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X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
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Normal organ dose reduction by fluence map prediction plan adjustment.

Yaoying Liu1,2, Yiru Peng3, Qichao Zhou4

  • 1National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China.

Physics in Medicine and Biology
|October 15, 2025
PubMed
Summary

This study introduces a rapid fluence map prediction method for online adaptive radiation therapy. The approach significantly reduces radiation dose to healthy tissues while maintaining tumor coverage, improving patient safety.

Keywords:
fluence maphypopharyngeal carcinomaonline-ARTplan adjustment

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Artificial Intelligence in Medicine

Background:

  • Anatomical changes during radiation therapy (RT) necessitate plan adaptation for optimal outcomes.
  • Current RT planning may lead to suboptimal dose delivery and increased risk to healthy tissues due to anatomical variations.
  • Online adaptive RT (OART) aims to address these changes for improved treatment efficacy and safety.

Purpose of the Study:

  • To investigate a fluence map prediction-based method (FM_PD) for rapid plan adaptation in OART.
  • To assess the potential of FM_PD for improved normal tissue sparing by accounting for structural changes during treatment.
  • To evaluate the dosimetric impact of FM_PD on organs-at-risk (OARs) compared to non-adapted plans.

Main Methods:

  • A 2D Dense-U-Net model was trained using 93 intensity-modulated RT plans for hypopharyngeal carcinoma, incorporating PTV-specific loss.
  • Planning target volumes (PTVs) and dose distributions were converted into 2D projection matrices for model training.
  • Nine re-planning scenarios simulating OART were used for testing; predicted fluence maps were applied to daily CTs to calculate updated dose distributions.

Main Results:

  • FM_PD significantly reduced radiation dose to normal tissues while preserving tumor coverage.
  • Dose reductions were observed in critical structures: Dmax to the lens, optic nerves, and brainstem decreased by 18.67%, 19.17%, and 14.54% respectively.
  • Mean total body dose decreased by 25.65%, with a notable 46.40% decrease in mean dose to adjacent lung tissue.

Conclusions:

  • FM_PD provides a rapid and effective strategy for adapting RT plans in response to anatomical changes.
  • This method significantly reduces radiation doses to healthy tissues, enhancing patient safety.
  • FM_PD is recommended for cross-fraction adaptation in clinical OART practice compared to maintaining the initial plan.