New Radiation Therapy Technology Delivers Real-time Insights to Enhance Precision and Patient Safety

This Clinician's View is written by Amber Orman, MD, Radiation Oncologist at AdventHealth Celebration.

Excluding skin cancer, breast cancer is the most common cancer among women in the United States with more than 300,000 cases estimated to be diagnosed this year alone. Approximately half of those women will receive radiation therapy as part of their treatment plan.

While an effective, targeted treatment for many cancers, radiation therapy involves the risk of damaging healthy surrounding tissues or organs. Even small errors in treatment planning, delivery or dosing can have negative consequences. With breast cancers, scattered radiation can even reach the opposite breast, increasing the risk of developing a secondary breast cancer in just under 3% of cases.

At AdventHealth, our primary objective in treating cancer patients with radiation is to maximize the therapeutic effects on cancer cells while minimizing the impact on surrounding healthy tissues. That is why we are currently using a variety of technologies to enhance patient safety and treatment effectiveness under the umbrella of surface guided radiation therapy (SGRT). Most recently, AdventHealth Celebration became the first hospital in Florida to use DoseRT® Cherenkov imaging plus AlignRT® technology and the first hospital globally to use the entire surface guided workflow from simulations to treatment. This latest advancement provides us with real-time insights into radiation dose delivery and patient positioning to avert errors and improve clinical outcomes.

Advancing Radiation Treatment Though Visualization

Historically, our only tools for maximizing the accuracy of radiation treatment involved pretreatment checks of the treatment plan, quality assurance tests of the linear accelerator and verification of patient positioning. Unfortunately, none of these verify treatment field delivery, spatial and fractional dose, or patient position during every fraction of the radiation treatment. With radiation treatment evolving toward the administration of larger doses in fewer fractions or faster dose rates, real-time monitoring of dose delivery and patient positioning has become more critical.

Cherenkov imaging is a technique that uses the light emitted by charged particles traveling through a medium faster than the speed of light to visualize the path of radiation within a material. Published data suggests that around 10% of patients have errors in their treatment that could be detected by Cherenkov imaging.

With our new FDA-approved DoseRT technology, Cherenkov imaging captures the emissions generated when radiation interacts with a patient’s body during treatment, allowing us to view the invisible light produced during radiation treatment. This enables our team to verify the accuracy of radiation delivery in real-time and helps ensure consistent and correct coverage.

The DoseRT technology integrates seamlessly with AlignRT, our SGRT system. AlignRT monitors patient positioning and triggers alerts if a patient moves out of the desired treatment position. This enables us to make quick corrections or pause treatment until the desired position is reinstated.

While there have always been gaps of uncertainty with radiation therapy, the combined use of DoseRT and AlignRT is helping to remove two key areas of that uncertainty, reducing the margin of error. Now our clinicians can view radiation as it is being delivered on the same screen as patient position and motion. We believe this real-time monitoring will help us detect radiation therapy errors when they can be immediately corrected, improving the safety and quality of treatment for our patients. One single-center study of the value of Cherenkov imaging found that this technology identified several minor incidents of dosing to surrounding tissue that otherwise would have gone undetected.

Adopting a Comprehensive Approach to Enhance Quality and Accuracy of Radiation Therapy

In addition to DoseRT and AlignRT, AdventHealth Central Florida Division has also been implementing other advanced technologies to help ensure our patients receive the highest quality radiation therapy treatment for their cancers from simulation to planning to treatment. These additional tools include the following:

• SimRT — By tracking the patient’s breathing, SimRT accounts for respiratory movement during the treatment planning and delivery phases. This system enables us to turn the radiation beam on and off in sync with the patient’s breathing, protecting healthy tissue from unnecessary radiation exposure.
• MapRT — This tool captures the entire surface of the patient along with the instruments required for treatment, generating a clearance map. The software detects potential collisions before the patient starts their treatment, allowing us to optimize the treatment plan and deliver it safely.
• PatientID — This system links the patient’s unique biometric signature to their personalized treatment plan, eliminating any risk of misidentification.

Pioneering Research to Continually Improve Radiation Therapy Delivery

As one of the early adopters of DoseRT worldwide, AdventHealth Celebration is committed to refining this breakthrough technology and unlocking its full potential through ongoing research initiatives. Although already approved by the FDA, DoseRT is still in beta testing to refine the workflow, and we are contributing to those efforts. Additionally, Adi Robinson, PhD, DABR, our senior medical physicist, is participating in a research forum with other early adopters to identify additional uses for DoseRT that will further improve patient care.

DoseRT is a brand-new way of doing things, and every member of our amazing team has been essential to its successful implementation, adapting beautifully to the changes. Now we are teaching others how to implement this advanced technology while also performing our own studies to evaluate outcomes and determine how we can better use this new tool to improve cancer care. It is all part of AdventHealth’s ongoing commitment to providing safe, efficient, effective and whole-person care.