Cherenkov light is emitted in response to therapeutic x-ray beam delivery for the treatment of breast cancer, and serves as a passive, non-contact approach for measuring optical signal that is intrinsically linear with dose. However, the intensity of emitted light is attenuated due to absorbers in the tissue (blood, pigment, radiodensity, etc.). If correction for this attenuation were possible, then absolute dose imaging would be feasible. In this study, the planning CT scan was spatially sampled over the area emitting Cherenkov, and the attenuation of the signal was corrected for, using CT radiodensity. There was a linear correlation between presence of fibroglandular (high HU) versus adipose (low HU) and the emitted Cherenkov light. This relationship was used to generate scale factors to normalize out existing tissue variability in images recorded during fractionated radiotherapy, which reduced patient-to-patient variability to under 10%.
Cherenkov light emission from tissue undergoing radiation therapy is a complex function of the dose deposition and is reduced by the optical attenuation of the tissue. A diffusion theory based integral of the remitted light is presented, using the assumption that only Cherenkov photons from the first 8 mm of tissue are able to appreciably escape from the surface. This depth restriction falls within the linear build-up region for both electron and photon beams used in radiotherapy. The resulting expression for Cherenkov light fluence formulated here indicates that the outgoing intensity is dependent upon the quasi-linear dose build up gradient (k2) in the first 8 mm of tissue, is inversely proportional to the optical absorption (μa), and is relatively independent of the scattering coefficient (μs/ ). Numerical evaluation suggests that the diffuse component of Cherenkov light emission dominates over any unscattered photons, suggesting that the radiation build-up factor dominates what is imaged off the surface. This observation could allow for linear corrections to Cherenkov images with knowledge of tissue optical properties and for better interpretation of the origin of Cherenkov from tissue.
Tissue optical properties attenuate a substantial percentage of the optical light being detected during real-time Cherenkov acquisition, which distortsthe signal linearity previously observed with absorbed dose in homogeneous media. This hinders progression toward establishing quantitative dosimetry using Cherenkov imaging in vivo. By spectrally weighting effective attenuation (μeff) maps generated by multi-wavelength Spatial Frequency Domain Imaging (SFDI), it became possible to more successfully correct clinical Cherenkov images for areolar attenuation (6% difference, as compared to the treatment plan) compared to selecting one wavelength channel in a previous study (41% difference). Additionally, using a reflected light-based patient positioning system, we were able to characterize and correct for gross tissue optical properties in patient images, namely for large-scale surface and subsurface attenuation. While the use of wide-field SFDI enabled pixel-bypixel corrections, the benefit of using an integrated, light-based system for reflectance-based corrections negates the use of an external imaging system, which substantially smooths workflow.
Imaging Cherenkov emission during radiotherapy permits real-time visualization of external beam delivery on superficial tissue. This signal is linear with absorbed dose in homogeneous media, indicating potential for quantitative dosimetry. In humans, the inherent heterogeneity of tissue optical properties (primarily from blood and skin pigment) distorts the linearity between detected Cherenkov signal and absorbed dose. We examine the potential to correct for superficial vasculature using spatial frequency domain imaging (SFDI) to map tissue optical properties for large fields of view. In phantoms, applying intensity corrections to simulate blood vessels improves Cherenkov image (CI) negative contrast by 24% for a vessel 1.9-mm-in diameter. In human trials, SFDI and CI are acquired for women undergoing whole breast radiotherapy. Applied corrections reduce heterogeneity due to vasculature within the sampling limits of the SFDI from a 22% difference as compared to the treatment plan, down to 6% in one region and from 14% down to 4% in another region. The optimal use for this combined imaging system approach is to correct for small heterogeneities such as superficial blood vessels or for interpatient variations in blood/melanin content such that the corrected CI more closely represents the surface dose delivered.
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