Initial Experience with Cherenkov Imaging: From Clinical Workflow to a Retrospective Image Review Trial
Abstract
Purpose
Cherenkov imaging (CI) provides direct, real-time visualization of dose on a patient's surface and has been used for treatment verification and error detection in radiation therapy. However, clinical adoption of CI remains in its infancy; existing image review studies are limited by having been conducted where the technology was developed, creating a learning bias, or by lacking comprehensive analysis of collected data because of gaps in clinical workflows. The primary objectives of this study are to develop a clinical workflow to enable routine Cherenkov image collection and review and to conduct a retrospective analysis of images acquired following CI implementation to decipher the true impact CI can have.
Methods
A retrospective, quality-based clinical trial was approved to begin following the installation of a CI system (DoseRT, VisionRT London UK) in February 2026. Patients treated on a designated linear accelerator will receive CI as part of their standard-of-care treatment, and the clinical team will use the developed workflow to review CI data. A study team will also review all Cherenkov images monthly to identify potential treatment delivery deviations that went undetected. Incidents will be flagged and investigated by correlating Cherenkov data with treatment plans, diagnostic imaging, and patient positioning metrics to determine their etiology.
Results
We will report on the frequency and types of treatment delivery errors identified through CI, real-time and retrospectively. This will include categorization of incidents, such as unintended dose to non-target areas due to patient positioning, sub-optimal planning, or other delivery anomalies. The findings will be compared to published data.
Conclusion
The implementation of the developed workflow and analysis of Cherenkov images collected following the introduction of CI into our clinic will provide critical insights into the incidence and nature of suboptimal radiation deliveries and how CI can be used to prevent them.