Real-Time Dose-Guided Radiation Therapy

Area of Science:

• Medical Physics
• Radiation Oncology
• Medical Imaging

Background:

• Adaptive radiation therapy (ART) has improved prostate cancer treatment by treating tumors as rigid bodies.
• The human body's dynamic nature presents challenges for traditional radiation therapy.
• Real-time adaptive approaches are needed to account for anatomical complexity during treatment.

Purpose of the Study:

• To review the development and potential of dose-guided radiation therapy (DGRT).
• To explore quasi-continuous volumetric imaging, dose accumulation, and treatment adaptation.
• To assess clinical evidence and future opportunities for DGRT.

Main Methods:

• Review of clinical evidence for real-time ART.
• Description of real-time volumetric imaging (X-ray and MRI).
• Evaluation of real-time dose accumulation and delivery measurement.
• Examination of real-time treatment adaptation strategies.

Main Results:

• Real-time volumetric imaging (X-ray, MRI) is nearing broader implementation.
• Real-time dose accumulation shows clinical feasibility with real-time approximations.
• Real-time treatment adaptation to deforming and multiple targets has been demonstrated.
• Improved patient outcomes correlate with conformal treatment to dynamic anatomy.

Conclusions:

• Dose-guided radiation therapy offers significant potential for improved patient outcomes.
• Advances in DGRT are primarily software-driven, enabling cost-effective upgrades.
• Artificial intelligence can accelerate the adoption of DGRT for wider patient use.