Dose guided real-time adaptive radiotherapy

A non-transitory computer readable medium comprising non-transitory computer-readable instructions, the computer-readable instructions comprising instructions for performing operations comprising:

• determining a patient anatomy at a first time within a given radiotherapy treatment fraction after a radiotherapy treatment dose has been delivered by a radiotherapy device;
• retrieving a reference patient anatomy for the given radiotherapy treatment fraction that indicates a prescribed dose parameter to be delivered within the given radiotherapy treatment fraction;
• comparing the patient anatomy at the first time with the reference patient anatomy during the given radiotherapy treatment fraction, the comparing comprising:
• determining a first amount of overlap between a tumor in the patient and an organ at risk, laterally or in depth, based on the determined patient anatomy at the first time, the first amount of overlap indicating a first quantity of radiation exposure to the tumor relative to the organ at risk;
• and
• determining a reference amount of overlap between the tumor in the patient and the organ at risk laterally or in depth based on the reference patient anatomy, the reference amount of overlap indicating a reference quantity of radiation exposure to the tumor relative to the organ at risk;
• and
• based on the comparison of the patient anatomy at the first time with the reference patient anatomy, adjusting a parameter of the radiotherapy device to change an amount of radiotherapy treatment dose delivered at a second time, following the first time, in accordance with the prescribed dose parameter to be delivered within the given radiotherapy treatment fraction.

A system comprising:

• a memory for storing instructions;
• and
• one or more processors for executing the instructions stored in the memory for performing operations comprising:
• determining a patient anatomy at a first time within a given radiotherapy treatment fraction after a radiotherapy treatment dose has been delivered by a radiotherapy device;
• retrieving a reference patient anatomy for the given radiotherapy treatment fraction that indicates a prescribed dose parameter to be delivered within the given radiotherapy treatment fraction;
• comparing the patient anatomy at the first time with the reference patient anatomy during the given radiotherapy treatment fraction, the comparing comprising:
• determining a first amount of overlap between a tumor in the patient and an organ at risk, laterally or in depth, based on the determined patient anatomy at the first time, the first amount of overlap indicating a first quantity of radiation exposure to the tumor relative to the organ at risk;
• and
• determining a reference amount of overlap between the tumor in the patient and the organ at risk laterally or in depth based on the reference patient anatomy, the reference amount of overlap indicating a reference quantity of radiation exposure to the tumor relative to the organ at risk;
• and
• based on the comparison of the patient anatomy at the first time with the reference patient anatomy, adjusting a parameter of the radiotherapy device to change an amount of radiotherapy treatment dose delivered at a second time, following the first time, in accordance with the prescribed dose parameter to be delivered within the given radiotherapy treatment fraction.