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Session: Quality Improvement and Outcomes [Return to Session]

Implementation of Continuous Cherenkov Imaging Over 1 Year for Radiation Therapy Quality Improvement

S Decker1*, D Alexander1, M Jermyn1, P Bruza1, R Zhang1,2, E Chen3, B Pogue1,4, L Jarvis2, D Gladstone1, (1) Thayer School of Engineering, Dartmouth College, Hanover, NH, (2) Geisel School of Medicine, Dartmouth College, Hanover, NH, (3) Cheshire Medical Center, Keene, NH, (4) Department of Medical Physics, University of Wisconsin-Madison, Madison, WI


SU-H430-IePD-F7-4 (Sunday, 7/10/2022) 4:30 PM - 5:00 PM [Eastern Time (GMT-4)]

Exhibit Hall | Forum 7

Purpose: The aim of this work was to implement an always-on Cherenkov imaging system across all treatment bunkers at our center as a time-of-delivery quality check on external beam radiation therapy treatments, in order to better understand treatment issues previously detected only with Cherenkov imaging.

Methods: Continuous imaging of all external beam radiation therapy patients was attempted during a 1-year period by automating image acquisition using an always-on commercially available Cherenkov imaging system. Camera systems were installed in two treatment bunkers in at our main center and one bunker in a satellite clinic, with a total seven cameras. Images were acquired automatically as part of normal treatment procedure for every patient and reviewed retrospectively, with potential incidents flagged for evaluation by the physician and physics teams. Planning information including CT scans and dose distributions were automatically exported from clinical databases based on timestamp syncing to co-register superficial dose distributions with acquired Cherenkov images.

Results: In total, 9/622 patients imaged and reviewed as part of this retrospective study were identified as having incidents occurring during their course of treatment that were detected only with Cherenkov imaging. Issues during simulation, planning, pre-treatment review, and treatment delivery were all found to contribute to these detected incidents, which included improper bolus placement, exit dose delivered to non-target extremities, and patient positioning. All detected events were deemed below the threshold for reporting.

Conclusion: The observations from this study indicate that in practice, an always-on Cherenkov imaging system can lead to quality improvement. The system provided both a real-time live view as well as a record of the treatment and required no effort from the clinical team to operate. Future work will involve better integration of the image review experience with routine clinical workflows and protocol development to formalize this system as a quality improvement method.

Funding Support, Disclosures, and Conflict of Interest: This work has been funded in part by NIH grants R01 EB023909 and R44 CA232879 and the Norris Cotton Cancer Center shared irradiation resources through P30 CA023108. DA reports receiving consulting fees from DoseOptics LLC.


Optical Imaging, Quality Assurance, Patient Positioning


IM/TH- Formal Quality Management Tools: Error taxonomies and incident reporting analyses

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