shared over a network by multiple computing devices (e.g., a cloud storage device), or some other large capacity storage device.

[0099] The input / output device 840 provides input / output operations for the system 800. In some implementations, the input / output device 840 can include one or more of a network interface device, e.g., an Ethernet card, a serial communication device, e.g., and RS-232 port, and / or a wireless interface device, e.g., and 802.11 card. In another implementation, the input / output device can include driver devices configured to receive input data and send output data to other input / output devices, e.g., keyboard, printer and display devices 860. Other implementations, however, can also be used, such as mobile computing devices, mobile communication devices, set-top box television client devices, etc.

[0100] Although an example processing system has been described in FIG. 8, implementations of the subject matter and the functional operations described in this specification can be implemented in other types of digital electronic circuitry, or in computer software, firmware, or hardware, including the structures disclosed in this specification and their structural equivalents, or in combinations of one or more of them.

[0101] Embodiments of the subject matter and the operations described in this specification can be implemented in digital electronic circuitry, or in computer software, firmware, or hardware, including the structures disclosed in this specification and their structural equivalents, or in combinations of one or more of them. Embodiments of the subject matter described in this specification can be implemented as one or more computer programs, i.e., one or more modules of computer program instructions, encoded on computer storage media (or medium) for execution by, or to control the operation of, data processing apparatus. Alternatively, or in addition, the program instructions can be encoded on an artificially- generated propagated signal, e.g., a machine-generated electrical, optical, or electromagnetic signal, that is generated to encode information for transmission to suitable receiver apparatus for execution by a data processing apparatus. A computer storage medium can be, or be included in, a computer-readable storage device, a computer-readable storage substrate, a random or serial access memory array or device, or a combination of one or more of them. Moreover, while a computer storage medium is not a propagated signal, a computer storage medium can be a source or destination of computer program instructions encoded in an artificially-generated propagated signal. The computer storage medium can also be, or be included in, one or more separate physical components or media (e.g., multiple CDs, disks, or other storage devices).

[0102] The operations described in this specification can be implemented as operations performed by a data processing apparatus on data stored on one or more computer-readable storage devices or received from other sources.

[0103] The term “data processing apparatus” encompasses all kinds of apparatus, devices, and machines for processing data, including by way of example a programmable processor, a computer, a system on a chip, or multiple ones, or combinations, of the foregoing. The apparatus can include special purpose logic circuitry, e.g., an FPGA (field programmable gate array) or an ASIC (application-specific integrated circuit). The apparatus can also include, in addition to hardware, code that creates an execution environment for the computer program in question, e.g., code that constitutes processor firmware, a protocol stack, a database management system, an operating system, a cross-platform runtime environment, a virtual machine, or a combination of one or more of them. The apparatus and execution environment can realize various computing model infrastructures, such as web services, distributed computing, cloud-based computing, and grid computing infrastructures.

[0104] A computer program (also known as a program, software, software application, script, or code) can be written in any form of programming language, including compiled or interpreted languages, declarative or procedural languages, and it can be deployed in any form, including as a stand-alone program or as a module, component, subroutine, object, or other unit suitable for use in a computing environment. A computer program may, but need not, correspond to a file in a file system. A program can be stored in a portion of a file that holds other programs or data (e.g., one or more scripts stored in a markup language document), in a single file dedicated to the program in question, or in multiple coordinated files (e.g., files that store one or more modules, sub-programs, or portions of code). A computer program can be deployed to be executed on one computer or on multiple computers that are located at one site or distributed across multiple sites and interconnected by a communication network, including cloud-based compute hardware provided by third parties.

