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首例高场 1.5TMR 直线加速器的临床应用经验

First clinical experiences with a high field 1.5 T MR linac.

机构信息

Laboratory of Radiation Physics, Odense University Hospital , Odense , Denmark.

Department of Oncology, Odense University Hospital , Odense , Denmark.

出版信息

Acta Oncol. 2019 Oct;58(10):1352-1357. doi: 10.1080/0284186X.2019.1627417. Epub 2019 Jun 26.

Abstract

A 1.5 T MR Linac (MRL) has recently become available. MRL treatment workflows (WF) include online plan adaptation based on daily MR images (MRI). This study reports initial clinical experiences after five months of use in terms of patient compliance, cases, WF timings, and dosimetric accuracy. Two different WF were used dependent on the clinical situation of the day; Adapt To Position WF (ATP) where the reference plan position is adjusted rigidly to match the position of the targets and the OARs, and Adapt To Shape WF (ATS), where a new plan is created to match the anatomy of the day, using deformable image registration. Both WFs included three 3D MRI scans for plan adaptation, verification before beam on, and validation during IMRT delivery. Patient compliance and WF timings were recorded. Accuracy in dose delivery was assessed using a cylindrical diode phantom. Nineteen patients have completed their treatment receiving a total of 176 fractions. Cases vary from prostate treatments (60Gy/20F) to SBRT treatments of lymph nodes (45 Gy/3F) and castration by ovarian irradiation (15 Gy/3F). The median session time (patient in to patient out) for 127 ATPs was 26 (21-78) min, four fractions lasted more than 45 min due to additional plan adaptation. For the 49 ATSs a median time of 12 (1-24) min was used for contouring resulting in a total median session time of 42 (29-91) min. Three SBRT fractions lasted more than an hour. The time on the MRL couch was well tolerated by the patients. The median gamma pass rate (2 mm,2% global max) for the adapted plans was 99.2 (93.4-100)%, showing good agreement between planned and delivered dose. MRL treatments, including daily MRIs, plan adaptation, and accurate dose delivery, are possible within a clinically acceptable timeframe and well tolerated by the patients.

摘要

一台 1.5T 的磁共振直线加速器(MRL)最近已经投入使用。MRL 治疗工作流程(WF)包括基于每日磁共振图像(MRI)的在线计划自适应。本研究报告了使用五个月后的初步临床经验,包括患者依从性、病例数、WF 时间和剂量准确性。根据当天的临床情况,使用了两种不同的 WF;一种是基于位置自适应 WF(ATP),其中参考计划位置被刚性地调整以匹配靶区和 OAR 的位置,另一种是基于形状自适应 WF(ATS),其中使用变形图像配准创建一个新的计划来匹配当天的解剖结构。两种 WF 都包括三次 3D MRI 扫描,用于计划自适应、光束前验证和调强放射治疗期间验证。记录了患者依从性和 WF 时间。使用圆柱形二极管体模评估剂量传递的准确性。 19 名患者已完成治疗,共接受了 176 个分次。病例范围从前列腺治疗(60Gy/20F)到淋巴结 SBRT 治疗(45Gy/3F)和卵巢照射的去势治疗(15Gy/3F)不等。127 个 ATP 的中位治疗时间(患者入位到出位)为 26(21-78)分钟,由于额外的计划自适应,四个分次治疗时间超过 45 分钟。49 个 ATS 的中位时间为 12(1-24)分钟,用于轮廓绘制,导致总中位治疗时间为 42(29-91)分钟。三个 SBRT 分次治疗时间超过一个小时。患者在 MRL 治疗床上的时间耐受良好。自适应计划的中位伽马通过率(2mm,2% 全局最大值)为 99.2(93.4-100)%,表明计划剂量和实际剂量之间具有良好的一致性。 MRL 治疗,包括每日 MRI、计划自适应和准确的剂量传递,在临床可接受的时间内是可行的,并且患者能够耐受。

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