Purpose The incorporation of cone‐beam computed tomography (CBCT) has allowed for enhanced image‐guided radiation therapy. While CBCT allows for daily 3D imaging, images suffer from severe artifacts, limiting the clinical potential of CBCT. In this work, a deep learning‐based method for generating high quality corrected CBCT (CCBCT) images is proposed. Methods The proposed method integrates a residual block concept into a cycle‐consistent adversarial network (cycle‐GAN) framework, called res‐cycle GAN, to learn a mapping between CBCT images and paired planning CT images. Compared with a GAN, a cycle‐GAN includes an inverse transformation from CBCT to CT images, which constrains the model by forcing calculation of both a CCBCT and a synthetic CBCT. A fully convolution neural network with residual blocks is used in the generator to enable end‐to‐end CBCT‐to‐CT transformations. The proposed algorithm was evaluated using 24 sets of patient data in the brain and 20 sets of patient data in the pelvis. The mean absolute error (MAE), peak signal‐to‐noise ratio (PSNR), normalized cross‐correlation (NCC) indices, and spatial non‐uniformity (SNU) were used to quantify the correction accuracy of the proposed algorithm. The proposed method is compared to both a conventional scatter correction and another machine learning‐based CBCT correction method. Results Overall, the MAE, PSNR, NCC, and SNU were 13.0 HU, 37.5 dB, 0.99, and 0.05 in the brain, 16.1 HU, 30.7 dB, 0.98, and 0.09 in the pelvis for the proposed method, improvements of 45%, 16%, 1%, and 93% in the brain, and 71%, 38%, 2%, and 65% in the pelvis, over the CBCT image. The proposed method showed superior image quality as compared to the scatter correction method, reducing noise and artifact severity. The proposed method produced images with less noise and artifacts than the comparison machine learning‐based method. Conclusions The authors have developed a novel deep learning‐based method to generate high‐quality corrected CBCT images. The proposed method increases onboard CBCT image quality, making it comparable to that of the planning CT. With further evaluation and clinical implementation, this method could lead to quantitative adaptive radiation therapy.

Recent studies have proposed that light emitted by the Cherenkov effect may be used for a number of radiation therapy dosimetry applications. There is a correlation between the captured light and expected dose under certain conditions, yet discrepancies have also been observed and a complete examination of the theoretical differences has not been done. In this study, a fundamental comparison between the Cherenkov emission and absorbed dose was explored for x-ray photons, electrons, and protons using both a theoretical and Monte Carlo-based analysis. Based on the findings of where dose correlates with Cherenkov emission, it was concluded that for x-ray photons the light emission would be optimally suited for narrow beam stereotactic radiation therapy and surgery validation studies, for verification of dynamic intensity-modulated and volumetric modulated arc therapy treatment plans in water tanks, near monoenergetic sources (e.g., Co-60 and brachy therapy sources) and also for entrance and exit surface imaging dosimetry of both narrow and broad beams. For electron use, Cherenkov emission was found to be only suitable for surface dosimetry applications. Finally, for proton dosimetry, there exists a fundamental lack of Cherenkov emission at the Bragg peak, making the technique of little use, although post-irradiation detection of light emission from radioisotopes could prove to be useful.