[0105] The processes and logic flows described in this specification can be performed by one or more programmable processors executing one or more computer programs to perform actions by operating on input data and generating output. The processes and logic flows can also be performed by, and apparatus can also be implemented as, special purpose logic circuitry, e.g., an FPGA (field programmable gate array) or an ASIC (application-specific integrated circuit). Processors suitable for the execution of a computer program include, by way of example, both general and special purpose microprocessors. Generally, a processor will receive instructions and data from a read-only memory or a random access memory or both. The essential elements of a computer are a processor for performing actions in accordance with instructions and one or more memory devices for storing instructions and data. Generally, a computer will also include, or be operatively coupled to receive data from or transfer data to, or both, one or more mass storage devices for storing data, e.g., magnetic, magneto-optical disks, or optical disks. However, a computer need not have such devices. Moreover, a computer can be embedded in another device, e.g., a mobile telephone, a personal digital assistant (PDA), a mobile audio or video player, a game console, a Global Positioning System (GPS) receiver, or a portable storage device (e.g., a universal serial bus (USB) flash drive), to name just a few. Devices suitable for storing computer program instructions and data include all forms of non-volatile memory, media and memory devices, including by way of example semiconductor memory devices, e.g., EPROM, EEPROM, and flash memory devices; magnetic disks, e.g., internal hard disks or removable disks; magnetooptical disks; and CD-ROM and DVD-ROM disks. The processor and the memory can be supplemented by, or incorporated in, special purpose logic circuitry.

[0106] To provide for interaction with a user, embodiments of the subject matter described in this specification can be implemented on a computer having a display device, e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor, for displaying information to the user and a keyboard and a pointing device, e.g., a mouse or a trackball, by which the user can provide input to the computer. Other kinds of devices can be used to provide for interaction with a user as well; for example, feedback provided to the user can be any form of sensory feedback, e.g., visual feedback, auditory feedback, or tactile feedback; and input from the user can be received in any form, including acoustic, speech, or tactile input. In addition, a computer can interact with a user by sending documents to and receiving documents from a device that is used by the user; for example, by sending web pages to a web browser on a user's client device in response to requests received from the web browser.

[0107] Embodiments of the subject matter described in this specification can be implemented in a computing system that includes a back-end component, e.g., as a data server, or that includes a middleware component, e.g., an application server, or that includes a front-end component, e.g., a client computer having a graphical user interface or a Web browser through which a user can interact with an implementation of the subject matter described in this specification, or any combination of one or more such back-end, middleware, or front- end components. The components of the system can be interconnected by any form or medium of digital data communication, e.g., a communication network. Examples of communication networks include a local area network (“LAN”) and a wide area network (“WAN”), an inter-network (e.g., the Internet), and peer-to-peer networks (e.g., ad hoc peer- to-peer networks).

[0108] The computing system can include clients and servers. A client and server are generally remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. In some embodiments, a server transmits data (e.g., an HTML page) to a client device (e.g., for purposes of displaying data to and receiving user input from a user interacting with the client device). Data generated at the client device (e.g., a result of the user interaction) can be received from the client device at the server.

[0109] NUMBERED PARAGRAPHS

[0110] In some embodiments, the inventions provided in this disclosure may be described by reference to the following numbered paragraphs.

[0111] 1. A method of exposing a patient to a neutron beam according to a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the method including: obtaining a first tomographic image of the patient, the first tomographic image including information about the tumor; determining a simulation plan for the patient based on the first tomographic image, the simulation plan including a set of set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment room in which the patient is exposed to the neutron beam through a beam port and a preliminary beam selection including one or more beams for the treatment; simulating the treatment of the patient based on the simulation plan, the simulating including: in either the treatment room or a treatment emulation room including a treatment platform emulator and a beam port emulator, immobilizing the patient on the treatment platform or the treatment platform emulator according to the set of immobilization instructions; varying a 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 validating 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 validation 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.

[0112] 2. The method of paragraph 1, further including acquiring a second tomographic image of the patient while the patient is immobilized according to the set of immobilization instructions.

[0113] 3. The method of paragraph 2, wherein the second tomographic image is acquired as part of the simulation.

[0114] 4. The method of paragraph 2, wherein the second tomographic image is acquired while the patient is immobilized with respect to the treatment platform or the treatment platform emulator.

[0115] 5. The method of paragraph 2, wherein the second tomographic image is acquired while the patient is immobilized with respect to a platform different from the treatment platform or the treatment platform emulator.

[0116] 6. The method of paragraph 2, wherein the second tomographic image is acquired in a separate facility from that the facility in which the patient is treated.

[0117] 7. The method of paragraph 1, wherein varying the relative position between the simulation platform and the simulation port includes varying a degree of freedom selected from the group consisting of a lateral position, a vertical position, a longitudinal position, a pitch angle, a roll angle, and yaw angle.

