Abstract
External beam radiation therapy (EBRT) is included in the treatment regimen of the majority of cancer patients. With the proliferation of hypofractionated radiotherapy treatment regimens, such as stereotactic body radiation therapy (SBRT), interfractional and intrafractional imaging technologies are becoming increasingly critical to ensure safe and effective treatment delivery. Ultrasound (US)-based image guidance systems offer real-time, markerless, volumetric imaging with excellent soft tissue contrast, overcoming the limitations of traditional X-ray or computed tomography (CT)-based guidance for abdominal and pelvic cancer sites, such as the liver and prostate. Interfractional US guidance systems have been commercially adopted for patient positioning but suffer from systematic positioning errors induced by probe pressure. More recently, several research groups have introduced concepts for intrafractional US guidance systems leveraging robotic probe placement technology and real-time soft tissue tracking software. This paper reviews various commercial and research-level US guidance systems used in radiation therapy, with an emphasis on hardware and software technologies that enable the deployment of US imaging within the radiotherapy environment and workflow. Previously unpublished material on tissue tracking systems and robotic probe manipulators under development by our group is also included.
Highlights
BackgroundExternal beam radiation therapy (EBRT) is used to treat > 60% of all cancer patients
Potent radiation doses with minimal treatment margins must be delivered in EBRT to maximize local tumor control and minimize toxicity to surrounding healthy tissue [1,2,3], but internal anatomy motion and deformation pose a fundamental threat to realizing these objectives
Electromagnetic marker tracking enables realtime radiation-free motion tracking [26,27,28], but markers produce severe artifacts when used with computed tomography (CT) and magnetic resonance imaging (MRI) and do not yield volumetric images
Summary
External beam radiation therapy (EBRT) is used to treat > 60% of all cancer patients. Electromagnetic marker tracking enables realtime radiation-free motion tracking [26,27,28], but markers produce severe artifacts when used with computed tomography (CT) and magnetic resonance imaging (MRI) and do not yield volumetric images. Recent attempts at real-time, volumetric, markerless tracking for radiotherapy include using MRI and positron emission tomography (PET), but these approaches require the construction of new therapy machines with integrated imaging capabilities [29,30,31]. Unpublished material on tissue tracking systems and robotic probe manipulators under development by our group is included in Sections 2 and 3
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