Loos G, Biau J, Bellière A, Toledano I, Chillès A, Lapeyre M
Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France.
Cancer Radiother. 2013 Feb;17(1):34-8. doi: 10.1016/j.canrad.2012.12.001. Epub 2013 Jan 18.
Daily set up of patients with prostate cancer using orthogonal kV/kV imaging and weekly set up control require 1h to 1h30 of off line revision by a radio-oncologist per day and per accelerator. The aim of this study was to evaluate the possibility to delegate this control to radiation therapists.
The files of 33 patients (including 13 with prostate cancer) treated from November 2010 to February 2011 on a Varian™ Clinac IX accelerator with an OBI™ system were evaluated. Radiation therapists made the daily kV/kV imaging. Radiation therapists made the online control by kV/kV for patient repositioning and radio-oncologists made the offline reviews; the results were compared and analysed (seven radiation therapists and seven radio-oncologists). For an isocentre displacement of 5mm, the radiation therapist had to call the radio-oncologist to make a medical decision (treatment or patient displacement). The difference of measures and the concordance of decisions between radiation therapists and radio-oncologists were calculated.
Five hundred and fifty-six measures were made for 33 treatments, including 226 measures for prostate cancer treatment. The difference of measures between radiation therapists and radio-oncologists was 3mm or less in 93.7% for all treatments and 96.2% for prostate cancer treatment. The concordance of decision between radiation therapists and radio-oncologists for measures up to 4mm was 97% (CI95±2%) vs. 57% (CI95±10%) for measures equal to or higher than 5mm (P<0.0001).
Radiation therapists are able to do daily set up using kV/kV on the bony structures of patients with prostate cancer, with a risk of disagreement higher than 3mm less than 4%. The weekly set up controls (different primaries) can be delegated to the radiation therapists, subject to an accurate procedure using a medical alert for a given threshold. Training and competence certification are required to secure the process.
使用正交千伏/千伏成像对前列腺癌患者进行每日摆位以及每周摆位控制，每位放疗医师每天在每个加速器上需要1至1.5小时进行离线复查。本研究的目的是评估将这种控制工作委托给放射治疗师的可能性。
评估了2010年11月至2011年2月期间在配备OBI™系统的Varian™ Clinac IX加速器上接受治疗的33例患者（包括13例前列腺癌患者）的病历。放射治疗师进行每日千伏/千伏成像。放射治疗师通过千伏/千伏进行在线控制以重新定位患者，放疗医师进行离线复查；对结果进行比较和分析（7名放射治疗师和7名放疗医师）。对于等中心位移5毫米的情况，放射治疗师必须呼叫放疗医师做出医疗决策（治疗或患者移位）。计算放射治疗师和放疗医师之间测量值的差异以及决策的一致性。
对33次治疗进行了556次测量，其中前列腺癌治疗226次测量。对于所有治疗，放射治疗师和放疗医师之间测量值的差异在93.7%的情况下为3毫米或更小，对于前列腺癌治疗为96.2%。对于4毫米及以下的测量，放射治疗师和放疗医师之间决策的一致性为97%（CI95±2%），而对于等于或高于5毫米的测量为57%（CI95±10%）（P< = 0.0001）。
放射治疗师能够使用千伏/千伏对前列腺癌患者的骨骼结构进行每日摆位，不一致风险高于3毫米的情况少于4%。每周摆位控制（不同的原发病灶）可以委托给放射治疗师，但需遵循使用针对给定阈值的医疗警报的准确程序。需要进行培训和能力认证以确保该过程的安全。
