Yoo Sua, O'Daniel Jennifer, Blitzblau Rachel, Yin Fang-Fang, Horton Janet K
Duke University Medical Center, Durham, NC, USA.
J Radiosurg SBRT. 2020;6(4):295-301.
To analyze and evaluate accuracy and efficiency of IGRT process for preoperative partial breast radiosurgery.
Patients were initially setup with skin marks and 5 steps were performed: (1) Initial orthogonal 2D kV images, (2) pre-treatment 3D CBCT images, (3) verification orthogonal 2D kV images, (4) treatment including mid-treatment 2D kV images (for the final 15 patients only), and (5) post-treatment orthogonal 2D kV or 3D CBCT images. Patient position was corrected at each step to align the biopsy clip and to verify surrounding soft tissue positioning.
The mean combined vector magnitude shifts and standard deviations at the 5 imaging steps were (1) 0.96 ± 0.69, (2) 0.33 ± 0.40, (3) 0.05 ± 0.12, (4) 0.15 ± 0.17, and (5) 0.27 ± 0.24 in cm. The mean total IGRT time was 40.2 ± 13.2 minutes. Each step was shortened by 2 to 5 minutes with improvements implemented. Overall, improvements in the IGRT process reduced the mean total IGRT time by approximately 20 minutes. Clip visibility was improved by implementing oblique orthogonal images.
Multiple imaging steps confirmed accurate patient positioning. Appropriate planning and imaging strategies improved the effectiveness and efficiency of the IGRT process for preoperative partial breast radiosurgery.
分析和评估术中影像引导放射治疗（IGRT）流程在术前部分乳腺放射外科手术中的准确性和效率。
患者最初通过皮肤标记进行摆位，并执行5个步骤：（1）初始正交二维千伏图像，（2）治疗前三维锥形束CT（CBCT）图像，（3）验证正交二维千伏图像，（4）治疗，包括治疗中二维千伏图像（仅针对最后15例患者），以及（5）治疗后正交二维千伏或三维CBCT图像。在每个步骤中均对患者体位进行校正，以对齐活检夹并验证周围软组织的定位。
5个成像步骤时的平均合成向量大小偏移及其标准差分别为：（1）0.96±0.69厘米，（2）0.33±0.40厘米，（3）0.05±0.12厘米，（4）0.15±0.17厘米，以及（5）0.27±0.24厘米。IGRT的平均总时间为40.2±13.2分钟。通过实施改进措施，每个步骤缩短了2至5分钟。总体而言，IGRT流程的改进使平均总IGRT时间减少了约20分钟。通过实施斜交正交图像提高了夹子的可视性。
多个成像步骤证实了患者体位的准确。适当的规划和成像策略提高了IGRT流程在术前部分乳腺放射外科手术中的有效性和效率。