[0118] 8. The method of paragraph 1, wherein the set of immobilization instructions specifies a setup of one or more immobilization devices and / or props, and wherein immobilizing the patient with respect to the treatment platform or the treatment platform emulator includes: securing the patient to the treatment platform or the treatment platform emulator using the setup of the one or more immobilization devices and / or props.

[0119] 9. The method of paragraph 8, wherein the one or more immobilization devices includes at least one of a thermoplastic mask and a vacuum-hardened bag.

[0120] 10. The method of 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 election.

[0121] 11. The method of paragraph 1, wherein establishing the treatment plan for the patient based on the one or more beams from the preliminary beam selection includes, 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 a different yaw angle of the treatment platform for each of the one or more beams.

[0122] 12. The method of paragraph 11, wherein the one or more beams includes a total of two beams or a total of three beams.

[0123] 13. The method of paragraph 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan includes: selecting a collimator for the beam port in accordance with the one or more beams specified by the treatment plan.

[0124] 14. The method of paragraph 1, wherein each of the one or more beams of the preliminary beam selection includes a different beam entrance angle with respect to the patient.

[0125] 15. The method of paragraph 2, wherein acquiring the second tomographic image of the patient while the patient is immobilized includes: using a portable CT scanner to acquire the second tomographic image of the patient while the patient is immobilized with respect to the treatment platform or the treatment platform emulator.

[0126] 16. The method of paragraph 1, wherein the first tomographic image is a magnetic resonance (MR) image or a computerized tomography (CT) scan image.

[0127] 17. The method of paragraph 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 making the preliminary beam selection based on the preliminary dose assessment.

[0128] 18. The method of paragraph 1, wherein determining the simulation plan includes estimating a dose for each beam of the preliminary beam selection.

[0129] 19. The method of paragraph 1, wherein the simulating includes using surface image guidance to immobilize the patient according to the set of immobilization instructions.

[0130] 20. The method of paragraph 1, wherein determining the simulation plan further includes specifying a surface structure of the patient’s skin surface, and wherein the simulating includes: positioning the patient on the treatment platform or the treatment platform emulator using surface image guidance and in accordance with the surface structure of the patient’s skin surface specified by the simulation plan.

[0131] 21. The method of paragraph 1, wherein the simulating includes checking that a surface-to-source distance of the patient to the beam port or beam port emulator is within a threshold distance for each of the beam exposure settings. 22. The method of paragraph 1, wherein the simulating includes determining a surface-to-source distance of the patient to the beam port or beam port emulator and wherein the final treatment plan is established based on the surface-to-source distances.

[0132] 23. The method of paragraph 1, wherein the simulating includes confirming that the patient or the treatment platform does not collide with any objects for each of the beam exposure settings.

[0133] 24. The method of paragraph 1, wherein the patient is immobilized in a nonsupine position.

[0134] 25. The method of paragraph 2, wherein establishing the treatment plan includes fusing the second tomographic image with the first tomographic image to generate a fused image.

[0135] 26. The method of paragraph 25, including contouring the fused image by assigning each voxel of the fused image to a structure type of a plurality of structure types.

[0136] 27. The method of paragraph 26, wherein the plurality of structure types includes a tumor or target and one or more organs at risk.

[0137] 28. The method of paragraph 1, wherein establishing the treatment plan includes calculating a final neutron beam dose for the treatment based on material properties of an anatomy of the patient.

[0138] 29. The method of paragraph 1, wherein establishing the treatment plan includes estimating a blood boron concentration for the patient.

[0139] 30. The method of paragraph 1, wherein positioning the patient on the treatment platform or the treatment platform emulator for each beam of the preliminary beam selection includes: engaging actuators coupled to the treatment platform or the treatment platform emulator to vary one or more of: a lateral position, a vertical position, a longitudinal position, a pitch angle, a roll angle, and a yaw angle of the treatment platform, to determine a position of the treatment platform or the treatment platform emulator with respect to the axis of the neutron beam; and marking the position of the treatment platform or the treatment platform emulator as a treatment position for the neutron beam.

