Significance: The Cherenkov emission spectrum overlaps with that of ambient room light sources. Choice of room lighting devices dramatically affects the efficient detection of Cherenkov emission during patient treatment.
Aim: To determine optimal room light sources allowing Cherenkov emission imaging in normally lit radiotherapy treatment delivery rooms.
Approach: A variety of commercial light sources and long-pass (LP) filters were surveyed for spectral band separation from the red to near-infrared Cherenkov light emitted by tissue. Their effects on signal-to-noise ratio (SNR), Cherenkov to background signal ratio, and image artifacts were quantified by imaging irradiated tissue equivalent phantoms with an intensified time-gated CMOS camera.
Results: Because Cherenkov emission from tissue lies largely in the near-infrared spectrum, a controlled choice of ambient light that avoids this spectral band is ideal, along with a camera that is maximally sensitive to it. An RGB LED light source produced the best SNR out of all sources that mimic room light temperature. A 675-nm LP filter on the camera input further reduced ambient light detected (optical density > 3), achieving maximal SNR for Cherenkov emission near 40. Reduction of the room light signal reduced artifacts from specular reflection on the tissue surface and also minimized spurious Cherenkov signals from non-tissue features such as bolus.
Conclusions: LP filtering during image acquisition for near-infrared light in tandem with narrow band LED illuminated rooms improves image quality, trading off the loss of red wavelengths for better removal of room light in the image. This spectral filtering is also critically important to remove specular reflection in the images and allow for imaging of Cherenkov emission through clear bolus. Beyond time-gated external beam therapy systems, the spectral separation methods can be utilized for background removal for continuous treatment delivery methods including proton pencil beam scanning systems and brachytherapy.
Significance: Optical imaging of Cherenkov emission during radiation therapy could be used to verify dose delivery in real-time if a more comprehensive quantitative understanding of the factors affecting emission intensity could be developed.
Aim: This study aims to explore the change in diffuse Cherenkov emission intensity with x-ray beam energy from irradiated tissue, both theoretically and experimentally.
Approach: Derivation of the emitted Cherenkov signal was achieved using diffusion theory, and experimental studies with 6 to 18 MV energy x-rays were performed in tissue phantoms to confirm the model predictions as related to the radiation build-up factor with depth into tissue.
Results: Irradiation at lower x-ray energies results in a greater surface dose and higher build-up slope, which results in a ∼46 % greater diffusely emitted Cherenkov signal per unit dose at 6 MV relative to 18 MV x-rays. However, this phenomenon competes with a decrease in signal from less Cherenkov photons being generated at lower energies, a ∼44 % reduction at 6 versus 18 MV. The result is an emitted Cherenkov signal that is nearly constant with beam energy.
Conclusions: This study explains why the observed Cherenkov emission from tissue is not a strong function of beam energy, despite the known strong correlation between Cherenkov intensity and particle energy in the absence of build-up and scattering effects.
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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