Adaptive radiotherapy treatment using ultrasound

Abstract

Radiation treatment is delivered to a patient by positioning the patient such that a radiation beam is delivered to a lesion within the patient along a beam-delivery path while securing a diagnostic imaging device about the patient such that the diagnostic imaging device does not intersect the beam-delivery path. Radiation therapy is simultaneously delivered along the beam-delivery path while diagnostic images are obtained using the imaging device.

1 . (canceled) 
     
     
         2 . An apparatus for monitoring delivery of radiation therapy to a patient, the apparatus comprising:
 an ultrasound imaging device positioned in contact with the patient's perineum to obtain, from at least one transperineal direction, a plurality of ultrasound images, such that the ultrasound imaging device does not intersect, while obtaining the plurality of ultrasound images, a beam-delivery path along which a radiation fraction is delivered to the patient during the radiation therapy by a radiation therapy device; and   a processor configured to perform operations comprising detecting, during delivery of the radiation fraction by the radiation therapy device, intrafractional movement of at least one of a target tissue or surrounding tissue based on the obtained plurality of ultrasound images of the target tissue and the surrounding tissue of the patient.   
     
     
         3 . The apparatus of  claim 2 , wherein the radiation therapy device simultaneously delivers the radiation fraction while the plurality of ultrasound images are obtained using the ultrasound imaging device. 
     
     
         4 . The apparatus of  claim 3 , wherein the radiation therapy device delivers the radiation fraction along the beam-delivery path to the target tissue, wherein the beam-delivery path is directed to the patient's anatomy in a non-transperineal direction. 
     
     
         5 . The apparatus of  claim 2 , wherein the ultrasound imaging device scans, transperineally, a target tissue in a genitourinary region of the patient to obtain, prior to the radiation fraction, a baseline image of the target tissue and surrounding tissue. 
     
     
         6 . The apparatus of  claim 5 , wherein the processor is configured to perform operations comprising:
 comparing one or more of the plurality of ultrasound images with the baseline image; and   determining intrafractional movement of at least one of the target tissue or the surrounding tissue based on the compared one or more ultrasound images as the radiation fraction is delivered to the patient by the radiation therapy device.   
     
     
         7 . The apparatus of  claim 2 , wherein the plurality of ultrasound images comprises at least one two-dimensional ultrasound image or three-dimensional ultrasound image. 
     
     
         8 . The apparatus of  claim 2 , wherein the ultrasound imaging device comprises one or more tracking devices to facilitate real-time positional tracking of the ultrasound imaging device. 
     
     
         9 . The apparatus of  claim 2 , wherein the operations further comprise combining a plurality of temporally-displaced three-dimensional ultrasound images to create a four-dimensional ultrasound image. 
     
     
         10 . The apparatus of  claim 2 , wherein the ultrasound imaging device is movable within a predetermined envelope to obtain the plurality of ultrasound images from different respective locations. 
     
     
         11 . The apparatus of  claim 2 , wherein the target tissue comprises a prostate tumor. 
     
     
         12 . The apparatus of  claim 2 , further comprising a brace for holding the ultrasound imaging device, the brace being connected to a stationary structure and being configured to hold the ultrasound imaging device at each of a plurality of different locations. 
     
     
         13 . The apparatus of  claim 12 , wherein a position of the brace is adjusted in response to a change in one or more radiation treatment parameters. 
     
     
         14 . The apparatus of  claim 12 , wherein the brace is rotated such that the ultrasound imaging device can obtain the plurality of ultrasound images of a genitourinary region of the patient, at each of a plurality of different locations, during delivery of the radiation fraction by the radiation therapy device. 
     
     
         15 . The apparatus of  claim 2 , wherein the operations further comprise comparing two or more of the plurality of ultrasound images obtained during the delivery of the radiation fraction by the radiation therapy device and adjusting one or more radiation treatment parameters based on the comparison. 
     
     
         16 . The apparatus of  claim 15 , wherein the one or more radiation treatment parameters comprises at least one of a beam angle, a beam isocenter, a couch position, a beam aperture, a beam delivery path, a focal point, an energy level, or a duration of a radiation fraction. 
     
     
         17 . The apparatus of  claim 2 , wherein the ultrasound imaging device is positioned between the patient's legs. 
     
     
         18 . A system for monitoring delivery of radiation therapy to a patient, the system comprising:
 an ultrasound imaging device positioned in contact with the patient's perineum to obtain, from at least one transperineal direction, a plurality of ultrasound images of a target tissue and surrounding tissue of the patient while a radiation fraction is simultaneously delivered by a radiation therapy device along one or more beam-delivery paths to the patient, wherein the ultrasound imaging device does not intersect, while obtaining the plurality of ultrasound images, the one or more beam-delivery paths of the radiation fraction;   a memory that stores the plurality of ultrasound images and a baseline image, the baseline image being obtained prior to the radiation fraction and represents the target tissue and the surrounding tissue; and   a processor configured to perform operations comprising:
 comparing the baseline image with at least one of the plurality of ultrasound images; 
 detecting intrafractional movement of anatomical structures associated with the target tissue or surrounding tissue based on a result of the comparison; and 
 determine an adjustment to a radiation treatment parameter based on the detected intrafractional movement of the anatomical structures. 
   
     
     
         19 . The system of  claim 18 , wherein the radiation therapy device delivers the radiation fraction along the beam-delivery path to the target tissue, wherein the beam-delivery path is directed to the patient's anatomy in a non-transperineal direction. 
     
     
         20 . The system of  claim 18 , wherein the ultrasound imaging device scans, transperineally, the target tissue in a genitourinary region of the patient to obtain, prior to the radiation fraction, the baseline image of the target tissue and surrounding tissue. 
     
     
         21 . The system of  claim 18 , wherein the plurality of ultrasound images comprises at least one two-dimensional ultrasound image or three-dimensional ultrasound image. 
     
     
         22 . The system of  claim 18 , wherein the ultrasound imaging device comprises one or more tracking devices to facilitate real-time positional tracking of the ultrasound imaging device. 
     
     
         23 . A method comprising:
 positioning an ultrasound imaging device in contact with a patient's perineum;   obtaining, by the ultrasound imaging device, a plurality of ultrasound images from at least one transperineal direction, wherein the ultrasound imaging device does not intersect a beam-delivery path along which a radiation fraction is delivered to the patient during a radiation therapy by a radiation therapy device;   simultaneously delivering the radiation fraction while obtaining a plurality of ultrasound images using the ultrasound imaging device; and   detecting, during delivery of the radiation fraction by the radiation therapy device, intrafractional movement of at least one of a target tissue or surrounding tissue based on the obtained plurality of ultrasound images of the target tissue and the surrounding tissue of the patient.   
     
     
         24 . The method of  claim 23 , further comprising scanning by the ultrasound imaging device, transperineally, the target tissue in a genitourinary region of the patient to obtain, prior to the radiation fraction, a baseline image of the target tissue and surrounding tissue. 
     
     
         25 . The method of  claim 24 , further comprising delivering the radiation fraction along the beam-delivery path to the target tissue using the radiation therapy device, wherein the beam-delivery path is directed to the patient's anatomy in a non-transperineal direction. 
     
     
         26 . The method of  claim 23 , further comprising:
 comparing one or more of the plurality of ultrasound images with a baseline image; and   determining intrafractional movement of at least one of the target tissue or the surrounding tissue based on the compared one or more ultrasound images as the radiation fraction is delivered to the patient by the radiation therapy device.