# Combined radiation acoustics and ultrasound imaging for real-time guidance in radiotherapy

> **NIH NIH R37** · H. LEE MOFFITT CANCER CTR & RES INST · 2022 · $489,551

## Abstract

Radiotherapy can be a highly effective treatment for many types of cancers. A major impediment to achieving its
full curative promise is the current delivery process, where typically the originally planned tumor area is exposed
to a fixed pattern of ionizing radiation over time irrespective of target deformations, organ motion, or function. To
avoid misses, geometric uncertainties in this feedforward process are dealt with by increasing the planning
margin around the tumor, but of necessity result in unnecessary exposure of uninvolved tissue which can lead
to debilitating toxicities. We hypothesize that the unwanted radiation dose to normal tissues could be significantly
reduced by using a feedback system that would “know” the shape and location of the tumor as well as the location
and intensity of the irradiated dose during delivery. This framework would require the unique ability to
simultaneously image the absorbed dose and the targeted tumor anatomy during radiation delivery, which is not
possible with currently existing technologies.
 A known phenomenon in radiation physics is the generation of acoustic waves due to thermal expansion of
a substance following the absorption of penetrating radiation. Detection of this radiation induced acoustic signal
from clinical treatment beams has been recently demonstrated but has not been clinically realized. That signal
exists “for free” in real time as a consequence of the treatment beam. The signal can be measured with
ultrasound detectors and processed to reveal the location and intensity of the deposited energy/dose.
Furthermore, ultrasound technologies have also long been established for medical imaging and monitoring of
tumor size, shape and location, without introducing ionizing radiation.
 Therefore, we propose to combine measurements of radiation acoustics and ultrasound imaging in an
integrated system using advanced matrix array probes to determine in real-time the volumetric delivered
radiation dose with respect to that day’s tumor shape and location, and ultimately to optimize tumor targeting via
online feedback. The system will be optimized in phantoms and preclinical models. Then, its feasibility and
versatility will be tested for treatment of tumors in the liver and the pancreas, two aggressive cancer sites where
misplaced dose due to deformation and physiological motion not only compromises tumor eradication but also
affects vital functions in the patient and subsequent treatment outcomes.
Impact statement: We aim to implement new, safe, simple, cost effective technology and methods for online
guidance of radiotherapy delivery that can provide simultaneous tumor tracking and dose compensation
capabilities. These technologies will be evaluated in a pilot clinical study of liver and pancreatic cancers to
demonstrate feasibility and potentials for translation. If successful, this feedback technology will have a
significant impact on personalizing radiotherapy delivery and achieving optimal ...

## Key facts

- **NIH application ID:** 10470308
- **Project number:** 5R37CA222215-05
- **Recipient organization:** H. LEE MOFFITT CANCER CTR & RES INST
- **Principal Investigator:** Issam M. El Naqa
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $489,551
- **Award type:** 5
- **Project period:** 2018-09-05 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10470308

## Citation

> US National Institutes of Health, RePORTER application 10470308, Combined radiation acoustics and ultrasound imaging for real-time guidance in radiotherapy (5R37CA222215-05). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10470308. Licensed CC0.

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