Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA.
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
J Appl Clin Med Phys. 2022 Jan;23(1):e13441. doi: 10.1002/acm2.13441. Epub 2021 Oct 25.
Ethos adaptive radiotherapy (ART) is emerging with AI-enhanced adaptive planning and high-quality cone-beam computed tomography (CBCT). Although a respiratory motion management solution is critical for reducing motion artifacts on abdominothoracic CBCT and improving tumor motion control during beam delivery, our institutional Ethos system has not incorporated a commercial solution. Here we developed an institutional visually guided respiratory motion management system to coach patients in regular breathing or breath hold during intrafractional CBCT scans and beam delivery with Ethos ART.
The institutional visual-guidance respiratory motion management system has three components: (1) a respiratory motion detection system, (2) an in-room display system, and (3) a respiratory motion trace management software. Each component has been developed and implemented in the clinical Ethos ART workflow. The applicability of the solution was demonstrated in installation, routine QA, and clinical workflow.
An air pressure sensor has been utilized to detect patient respiratory motion in real time. Either a commercial or in-house software handled respiratory motion trace display, collection and visualization for operators, and visual guidance for patients. An extended screen and a projector on an adjustable stand were installed as the in-room visual guidance solution for the closed-bore ring gantry medical linear accelerator utilized by Ethos. Consistent respiratory motion traces and organ positions on intrafractional CBCTs demonstrated the clinical suitability of the proposed solution in Ethos ART.
The study demonstrated the utilization of an institutional visually guided respiratory motion management system for Ethos ART. The proposed solution can be easily applied for Ethos ART and adapted for use with any closed bore-type system, such as computed tomography and magnetic resonance imaging, through incorporation with appropriate respiratory motion sensors.
随着人工智能增强自适应规划和高质量锥形束计算机断层扫描（CBCT）的出现，出现了医德自适应放疗（ART）。尽管呼吸运动管理解决方案对于减少腹部胸部 CBCT 上的运动伪影并改善射束输送期间的肿瘤运动控制至关重要，但我们的机构 Ethos 系统尚未采用商业解决方案。在这里，我们开发了一种机构视觉引导呼吸运动管理系统，用于在 Ethos ART 分次内 CBCT 扫描和射束输送期间指导患者进行常规呼吸或屏气。
机构视觉引导呼吸运动管理系统有三个组成部分：（1）呼吸运动检测系统，（2）室内显示系统，和（3）呼吸运动轨迹管理软件。每个组件都已在临床 Ethos ART 工作流程中开发和实施。该解决方案的适用性已在安装、常规 QA 和临床工作流程中得到证明。
已利用气压传感器实时检测患者呼吸运动。商业或内部软件处理呼吸运动轨迹显示、收集和可视化，供操作员使用，并为患者提供视觉指导。在 Ethos 使用的封闭孔环架医用线性加速器上，安装了一个可调节支架上的扩展屏幕和投影仪作为室内视觉引导解决方案。分次内 CBCT 上一致的呼吸运动轨迹和器官位置证明了所提出的解决方案在 Ethos ART 中的临床适用性。
本研究证明了机构视觉引导呼吸运动管理系统在 Ethos ART 中的应用。该解决方案可轻松应用于 Ethos ART，并通过与适当的呼吸运动传感器结合，适应任何封闭孔型系统（如计算机断层扫描和磁共振成像）的使用。