[0140] 31. The method of paragraph 30, wherein each of the one or more beams of the preliminary beam selection includes a different beam entrance angle with respect to the patient, and wherein positioning the patient on the treatment platform or the treatment platform emulator includes: engaging the actuators to vary the one or more of: the lateral position, the vertical position, the longitudinal position, the pitch angle, the roll angle, and the yaw angle of the treatment platform, such that treatment positions for the one or more beams of the preliminary beam selection share the same pitch angle and the same roll angle.

[0141] 32. The method of paragraph 1, wherein positioning the patient on the treatment platform or the treatment platform emulator for each beam of the preliminary beam selection includes: engaging actuators coupled to the treatment platform or the treatment platform emulator to vary one or more of: a lateral position, a vertical position, a longitudinal position, a pitch angle, a roll angle, and a yaw angle of the treatment platform or the treatment platform emulator, to determine a position of the treatment platform or the treatment platform emulator with respect to the axis of the neutron beam; and recording a source-to-skin distance (SSD) of the patient as a treatment position for the neutron beam.

[0142] 33. The method of paragraph 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan includes: positioning the patient on the treatment platform in the treatment room; immobilizing the patient with respect to the treatment platform in accordance with the set of immobilization instructions; and exposing the patient to the one or more beams specified by the treatment plan.

[0143] 34. The method of paragraph 1, wherein determining the simulation plan for the patient based on the first tomographic image, includes: determining an estimated neutron beam dose corresponding to the one or more beams of the preliminary beam selection; determining a 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 treatment.

[0144] 35. The method of paragraph 34, further including: after adjusting the one or more beams of the preliminary beam selection, adjusting the set of immobilization instructions.

[0145] 36. The method of paragraph 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan includes: infusing the patient with a delivery agent; determining a concentration of the delivery agent in the patient’s blood; and based on the concentration, selecting an exposure order of the one or more neutron beams for exposing the patient during treatment.

[0146] 37. The method of paragraph 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan includes, for each of the one or more beams: performing dose modeling to determine a beam exposure quantity for the neutron beam. 38. The method of paragraph 37, wherein performing the dose modeling includes incorporating information about delivery agent uptake in the patient acquired during or following administration of the delivery agent to the patient.

[0147] 39. The method of paragraph 1, wherein the NCT is boron neutron capture therapy.

[0148] 40. The method of paragraph 2, wherein the first tomographic image is an initial tomographic image and the second tomographic image is a primary tomographic image.

[0149] 41. A system for exposing a patient to a neutron beam according to a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the system including: a treatment platform in a treatment room configured to support the patient, the treatment platform coupled to actuators to vary a relative position of the treatment platform with respect to a beam port for the neutron beam; a treatment planning and delivery subsystem communicatively coupled to the treatment platform, the treatment planning and delivery sub-system configured to: (i) receive a first tomographic image of the patient, the first tomographic image including information about the tumor; (ii) determine a simulation plan for the patient based on the first tomographic image, the simulation plan including 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 of the patient based on the simulation plan using the treatment platform or a treatment platform emulator to validate 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 acquired while the patient is immobilized according to the set of immobilization instructions.

[0150] 42. The system of paragraph 40, further including a surface image guidance subsystem including one or more cameras positioned in the treatment room, the surface image guidance sub-system being communicatively coupled to the treatment planning and delivery sub-system, wherein configured to generate data characterizing a position of the patient on the treatment platform with respect to the beam port.

[0151] 43. A method of exposing a patient to a neutron beam according to a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the method including: obtaining a first tomographic image of the patient, the first tomographic image including information about the tumor; determining a simulation plan for the patient based on the first tomographic image, the simulation plan including a set of set of immobilization instructions to immobilize the patient with respect to a beam port and a preliminary beam selection including one or more beams for the treatment; simulating the treatment of the patient based on the simulation plan, the simulating including: (i) in either the treatment room or a treatment emulation room including a beam port emulator, immobilizing the patient according to the set of immobilization instructions; (ii)varying a 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) validating 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 validation 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.

[0152] 44. The method of paragraph 43, wherein the patient is immobilized while positioned on a support apparatus.

[0153] 45. The method of paragraph 44, wherein the support apparatus is selected from the group consisting of a treatment platform and a chair.

[0154] 46. The method of paragraph 43, wherein the patient is immobilized while standing.

