A Phantom Investigation of the Robustness and Adaptability of the Novel PET LINAC During Lung Cancer Biology Guided Radiotherapy (BgRT) Characterized by Unpl

The novel biology-guided radiotherapy system (BgRT), the RefleXion X1 SCINTIX™ system uses annihilation photons produced from a PET-avid tumor to plan and then subsequently guide the delivery of beamlets of radiation to the tumor, tracking the dose delivered in real time. The current BgRT system is cleared by the U.S. Food and Drug Administration (FDA) to treat tumors in the lung or bone characterized by periodic or non-periodic motion respectively. In this work, we assessed the robustness and adaptability of the dose tracking capability under tumor motion perturbation. We designed a phantom study based on a lung case planned under periodic tracking for four pass (4-Pass) BgRT and then introduced transient translational shifts to the phantom motion continuously under treatment. By comparing the dose delivered under a normal periodic sinusoidal tumor motion to the dose delivered under a perturbed sinusoidal delivery, with a simple perturbation introduced at the end of the second of a 4-Pass delivery and a more complex situation with perturbation introduced at each of the four passes of the 4-Pass delivery, we assessed the robustness and adaptability of the RefleXion X1 SCINTIX™ system to deliver the correct dose under such circumstances.