University of Central Florida College of Medicine, Orlando, Florida.
Center for Advanced Radiation Therapy, Orlando Health-UF Health Cancer Center, Orlando, Florida.
Pract Radiat Oncol. 2020 Sep-Oct;10(5):e425-e431. doi: 10.1016/j.prro.2020.01.009. Epub 2020 Jan 28.
Treating critically ill patients in radiation oncology departments poses multiple safety risks. This study describes a method to improve the speed of radiation treatment for patients in the intensive care unit by eliminating the need for computed tomography (CT) simulation or on-table treatment planning using patients' previously acquired diagnostic CT scans.
Initially, a retrospective planning study was performed to assess the applicability and safety of diagnostic scan-based planning (DSBP) for 3 typical indications for radiation therapy in patients in the intensive care unit: heterotopic ossification (10), spine metastases (cord compression; 10), and obstructive lung lesions (5). After identification of an appropriate diagnostic CT scan, treatment planning was performed using the diagnostic scan data set. These treatment plans were then transferred to the patients' simulation scans, and a dosimetric comparison was performed between the 2 sets of plans. Additionally, a time study of the first 10 patients treated with DSBP in our department was performed.
The retrospective analysis demonstrated that DSBP resulted in treatment plans that, when transferred to the CT simulation data sets, provided excellent target coverage, a median D of 96% (range, 86%-100%) of the prescription dose with acceptable hot spots, and a median D108% (range, 102%-113%). Subsequently, DSBP has been used for 10 critically ill patients. The patients were treated without CT simulation, and the median time between patient check-in to the department and completion of radiation therapy was 28 minutes (range, 18-47 minutes.) CONCLUSIONS: This study demonstrates that it is possible to safely use DSBP for the treatment of critically ill patients. This method has the potential to simplify the treatment process and improve the speed and safety of treatment.
在放射肿瘤学部门治疗危重症患者存在多种安全风险。本研究描述了一种通过消除对重症监护病房（ICU）患者进行 CT 模拟或桌上治疗计划的需求，从而提高 ICU 患者放射治疗速度的方法，该方法利用患者之前获得的诊断性 CT 扫描。
最初，进行了一项回顾性规划研究，以评估基于诊断性扫描的计划（DSBP）对于 ICU 中 3 种典型放射治疗适应证的适用性和安全性：异位骨化（10 例）、脊柱转移瘤（脊髓压迫；10 例）和阻塞性肺病变（5 例）。在识别出合适的诊断性 CT 扫描后，使用诊断性扫描数据集进行治疗计划。然后将这些治疗计划转移到患者的模拟扫描上，并对这两套计划进行剂量比较。此外，对我们科室前 10 例接受 DSBP 治疗的患者进行了时间研究。
回顾性分析表明，DSBP 生成的治疗计划，当转移到 CT 模拟数据集时，提供了极好的靶区覆盖，处方剂量的中位数 D 为 96%（范围，86%-100%），可接受的热点，以及中位数 D108%（范围，102%-113%）。随后，DSBP 已用于 10 例危重症患者。这些患者无需进行 CT 模拟治疗，从患者就诊到科室完成放射治疗的中位数时间为 28 分钟（范围，18-47 分钟）。
本研究表明，使用 DSBP 治疗危重症患者是安全的。该方法有可能简化治疗过程，并提高治疗速度和安全性。
