Yang Jaewon, Yamamoto Tokihiro, Pollock Sean, Berger Jonathan, Diehn Maximilian, Graves Edward E, Loo Billy W, Keall Paul J
Department of Electrical Engineering, Stanford University, USA; Department of Radiation Oncology, Stanford University School of Medicine, USA.
Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, USA.
Radiother Oncol. 2016 Aug;120(2):267-72. doi: 10.1016/j.radonc.2016.05.016. Epub 2016 May 30.
The impact of audiovisual (AV) biofeedback on four dimensional (4D) positron emission tomography (PET) and 4D computed tomography (CT) image quality was investigated in a prospective clinical trial (NCT01172041).
4D-PET and 4D-CT images of ten lung cancer patients were acquired with AV biofeedback (AV) and free breathing (FB). The 4D-PET images were analyzed for motion artifacts by comparing 4D to 3D PET for gross tumor volumes (GTVPET) and maximum standardized uptake values (SUVmax). The 4D-CT images were analyzed for artifacts by comparing normalized cross correlation-based scores (NCCS) and quantifying a visual assessment score (VAS). A Wilcoxon signed-ranks test was used for statistical testing.
The impact of AV biofeedback varied widely. Overall, the 3D to 4D decrease of GTVPET was 1.2±1.3cm(3) with AV and 0.6±1.8cm(3) for FB. The 4D-PET increase of SUVmax was 1.3±0.9 with AV and 1.3±0.8 for FB. The 4D-CT NCCS were 0.65±0.27 with AV and 0.60±0.32 for FB (p=0.08). The 4D-CT VAS was 0.0±2.7.
This study demonstrated a high patient dependence on the use of AV biofeedback to reduce motion artifacts in 4D imaging. None of the hypotheses tested were statistically significant. Future development of AV biofeedback will focus on optimizing the human-computer interface and including patient training sessions for improved comprehension and compliance.
在一项前瞻性临床试验（NCT01172041）中，研究了视听生物反馈对四维（4D）正电子发射断层扫描（PET）和4D计算机断层扫描（CT）图像质量的影响。
对10例肺癌患者进行了4D-PET和4D-CT图像采集，分别采用视听生物反馈（AV）和自由呼吸（FB）两种方式。通过比较4D与3D PET图像的大体肿瘤体积（GTVPET）和最大标准化摄取值（SUVmax），分析4D-PET图像的运动伪影。通过比较基于归一化互相关的评分（NCCS）并量化视觉评估评分（VAS），分析4D-CT图像的伪影。采用Wilcoxon符号秩检验进行统计学分析。
视听生物反馈的影响差异很大。总体而言，采用AV时GTVPET从3D到4D的减小量为1.2±1.3cm³，采用FB时为0.6±1.8cm³。采用AV时4D-PET的SUVmax增加量为1.3±0.9，采用FB时为1.3±0.8。采用AV时4D-CT的NCCS为0.65±0.27，采用FB时为0.60±0.32（p = 0.08）。4D-CT的VAS为0.0±2.7。
本研究表明，患者对使用视听生物反馈减少4D成像中的运动伪影高度依赖。所测试的假设均无统计学意义。视听生物反馈的未来发展将侧重于优化人机界面，并纳入患者培训课程以提高理解和依从性。
