A camera system created by Dartmouth captures real-time video of the behavior during radiation treatment

The Norris Dartmouth and Dartmouth-Hitchcock Cotton Cancer Center (NCCC) is the first cancer center in the world to have BerenSite Cherenkov imaging cameras installed in its radiotherapy treatment rooms. The camera system, created, tested and commercialized by entrepreneurs from NCCC and Dartmouth biomed spinoff tech company, DoseOptics, LLC, captures real-time images and video of the behavior directly on the patient, which allow the radiation oncology team to demonstrate treatment delivery.

Cherenkov images make radiation manipulation as a visual process. The Cherenkov effect occurs when the radiation of a photon or electron interacts with a particle, such as a skin, to emit small light emissions from the surface. BeamSite cameras can capture images of the behavioral manipulations in real time, as well as reveal intensity levels that are proportional to the radiation dose. This visual data can be used to verify both dose accuracy and behavioral delivery at each daily treatment, confirmation that is not possible using standard quality assurance measures.

“Cherenkov’s images provide an insight into the radiation therapy treatment, so that the treatment team can see everything, and make adjustments when unexpected things happen,” explained Brian Pogue, PhD, co-director of the NCCC Cancer Engineering Translation Program, MacLean Professor of Engineering Sciences at Dartmouth Engineering and co-founder of DoseOptics, LLC. A joint engineering and oncology team reviewed events recorded in their Cherenkov imaging study over a few years, when they recorded events when the delivery of radiotherapy was not particularly appropriate and the changes made to correct. Their findings, “Initial Clinical Knowledge of Cherenkov Imaging in Outdoor Beam Radiation Medicine identify opportunities to improve treatment delivery,” were published in International Journal of Radiation Oncology, Biology, Physics.

A total of 64 patients were included in the study, led by a radiation oncologist and lead author Lesley Jarvis, MD, PhD, Member of the NCCC Cancer Research Research Program and Associate Professor of Medicine at Geisel School of Medicine in Dartmouth. The patients were being treated for breast cancer, sarcoma, lymphoma and other cancers. Six patients were found to show changes to better treatment, such as a dose of stray radiation on the chest, arm or chin versus breast cancer treatment. The imaging system was also used to determine when a random dose was not an issue, such as confirming that there was no abnormal view of the opposite leg during external sarcoma treatment.

Radiation therapy is a repetitive procedure that is given to patients every day for about 30 days. Placing patients on the treatment bed and the daily alignment of the beam is a complex process. Beyond situation problems, the medical team has to leave the room when the transport is in progress, so if anything happens during delivery, problem-solving tools are very limited. National statistics show that incidents of incorrect delivery could occur at around 1%. In a busy clinic, this could mean one patient per week. “The treatments are usually just fine,” Pogue says. “However, if you can’t see where the behavior is, it is blind treatment, and the interaction between patients and treatment team is just more natural than it might be if the treatment was visual. “

NCCC is currently the only cancer center in the world with consistent use of Cherenkov imaging in all radiotherapy treatments, and was in a unique position for clinical research teams to test these cameras for the planned study . Cherenkov imaging cameras were installed in most serial accelerators within Dartmouth-Hitchcock, providing an additional level of safety during each patient’s treatment session. “Cherenkov cameras are mounted inside the radiotherapy treatment rooms giving us the ability to directly view the treatment and provide intuitive guidance to physicians that we would not otherwise have,” Pogue said. This is great for monitoring what happens each day and in each treatment, and for improving the quality of radiotherapy delivery. “

DoseOptics technology was developed through research at Dartmouth by the Dartmouth faculty, which then licensed the product to the company. Distributed at Dartmouth-Hitchcock, it is now expanding to other cancer centers. Since DoseOptics, LLC received FDA approval to market BeamSite in December 2020, the team hopes that all radiation oncology clinics will incorporate the technology into their programs. “Clinics should have all the tools to ensure that every treatment for every patient is accurate, and be able to quickly detect and repair issues,” Pogue says.

Brian W. Pogue, PhD, is Co-Director of the Engineering Translation Program in Cancer at the Dartmouth Cotton Cancer Center and Dartmouth-Hitchcock, MacLean Professor of Engineering at Dartmouth Engineering, Professor of surgery at the Geisel School of Medicine at Dartmouth , and President and Co – Founder of DoseOptics, LLC, which develops camera systems and software for radiotherapy imaging of Cherenkov light for dosimetry. His research interests include optics in medicine, biochemical imaging to guide cancer management, molecular-guided surgery, dose imaging in radiation therapy, Cherenkov light imaging, image-guided cancer spectroscopy, medicine photodynamic, and modulation of tumor pathophysiology and contrast.