title: Cherenkov video imaging allows for the first visualization of radiation therapy in real time.
abstract: OBJECTIVE
  To determine whether Cherenkov light imaging can visualize radiation therapy in real time during breast radiation therapy.
  
  
  METHODS
  An intensified charge-coupled device (CCD) camera was synchronized to the 3.25-μs radiation pulses of the clinical linear accelerator with the intensifier set × 100. Cherenkov images were acquired continuously (2.8 frames/s) during fractionated whole breast irradiation with each frame an accumulation of 100 radiation pulses (approximately 5 monitor units).
  
  
  RESULTS
  The first patient images ever created are used to illustrate that Cherenkov emission can be visualized as a video during conditions typical for breast radiation therapy, even with complex treatment plans, mixed energies, and modulated treatment fields. Images were generated correlating to the superficial dose received by the patient and potentially the location of the resulting skin reactions. Major blood vessels are visible in the image, providing the potential to use these as biological landmarks for improved geometric accuracy. The potential for this system to detect radiation therapy misadministrations, which can result from hardware malfunction or patient positioning setup errors during individual fractions, is shown.
  
  
  CONCLUSIONS
  Cherenkoscopy is a unique method for visualizing surface dose resulting in real-time quality control. We propose that this system could detect radiation therapy errors in everyday clinical practice at a time when these errors can be corrected to result in improved safety and quality of radiation therapy.
authors.affiliation: Department of Medicine, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center at the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: Lesley.a.jarvis@hitchcock.org.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Jarvis
authors.affiliation: Department of Physics and Astronomy, Dartmouth College, Hanover, New Hampshire.
authors.forename: Rongxiao
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire; Norris Cotton Cancer Center at the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gladstone
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Shudong
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.
authors.forename: Whitney
authors.initials: W
authors.lastname: Hitchcock
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Friedman
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Glaser
authors.affiliation: Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Michael
authors.initials: M
authors.lastname: Jermyn
authors.affiliation: Department of Physics and Astronomy, Dartmouth College, Hanover, New Hampshire; Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pogue
mesh_terms: D059925:Anatomic Landmarks; D001943:Breast Neoplasms / Q000098:blood supply / Q000532:radiotherapy* / Q000601:surgery; D003116:Color; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008029:Lighting; D015412:Mastectomy, Segmental; D010315:Particle Accelerators; D017785:Photons; D011786:Quality Control; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061106:Radiotherapy Setup Errors / Q000517:prevention & control*; D015203:Reproducibility of Results; D012867:Skin / Q000528:radiation effects; D014741:Video Recording / Q000295:instrumentation / Q000379:methods*