Reflexion Medical, Inc.

Leland Stanford Junior University

Peter D Olcott

Rostem Bassalow

Yevgen Voronenko

Craig Steven Levin

Michael Kirk Owens

Debashish Pal

Matthew Francis Bieniosek

David Q Larkin

Brent Harper

Christopher Eric Brown

Ayan Mitra

Samuel Mazin

Garry Chinn

David Nett

George Andrew Zdasiuk

Sanjiv Sam Gambhir

Jin Zhang

Henry Meyer Daghighian

Manat Maolinbay

Jayakrishnan Janardhanan

Chris A Julian

Robert Thomas Wiggers

Ewout Van Den Berg

David Meer

Guillem Pratx

Emmanuel J Candes

William Pearce

Farhad Taghibakhsh

Brent Dolan

Carlos Alberto Sing-Long Collao

Victor Carboni

William Jorge Pearce

This application relates to methods for delivering radiation to a positron-emitting target within a subject under continuous PET guidance. Instead of directing radiation at a collinear path along each detected positron line-of-response (LOR), the methods generally include detecting a pattern of LORs that intersect the target. In response to the pattern, radiation may be delivered along paths that are not necessarily collinear to any of the LORs. Methods for further modifying radiation delivery as well as the detected LOR population are also described.

Methods for radiation delivery in emission-guided radiotherapy

Systems and methods for shuttle mode radiation delivery are described herein. One method for radiation delivery comprises moving the patient platform through the patient treatment region multiple times during a treatment session. This may be referred to as patient platform or couch shuttling (i.e., couch shuttle mode). Another method for radiation delivery comprises moving the therapeutic radiation source jaw across a range of positions during a treatment session. The jaw may move across the same range of positions multiple times during a treatment session. This may be referred to as jaw shuttling (i.e., jaw shuttle mode). Some methods combine couch shuttle mode and jaw shuttle mode. Methods of dynamic or pipelined normalization are also described.

Systems and methods for shuttle mode radiation delivery

Described herein are methods for monitoring the radiation delivery during a radiotherapy delivery session and providing a graphical representation of radiation delivery to an operator (e.g., a clinician, a medical physicist, a radiation therapy technologist). The graphics are updated in real-time, as radiation data is collected by the radiotherapy system, and in some variations, can be updated every 15 minutes or less. A variety of graphical representations ('graphics') can be used to indicate the status of radiation delivery relative to the planned radiation delivery. Methods optionally include calculating a range of acceptable metric values, generating graphics that represent the range of acceptable metrics values, and generating a graphic that depicts the real-time values of those metrics overlaid with the range of acceptable metrics values.

Graphical representation of radiation therapy

Disclosed herein are methods for radiotherapy treatment plan optimization for irradiating one or more target regions using both an internal therapeutic radiation source (ITRS) and an external therapeutic radiation source (ETRS). One variation of a method comprises iterating through ITRS radiation dose values and ETRS radiation dose values to attain a cumulative dose that meets prescribed dose requirements. In some variations, an ITRS is an injectable compound that has a targeting backbone and a radionuclide, and images acquired using an imaging compound that has the same targeting backbone as the injectable compound can be used to calculate the radiation dose deliverable using the injectable ITRS, and also to calculate firing filters for delivering radiation using a biologically-guided radiation therapy (BGRT) system. Image data acquired from a previous treatment session may be used to adapt the dose provided by an ITRS and/or ETRS for a future treatment session.

Joint optimization of radionuclide and external beam radiotherapy

Described herein are methods for beam station delivery of radiation treatment, where the patient platform is moved to a series of discrete patient platform locations or beam stations that are determined during treatment planning, stopped at each of these locations while the radiation source rotates about the patient delivering radiation to the target regions that intersect the radiation beam path, and then moving to the next location after the prescribed dose of radiation (e.g., in accordance with a calculated fluence map) for that location has been delivered to the patient.

Beam station treatment planning and radiation delivery methods

Disclosed herein are systems and methods for adapting and/or updating radiotherapy treatment plans based on biological and/or physiological data and/or anatomical data extracted or calculated from imaging data acquired in real-time (e.g., during a treatment session). Functional imaging data acquired at the time of radiation treatment is used to modify a treatment plan and/or dose delivery instructions to provide a prescribed dose distribution to patient target regions. Also disclosed herein are methods for evaluating treatment plans based on imaging data acquired in real-time.

Systems and methods for biological adaptive radiotherapy

Disclosed herein are methods for patient setup and patient target region localization for the irradiation of multiple patient target regions in a single treatment session. Virtual localization is a method that can be used to register a patient target region without requiring that the patient is physically moved using the patient platform. Instead, the planned fluence is updated to reflect the current location of the patient target region by selecting a localization reference in the localization image, calculating a localization function based on the localization reference point, and calculating the delivery fluence by convolving the localization function with a shift-invariant firing filter. Mosaic multi-target localization partitions a planned fluence map for multiple patient target regions into sub-regions that can be individually localized. De-coupled multi-target localization involves generating a separate planned fluence map for each target but constraining a cumulative fluence map to ensure dosimetric goals are met.

Multi-target treatment planning and delivery and virtual localization for radiation therapy

Disclosed herein are systems and methods for rapidly delivering high doses of radiation, also known as, flash dose radiotherapy or flash radiotherapy. One variation of a system for flash radiotherapy has a plurality of therapeutic radiation sources on a support structure (e.g., a gantry or arm) and configured to toward a patient target region, and a controller in communication with all of the therapeutic radiation sources. The controller is configured to activate the plurality of therapeutic radiation sources simultaneously so that the patient target region rapidly receives a high dose of radiation, e.g. the entire prescribed dose of radiation. In some variations, a flash radiotherapy system has a pulsed, high-power source that may be used to generate an X-ray pulse that delivers a dose having a dose rate from about 7.5 Gy/s to about 70 Gy/s. Flash radiotherapy systems may also include one or more imaging systems mounted on the support structure.

Flash dose radiotherapy systems and methods

Disclosed herein are methods and devices for the acquisition of positron emission (or PET) data in the presence of ionizing radiation that causes afterglow of PET detectors. In one variation, the method comprises adjusting a coincidence trigger threshold of the PET detectors during a therapy session. In one variation, the method comprises adjusting a gain factor used in positron emission data acquisition (e.g., a gain factor used to multiply and/or shift the output(s) of a PET detector(s)) during a therapy session. In some variations, a method for acquiring positron emission data during a radiation therapy session comprises suspending communication between the PET detectors and a signal processor of a controller for a predetermined period of time after a radiation pulse has been emitted by the linac.

Methods for PET detector afterglow management

Disclosed herein are systems and methods for monitoring calibration of positron emission tomography (PET) systems. In some variations, the systems include an imaging assembly having a gantry comprising a plurality of positron emission detectors. A housing may be coupled to the gantry, and the housing may include a bore and a radiation source holder spaced away from a patient scan region within the bore. A processor may be configured to receive positron emission data from the positron emission detectors and to distinguish the positron emission data from the radiation source holder and from the patient scan region. A fault signal may be generated when the positron emission data from the radiation source holder exceeds one or more threshold parameters or criteria.

Systems and methods for fault detection in emission-guided radiotherapy

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Stanford, CA, United States of America

Peter D Olcott