Purpose: A novel technique for beam profiling of megavoltage photon beams was investigated for the first time by capturing images of the inducedČerenkov emission in water, as a potential surrogate for the imparted dose in irradiated media. Methods: A high-sensitivity, intensified CCD camera (ICCD) was configured to acquire 2D projection images ofČerenkov emission from a 4 × 4 cm 2 6 MV linear accelerator (LINAC) x-ray photon beam operating at a dose rate of 400 MU/min incident on a water tank with transparent walls. The ICCD acquisition was gated to the LINAC sync pulse to reduce background light artifacts, and the measurement quality was investigated by evaluating the signal to noise ratio and measurement repeatability as a function of delivered dose. Monte Carlo simulations were used to derive a calibration factor for differences between the optical images and deposited dose arising from the anisotropic angular dependence ofČerenkov emission. Finally,Čerenkov-based beam profiles were compared to a percent depth dose (PDD) and lateral dose profile at a depth of d max from a reference dose distribution generated from the clinical Varian ECLIPSE treatment planning system (TPS). Results: The signal to noise ratio was found to be 20 at a delivered dose of 66.6 cGy, and proportional to the square root of the delivered dose as expected from Poisson photon counting statistics. A 2.1% mean standard deviation and 5.6% maximum variation in successive measurements were observed, and the Monte Carlo derived calibration factor resulted inČerenkov emission images which were directly correlated to deposited dose, with some spatial issues. The dose difference between the TPS and PDD predicted byČerenkov measurements was within 20% in the buildup region with a distance to agreement (DTA) of 1.5-2 mm and ±3% at depths beyond d max . In the lateral profile, the dose difference at the beam penumbra was within ±13% with a DTA of 0-2 mm, ±5% in the central beam region, and 2%-3% in the beam umbra. Conclusions:The results from this initial study demonstrate the first documented use ofČerenkov emission imaging to profile x-ray photon LINAC beams in water. The proposed modality has several potential advantages over alternative methods, and upon future refinement may prove to be a robust and novel dosimetry method.

While spatial dose conformity delivered to a target volume has been pushed to its practical limits with advanced treatment planning and delivery, investigations in novel temporal dose delivery are unfolding new mechanisms. Recent advances in ultra-high dose radiotherapy, abbreviated as FLASH, indicate the potential for reduction in healthy tissue damage while preserving tumor control. FLASH therapy relies on very high dose rate of > 40Gy/s with sub-second temporal beam modulation, taking a seemingly opposite direction from the conventional paradigm of fractionated therapy. FLASH brings unique challenges to dosimetry, beam control, and verification, as well as complexity of radiobiological effective dose through altered tissue response. In this review, we compare the dosimetric methods capable of operating under high dose rate environments. Due to excellent dose-rate independence, superior spatial (∼ <1 mm) and temporal (∼ns) resolution achievable with Cherenkov and scintillation-based detectors, we show that luminescent detectors have a key role to play in the development of FLASH, as the field rapidly progresses toward clinical adaptation. Additionally, we show that the unique ability of certain luminescence-based methods to provide tumor oxygenation maps in real-time with submillimeter resolution can elucidate the radiobiological mechanisms behind the FLASH effect. In particular, such techniques will be crucial for understanding the role of oxygen in mediating the FLASH effect.

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Radiation from a linear accelerator induces Cerenkov emission in tissue, which has recently been shown to produce biochemical spectral signatures which can be interpreted to estimate tissue hemoglobin and oxygen saturation or molecular fluorescence from reporters. The Cerenkov optical light levels are in the range of 10−6–10−9 W/cm2, which limits the practical utility of the signal in routine radiation therapy monitoring. However due to the fact that the radiation is pulsed, gated-acquisition of the signal allows detection in the presence of ambient lighting, as is demonstrated here. This observation has the potential to significantly increase the value of Cerenkov emission spectroscopy during radiation therapy to monitor tissue molecular events.

Full 3D beam profiling and quality assurance (QA) of therapeutic megavoltage linear accelerator (LINAC) x-ray photon beams is not routinely performed due to the slow point-by-point measurement nature of conventional scanning ionization chamber systems. In this study we explore a novel optical-based dose imaging approach using a standard commercial camera, water tank, and fluorescent dye, which when excited by the Čerenkov emission induced by the radiation beam, allows 2D projection imaging in a fast timeframe, potentially leading towards 3D tomographic beam profiling. Detailed analysis was done to optimize the imaging parameters in the experimental setup. The results demonstrate that the captured images are linear with delivered dose, independent of dose rate, and comparison of experimentally captured images to a reference dose distribution for a 4×4 cm 6 MV x-ray photon beam yielded results with improved accuracy over a previous study which used direct imaging and Monte Carlo calibration of the Čerenkov emission itself. The agreement with the reference dose distribution was within 1-2% in the lateral direction, and ± 3 % in the depth direction. The study was restricted to single 2D image projection, with the eventual goal of creating full 3D profiles after tomographic reconstruction from multiple projections. Given the increasingly complex advances in radiation therapy, and the increased emphasis on patient-specific treatment plans, further refinement of the technique could prove to be an important tool for fast and robust QA of x-ray photon LINAC beams.

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