[0155] 47. A system, including: one or more memory devices storing instructions; and one or more data processing apparatus that are configured to interact with the one or more memory devices, and upon execution of the instructions, perform operations including: receiving, at a simulation planning engine, a first tomographic image of a patient including information about a tumor in the patient; determining, using the simulation planning engine, a simulation plan based on the first tomographic image, the simulation plan including a set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment platform in a treatment room in which 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, at a treatment planning engine, 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 for treating the tumor using neutron capture therapy (NCT) based on the results of the simulation.

[0156] 48. A computer-implemented method, including: receiving, at a simulation planning engine, a first tomographic image of a patient including information about a tumor in the patient; determining, using the simulation planning engine, a simulation plan based on the first tomographic image, the simulation plan including a set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment platform in a treatment room in which 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, at a treatment planning engine, 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 for treating the tumor using neutron capture therapy (NCT) based on the results of the simulation.

[0157] 49. A non-transitory computer readable medium storing instructions that, when executed by one or more data processing apparatus, cause the one or more data processing apparatus to perform operations including: receiving, at a simulation planning engine, a first tomographic image of a patient including information about a tumor in the patient; determining, using the simulation planning engine, a simulation plan based on the first tomographic image, the simulation plan including a set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment platform in a treatment room in which 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, at a treatment planning engine, 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 for treating the tumor using neutron capture therapy (NCT) based on the results of the simulation.

[0158] OTHER EMBODIMENTS

[0159] It should be noted that all features, elements, components, functions, and steps described with respect to any embodiment provided herein are intended to be freely combinable and substitutable with those from any other embodiment. If a certain feature, element, component, function, or step is described with respect to only one embodiment, then that feature, element, component, function, or step can be used with every other embodiment described herein unless explicitly stated otherwise. This paragraph therefore serves as antecedent basis and written support for the introduction of claims, at any time, that combine features, elements, components, functions, and steps from different embodiments, or that substitute features, elements, components, functions, and steps from one embodiment with those of another, even if the following description does not explicitly state, in a particular instance, that such combinations or substitutions are possible. It is explicitly acknowledged that express recitation of every possible combination and substitution is overly burdensome, especially given that the permissibility of each and every such combination and substitution will be readily recognized by those of ordinary skill in the art.

[0160] To the extent the embodiments disclosed herein include or operate in association with memory, storage, and / or computer readable media, then that memory, storage, and / or computer readable media are non-transitory. Accordingly, to the extent that memory, storage, and / or computer readable media are covered by one or more claims, then that memory, storage, and / or computer readable media is only non-transitory.

[0161] As used herein and in the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise.

[0162] While the embodiments are susceptible to various modifications and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that these embodiments are not to be limited to the form disclosed, but to the contrary, these embodiments are to cover all modifications, equivalents, and alternatives falling within the spirit of the disclosure. Furthermore, any features, functions, steps, or elements of the embodiments may be recited in or added to the claims, as well as negative limitations that define the inventive scope of the claims by features, functions, steps, or elements that are not within that scope.

[0163] Other embodiments are in the following claims.

Claims

CLAIMS1. A method of exposing a patient to a neutron beam according to 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 about the tumor; determining a simulation plan for the patient based on the first tomographic image, the simulation plan comprising a set of set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment room in which the patient is exposed to the neutron beam through a beam port and a preliminary beam selection comprising one or more beams for the treatment; simulating the treatment of the patient based on the simulation plan, the simulating comprising:(i) in either the treatment room or a treatment emulation room comprising a treatment platform emulator and a beam port emulator, immobilizing the patient on the treatment platform or the treatment platform emulator according to the set of immobilization instructions;(ii) varying a 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(iii) validating 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 validation 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.

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

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

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

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

6. The method of claim 2, wherein the second tomographic image is acquired in a separate facility from that the facility in which the patient is treated.

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

8. The method of claim 1, wherein the set of immobilization instructions specifies a setup of one or more immobilization devices and / or props, and wherein immobilizing the patient with respect to the treatment platform or the treatment platform emulator comprises: securing the patient to the treatment platform or the treatment platform emulator using the setup of the one or more immobilization devices and / or props.

