A personalized tumor kV-IORT navigation system based on hybrid twin

Area of Science:

• Medical Physics
• Radiotherapy Technology
• Surgical Navigation

Background:

• Intraoperative radiotherapy (IORT) requires high precision for accurate dose delivery.
• Low-energy x-ray intraoperative radiotherapy (kV-IORT) presents unique applicator placement challenges, especially for less-experienced practitioners.
• Existing navigation systems may lack the necessary accuracy and usability for optimal kV-IORT outcomes.

Purpose of the Study:

• To develop and evaluate a multidimensional hybrid twin navigation system for enhanced applicator placement accuracy in kV-IORT.
• To improve intraoperative precision and usability, particularly for novice users.
• To integrate augmented reality (AR) and digital twin technologies for advanced radiotherapy guidance.

Main Methods:

• A hybrid twin system combining holographic dose visualization, patient-specific AR applicator positioning, and robot-virtual twin control was developed.
• Phantom experiments were conducted using a spherical applicator and simulated tumor bed.
• Accuracy was quantified using root mean square error (RMSE) and target registration error (TRE).

Main Results:

• Novice users (medical students and inexperienced physicians) demonstrated significantly improved applicator placement accuracy (2.971 mm and 2.803 mm, respectively).
• Experienced surgeons showed no significant improvement, highlighting the system's utility as a training aid.
• High user satisfaction was reported, with an average System Usability Scale (SUS) score of 83.5.

Conclusions:

• The hybrid twin navigation system effectively enhances applicator placement accuracy for novice kV-IORT users.
• The system shows potential as a valuable training and assistance tool, improving both precision and usability.
• Sub-millimeter accuracy and high user satisfaction suggest strong potential for clinical translation in radiotherapy.