A Review of Cherenkov Imaging for Real-Time Verification in Radiation Therapy

PURPOSE: This paper aimed to evaluate the integration of Cherenkov imaging into radiation therapy practices, focusing on its utility in enhancing treatment precision, patient safety, and clinical decision-making. The research highlights its application in quality and safety verification, breast treatment, and dose visualization, confirming the absence of radiation in unintended areas and its broader clinical impact. METHODS AND MATERIALS: We employed 2 commercially available Cherenkov imaging systems, BeamSite and DoseRT, integrated with Varian and Elekta linear accelerators. The methodology involved real-time imaging during radiation therapy sessions for various treatments, capturing Cherenkov light with time-gated cameras synchronized with radiation pulses. Posttreatment, images were analyzed to assess treatment accuracy, dose distribution, and any deviations from the intended plan. RESULTS: Cherenkov imaging consistently provided high-quality images that allowed immediate visualization of the radiation dose distribution, detection of deviations in real time, and ensured no radiation was delivered to unintended areas. The results are presented, focusing on 5 main topics: quality and patient safety verification; breast treatment applications; dose visualization for treatment verification; verification of a negative dose in areas of concern; and observations with clinical impact. It was particularly beneficial in complex scenarios like breast cancer treatments and in cases where patient positioning was challenging. The technology facilitated immediate treatment adjustments, improved patient safety, and offered insights into treatment response without adding significant time to the clinical workflow. CONCLUSIONS: Cherenkov imaging has shown substantial promise in enhancing radiation therapy by providing real-time, visual feedback on treatment delivery. It complements traditional verification methods by offering continuous monitoring, which can lead to fewer treatment errors and better patient outcomes. The findings suggest that Cherenkov imaging should be considered for broader clinical adoption to elevate the standard of care in radiation oncology, although further refinement of image processing and camera positioning could enhance its effectiveness.