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

10. The method of 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 election.

11. The method of claim 1, wherein establishing the treatment plan for the patient based on the one or more beams from the preliminary beam selection comprises, for each ofthe 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 a different yaw angle of the treatment platform for each of the one or more beams.

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

13. The method of claim 1, wherein treating the patient by exposing the patient to the neutron beam according to 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 of claim 1, wherein each of the one or more beams of the preliminary beam selection comprises a different beam entrance angle with respect to the patient.

15. The method of claim 2, wherein acquiring the second tomographic image of the patient while the patient is immobilized comprises: using a portable CT scanner to acquire the second tomographic image of the patient while the patient is immobilized with respect to the treatment platform or the treatment platform emulator.

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

17. The method of claim 1, wherein determining the simulation plan comprises specifying a 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 of claim 1, wherein determining the simulation plan comprises estimating a dose for each beam of the preliminary beam selection.

19. The method of claim 1, wherein the simulating comprises using surface image guidance to immobilize the patient according to the set of immobilization instructions.

20. The method of claim 1, wherein determining the simulation plan further comprises specifying a surface structure of the patient’s skin surface, and wherein the simulating comprises: positioning the patient on the treatment platform or the treatment platform emulator using surface image guidance and in accordance with the surface structure of the patient’s skin surface specified by the simulation plan.

21. The method of claim 1, wherein the simulating comprises checking that a surface-to-source distance of the patient to the beam port or beam port emulator is within a threshold distance for each of the beam exposure settings.

22. The method of claim 1, wherein the simulating comprises determining a surface-to-source distance of the patient to the beam port or beam port emulator and wherein the final treatment plan is established based on the surface-to-source distances.

23. The method of claim 1, wherein the simulating comprises confirming that the patient or the treatment platform does not collide with any objects for each of the beam exposure settings.

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

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

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

27. The method of claim 26, wherein the plurality of structure types comprises a tumor or target and one or more organs at risk.

28. The method of claim 1, wherein establishing the treatment plan comprises calculating a final neutron beam dose for the treatment based on material properties of an anatomy of the patient.

29. The method of claim 1, wherein establishing the treatment plan comprises estimating a blood boron concentration for the patient.

30. The method of claim 1, wherein positioning the patient on the treatment platform or the treatment platform emulator for each beam of the preliminary beam selection comprises: engaging actuators coupled to the treatment platform or the treatment platform emulator to vary one or more of: a lateral position, a vertical position, a longitudinal position, a pitch angle, a roll angle, and a yaw angle of the treatment platform, to determine a position of the treatment platform or the treatment platform emulator with respect to the axis of the neutron beam; and marking the position of the treatment platform or the treatment platform emulator as a treatment position for the neutron beam.

31. The method of claim 30, wherein each of the one or more beams of the preliminary beam selection comprises a different beam entrance angle with respect to the patient, and wherein positioning the patient on the treatment platform or the treatment platform emulator comprises: engaging the actuators to vary the one or more of: the lateral position, the vertical position, the longitudinal position, the pitch angle, the roll angle, and the yaw angle of the treatment platform, such that treatment positions for the one or more beams of the preliminary beam selection share the same pitch angle and the same roll angle.

32. The method of claim 1, wherein positioning the patient on the treatment platform or the treatment platform emulator for each beam of the preliminary beam selection comprises:engaging actuators coupled to the treatment platform or the treatment platform emulator to vary one or more of: a lateral position, a vertical position, a longitudinal position, a pitch angle, a roll angle, and a yaw angle of the treatment platform or the treatment platform emulator, to determine a position of the treatment platform or the treatment platform emulator with respect to the axis of the neutron beam; and recording a source-to-skin distance (SSD) of the patient as a treatment position for the neutron beam.

33. The method of claim 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan comprises: positioning the patient on the treatment platform in the treatment room; immobilizing the patient with respect to the treatment platform in accordance with the set of immobilization instructions; and exposing the patient to the one or more beams specified by the treatment plan.

34. The method of claim 1, wherein determining the simulation plan for the patient based on the first tomographic image, comprises: determining an estimated neutron beam dose corresponding to the one or more beams of the preliminary beam selection; determining a 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 treatment.

