Greer Peter, Martin Jarad, Sidhom Mark, Hunter Perry, Pichler Peter, Choi Jae Hyuk, Best Leah, Smart Joanne, Young Tony, Jameson Michael, Afinidad Tess, Wratten Chris, Denham James, Holloway Lois, Sridharan Swetha, Rai Robba, Liney Gary, Raniga Parnesh, Dowling Jason
Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia.
School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.
Front Oncol. 2019 Aug 29;9:826. doi: 10.3389/fonc.2019.00826. eCollection 2019.
This project investigates the feasibility of implementation of MRI-only prostate planning in a prospective multi-center study. A two-phase implementation model was utilized where centers performed retrospective analysis of MRI-only plans for five patients followed by prospective MRI-only planning for subsequent patients. Feasibility was assessed if at least 23/25 patients recruited to phase 2 received MRI-only treatment workflow. Whole-pelvic MRI scans (T2 weighted, isotropic 1.6 mm voxel 3D sequence) were converted to pseudo-CT using an established atlas-based method. Dose plans were generated using MRI contoured anatomy with pseudo-CT for dose calculation. A conventional CT scan was acquired subsequent to MRI-only plan approval for quality assurance purposes (QA-CT). 3D Gamma evaluation was performed between pseudo-CT calculated plan dose and recalculation on QA-CT. Criteria was 2%, 2 mm criteria with 20% low dose threshold. Gold fiducial marker positions for image guidance were compared between pseudo-CT and QA-CT scan prior to treatment. All 25 patients recruited to phase 2 were treated using the MRI-only workflow. Isocenter dose differences between pseudo-CT and QA-CT were -0.04 ± 0.93% (mean ± SD). 3D Gamma dose comparison pass-rates were 99.7% ± 0.5% with mean gamma 0.22 ± 0.07. Results were similar for the two centers using two different scanners. All gamma comparisons exceeded the 90% pass-rate tolerance with a minimum gamma pass-rate of 98.0%. In all cases the gold fiducial markers were correctly identified on MRI and the distances of all seeds to centroid were within the tolerance of 1.0 mm of the distances on QA-CT (0.07 ± 0.41 mm), with a root-mean-square difference of 0.42 mm. The results support the hypothesis that an MRI-only prostate workflow can be implemented safely and accurately with appropriate quality assurance methods.
本项目在一项前瞻性多中心研究中调查了仅使用磁共振成像(MRI)进行前列腺癌治疗计划制定的可行性。采用了两阶段实施模型,各中心先对5例患者的仅基于MRI的计划进行回顾性分析,然后对后续患者进行前瞻性的仅基于MRI的计划制定。若至少23/25名招募到第二阶段的患者接受了仅使用MRI的治疗流程,则评估其可行性。全盆腔MRI扫描(T2加权,各向同性1.6毫米体素3D序列)使用既定的基于图谱的方法转换为伪CT。使用基于MRI轮廓解剖结构的伪CT生成剂量计划以进行剂量计算。在仅基于MRI的计划获批后,为了质量保证目的(QA-CT)进行一次常规CT扫描。在伪CT计算的计划剂量与QA-CT上的重新计算剂量之间进行三维伽马评估。标准为2%、2毫米标准以及20%的低剂量阈值。在治疗前,比较了伪CT和QA-CT扫描上用于图像引导的金基准标记位置。所有招募到第二阶段的25例患者均采用仅使用MRI的工作流程进行治疗。伪CT和QA-CT之间的等中心剂量差异为-0.04±0.93%(平均值±标准差)。三维伽马剂量比较通过率为99.7%±0.5%,平均伽马值为0.22±0.07。使用两台不同扫描仪的两个中心的结果相似。所有伽马比较均超过了90%的通过率容限,最低伽马通过率为98.0%。在所有情况下,金基准标记在MRI上均能正确识别,并且所有籽源到质心的距离均在QA-CT上距离的1.0毫米容差范围内(0.07±0.41毫米),均方根差为0.42毫米。结果支持这样的假设,即通过适当的质量保证方法,可以安全、准确地实施仅使用MRI的前列腺癌治疗工作流程。