Objective. The goal is to increase the precision of radiation delivery during radiotherapy by tracking the movements of the tumor and other surrounding normal tissues due to respiratory and other body motions. Introduction. This work presents the recent advancement of X-ray-induced radiation acoustic imaging (xRAI) technology and the evaluation of its feasibility for real-time monitoring of geometric and morphological misalignments of the X-ray field with respect to the target tissue by combining xRAI with established ultrasound (US) imaging, thereby improving radiotherapy tumor eradication and limiting treatment side effects. Methods. An integrated xRAI and B-mode US dual-modality system was established based on a clinic-ready research US platform. The performance of this dual-modality imaging system was evaluated via experiments on phantoms and ex vivo and in vivo rabbit liver models. Results. This system can alternatively switch between the xRAI and the US modes, with spatial resolutions of 1.1&#x2009;mm and 0.37&#x2009;mm, respectively. 300 times signal averaging was required for xRAI to reach a satisfactory signal-to-noise ratio, and a frame rate of 1.1&#x2009;Hz was achieved with a clinical linear accelerator. The US imaging frame rate was 22&#x2009;Hz, which is sufficient for real-time monitoring of the displacement of the target due to internal body motion. Conclusion. Our developed xRAI, in combination with US imaging, allows for mapping of the dose deposition in biological samples in vivo, in real-time, during radiotherapy. Impact Statement. The US-based image-guided radiotherapy system presented in this work holds great potential for personalized cancer treatment and better outcomes.

Wei Zhang

Ibrahim Oraiqat

Hao Lei

Paul L. Carson

Issam EI Naqa

Xueding Wang

Dual-Modality X-Ray-Induced Radiation Acoustic and Ultrasound Imaging for Real-Time Monitoring of Radiotherapy

Xingde Li

Guoqi Zhang

Yuguo Tang

BME Frontiers: A Platform for Engineering the Future of Biomedicine

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The open access journal BME Frontiers, published in association with SIBET CAS, is a platform for the multidisciplinary community of biomedical engineering, publishing wide-ranging research in the field.

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BME Frontiers' editorial board is led by Xingde Li&nbsp;(Johns Hopkins University), Yuguo Tang&nbsp;(Suzhou Institute of Biomedical Engineering and Technology), and&nbsp;Guoqi Zhang&nbsp;(Delft University of Technology) and is comprised of leading experts in the field of biomedical engineering.

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Dual-Modality X-Ray-Induced Radiation Acoustic and Ultrasound Imaging for Real-Time Monitoring of Radiotherapy

BME Frontiers: A Platform for Engineering the Future of Biomedicine