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

36. The method of claim 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan comprises: infusing the patient with a delivery agent; determining a concentration of the delivery agent in the patient’s blood; and based on the concentration, selecting an exposure order of the one or more neutron beams for exposing the patient during treatment.

37. The method of claim 1, wherein treating the patient by exposing the patient to the neutron beam according to the treatment plan comprises, for each of the one or more beams: performing dose modeling to determine a beam exposure quantity for the neutron beam.

38. The method of claim 37, wherein performing the dose modeling comprises incorporating information about delivery agent uptake in the patient acquired during or following administration of the delivery agent to the patient.

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

40. The method of 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 according to a treatment plan for treating a tumor in the patient using neutron capture therapy (NCT), the system comprising: a treatment platform in a treatment room configured to support the patient, the treatment platform coupled to actuators to vary a relative position of the treatment platform with respect to a beam port for the neutron beam; a treatment planning and delivery sub-system communicatively coupled to the treatment platform, the treatment planning and delivery sub-system configured to:(i) receive a first tomographic image of the patient, the first tomographic image comprising information about the tumor;(ii) determine a simulation plan for the patient based on the first tomographic image, the simulation plan comprising a set of immobilization instructions and a preliminary beam selection comprising one or more beams for the treatment;(iii) perform a simulation of the treatment of the patient based on the simulation plan using the treatment platform or a treatment platform emulator to validate 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 acquired while the patient is immobilized according to the set of immobilization instructions.

42. The system of claim 40, further comprising a surface image guidance subsystem comprising one or more cameras positioned in the treatment room, the surface image guidance sub-system being communicatively coupled to the treatment planning and delivery sub-system, wherein configured to generate data characterizing a position of the patient on the treatment platform with respect to the beam port.

43. A method of exposing a patient to a neutron beam according to 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 about the tumor; determining a simulation plan for the patient based on the first tomographic image, the simulation plan comprising a set of set of immobilization instructions to immobilize the patient with respect to a beam port and a preliminary beam selection comprising one or more beams for the treatment; simulating the treatment of the patient based on the simulation plan, the simulating comprising:(i) in either the treatment room or a treatment emulation room comprising a beam port emulator, immobilizing the patient according to the set of immobilization instructions;(ii) varying a 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) validating 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 validation 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 of claim 43, wherein the patient is immobilized while positioned on a support apparatus.

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

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

47. A system, comprising: one or more memory devices storing instructions; and one or more data processing apparatus that are configured to interact with the one or more memory devices, and upon execution of the instructions, perform operations including: receiving, at a simulation planning engine, a first tomographic image of a patient comprising information about a tumor in the patient; determining, using the simulation planning engine, a simulation plan based on the first tomographic image, the simulation plan comprising a set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment platform in a treatment room in which the patient is exposed to a neutron beam through a beam port and a preliminary beam selection comprising one or more beams for the treatment; outputting the simulation plan; receiving, at a treatment planning engine, 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 for treating the tumor using neutron capture therapy (NCT) based on the results of the simulation.

48. A computer-implemented method, comprising: receiving, at a simulation planning engine, a first tomographic image of a patient comprising information about a tumor in the patient; determining, using the simulation planning engine, a simulation plan based on the first tomographic image, the simulation plan comprising a set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment platform in a treatment room in which the patient is exposed to a neutron beam through a beam port and a preliminary beam selection comprising one or more beams for the treatment; outputting the simulation plan;receiving, at a treatment planning engine, 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 for treating the tumor using neutron capture therapy (NCT) based on the results of the simulation.

49. A non-transitory computer readable medium storing instructions that, when executed by one or more data processing apparatus, cause the one or more data processing apparatus to perform operations comprising: receiving, at a simulation planning engine, a first tomographic image of a patient comprising information about a tumor in the patient; determining, using the simulation planning engine, a simulation plan based on the first tomographic image, the simulation plan comprising a set of immobilization instructions to immobilize the patient with respect to a treatment platform in a treatment platform in a treatment room in which the patient is exposed to a neutron beam through a beam port and a preliminary beam selection comprising one or more beams for the treatment; outputting the simulation plan; receiving, at a treatment planning engine, 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 for treating the tumor using neutron capture therapy (NCT) based on the results of the simulation.

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